Shared language for suicide prevention in MDTs
Why multidisciplinary teams need a shared language for suicide prevention
In mental health services across the UK, multidisciplinary teams (MDTs) form the backbone of care delivery. These teams, comprising psychiatrists, practitioner psychologists, mental health nurses, social workers, occupational therapists, and support staff, bring diverse expertise to complex clinical presentations. Yet when it comes to working with suicidality, this diversity can sometimes present challenges to delivering consistent, evidence-based care.
The challenge facing mental health MDTs
Mental health MDTs encounter suicidality across all service settings: acute inpatient wards, crisis resolution and home treatment teams, community mental health teams, liaison psychiatry, and older adult services. Each team member brings valuable skills, but may approach suicide risk assessment and management differently, shaped by their professional background and training.
Consider the composition of a typical community mental health team: a consultant psychiatrist focused on diagnosis and medication management; a practitioner psychologist trained in formulation and therapy; community psychiatric nurses managing care plans and medication adherence; social workers addressing housing and relationships; and occupational therapists focusing on functional recovery. When a service user presents with suicidal ideation, each professional may assess and document risk in their own way, which results in varying approaches to care planning and handovers.
This can create problems. First, service users may receive contradictory messages or experience their care as disjointed. Second, team discussions about suicidality can become unfocused, with professionals speaking different clinical languages. Third, documentation varies in quality and usefulness, making continuity of care difficult—particularly during transitions between shifts, services, or crisis points.
Staff report feeling a lack of confidence in working with suicidality. A quote from a consultant in an acute older adults service captures how the CAMS approach has increased confidence.
“I really appreciate the evidence-based assessment framework of CAMS. It gives me much more confidence in assessing and working with suicidality, knowing that I have explored relevant factors to inform the formulation of risk, and giving me a structure to document my assessment, explain my opinions and recommendations, and intervene effectively.”
A unifying framework
What mental health MDTs need is not another standalone intervention, but a framework that can unite diverse professionals around suicide-specific care. The Collaborative Assessment and Management of Suicidality (CAMS) provides a structured yet flexible approach that is applicable across various disciplines and service settings.
CAMS is a therapeutic framework. It provides a common assessment structure through the Suicide Status Form (SSF), which incorporates all aspects of theoretical understandings of what drives suicidality and allows each professional to bring their unique skills to intervention.
Research demonstrates this principle clearly. A recent meta-analysis found that CAMS produces significant effect sizes for reducing suicidal ideation (d = 0.25), general symptom distress (d = 0.29), and treatment acceptance (d = 0.42), with particularly strong effects on increasing hope and reducing hopelessness (d = 0.88) (Swift et al., 2021). These outcomes emerge from addressing what makes someone suicidal—the “drivers” of their suicidality—rather than treating suicidality as secondary to diagnosis.
Bring CAMS to your multidisciplinary team
The evidence for CAMS in team-based settings
Multiple randomised controlled trials support CAMS effectiveness across different contexts relevant to UK MDTs. In a German inpatient crisis intervention study, Santel and colleagues (2023) compared CAMS with enhanced treatment as usual for 88 acutely suicidal inpatients. Both groups improved, but CAMS showed larger effect sizes across all measures. Significantly, CAMS patients rated the therapeutic relationship better (p = 0.02) and were less likely to attempt suicide within four weeks after discharge (p = 0.05), precisely the high-risk period that concerns inpatient teams.
These findings align with earlier work by Comtois and colleagues (2011) in a community mental health setting, where CAMS demonstrated significant effectiveness in reducing suicidal ideation and overall symptom distress whilst increasing hope and patient satisfaction. The treatment required only 4–16 sessions, making it practical within NHS service constraints.
What stands out across these trials is clinical effectiveness, as well as an improved therapeutic relationship; an essential foundation for any MDT’s work.
As the consultant quoted earlier noted: “I am currently the only CAMS-trained professional in my MDTs; I discuss CAMS with team members often and I see them make use of insights and ideas generated from my CAMS work with people.”
How CAMS supports MDT working
Shared assessment language
The SSF provides a common structure that any team member can use. Whether a service user first presents to a psychiatric nurse during a home visit, a psychiatrist in clinic, or a duty worker in a crisis team, the assessment captures the same core information about psychological pain, stress, agitation, hopelessness, self-hate, and overall risk. This consistency supports safer handovers and clearer team discussions.
Collaborative philosophy
CAMS explicitly positions the service user as an expert on their own suicidality. The clinician and service user sit side-by-side, completing the SSF together. This collaborative stance fits naturally with recovery-oriented practice and the values many MDT professionals already hold.
Driver-focused intervention
By identifying what makes someone suicidal (their “drivers”), CAMS creates a shared treatment focus for the entire team. A psychiatrist might address medication-responsive symptoms that function as drivers; a psychologist might target cognitive patterns; an occupational therapist might work on activity scheduling and meaningful occupation; a social worker might address housing instability or financial stress. All interventions connect to reducing the same identified drivers.
Clear documentation
The SSF creates a concise, professional record of assessment, formulation, and planning. This addresses one of the ongoing frustrations in MDTs: inconsistent documentation that makes it difficult for colleagues to quickly understand current risk and the rationale for management decisions.
Transdiagnostic approach
CAMS works regardless of diagnosis. This matters enormously in MDTs working with diverse presentations, from first-episode psychosis to personality disorder, from depression to dementia-related distress in older adults. The framework adapts whilst maintaining fidelity to suicide-specific care.
Addressing practical concerns
CAMS is suitable for the wide range of presentations encountered by MDTs, including complex comorbidity, diagnostic uncertainty and distress associated with physical illness or cognitive decline. Its flexibility allows it to be adapted to local service contexts without losing its core focus on suicide-specific care.
Concerns are sometimes raised about whether CAMS adds to workload. Evidence suggests that engaging directly and collaboratively with suicidality can reduce crisis presentations and unplanned admissions, easing pressure rather than increasing it.
CAMS training provides comprehensive grounding in the framework, with ongoing supervision supporting implementation.
Find out more about the CAMS FrameworkFind out more about the CAMS Framework
References
Comtois, K. A., Jobes, D. A., O’Connor, S. S., Atkins, D. C., Janis, K., Chessen, C. E., Landes, S. J., Holen, A., & Yuodelis-Flores, C. (2011). Collaborative assessment and management of suicidality (CAMS): Feasibility trial for next-day appointment services. Depression and Anxiety, 28(11), 963–972. https://doi.org/10.1002/da.20895
Ellis, T. E., Rufino, K. A., & Allen, J. G. (2017). A controlled comparison trial of the Collaborative Assessment and Management of Suicidality (CAMS) in an inpatient setting: Outcomes at discharge and six-month follow-up. Psychiatry Research, 249, 252–260. https://doi.org/10.1016/j.psychres.2017.01.032
Jobes, D. A., Comtois, K. A., Gutierrez, P. M., Brenner, L. A., Huh, D., Chalker, S. A., Jennings, K. W., Crumlish, J. A., Corona, C. D., O’Connor, S. S., Hendricks, K. E., Schembari, B., Singer, B. N., & Crow, B. (2017). A randomized controlled trial of the Collaborative Assessment and Management of Suicidality versus enhanced care as usual with suicidal soldiers. Psychiatry: Interpersonal and Biological Processes, 80(4), 339–356. https://doi.org/10.1080/00332747.2017.1354607
Santel, M., Neuner, F., Berg, M., Steuwe, C., Jobes, D. A., Driessen, M., & Beblo, T. (2023). The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial. Frontiers in Psychiatry, 14, Article 1038302. https://doi.org/10.3389/fpsyt.2023.1038302
Swift, J. K., Trusty, W. T., & Penix, E. A. (2021). The effectiveness of the Collaborative Assessment and Management of Suicidality (CAMS) compared to alternative treatment conditions: A meta-analysis. Suicide and Life-Threatening Behavior, 51(5), 882–896. https://doi.org/10.1111/sltb.12765
