The Role Of CAMS in EAP

Prior to the COVID-19 pandemic, The World Health Organization (WHO) estimated that approximately 800,000 people die by suicide each year with nearly 20 suicides attempted for each suicide completed annually. It was also estimated that the age-standardized suicide rate was 8.8 per 100,000 person-years. Now, as workplaces begin to re-open in the COVID-19 era, employers must prepare themselves for an unprecedented tsunami of mental health issues and emergencies. Twenty-eight percent of Americans reported worsening mental health and 34% reported worsening emotional well-being at the end of April (Axios, 2020). A May 2020 Pew Research Center survey found this figure was significantly higher (55%) for those experiencing financial difficulties (Ketter, 2020). As psychological pain, distress, agitation, and hopelessness increase so too will urges to end the suffering via suicide. Alarmingly, calls and texts to crisis hotlines are up more than 1000% in the second quarter of 2020. For example, The Hotline, run by the Substance Abuse and Mental Health Services Administration, reported 20,000 texts last month—compared to 1,790 in April of 2019. According to Pew, one-third of adults ages 18 to 29 are in this high distress group, compared with just 15% of adults 65 and older.

Our workforce is at risk. Now, just as extreme measures were taken at the start of this pandemic to try to stave off the physical health effects of the coronavirus, business leaders (with their Employee Assistance Program (EAP) forces) must immediately position themselves for the inevitable mental health effects of this crisis by evolving their EAPs to address a fuller range of high acuity mental health needs adequately. Leaders who step up and embrace the challenge of creating ZERO SUICIDE work environments will set their organizations apart and make a substantial contribution to our collective recovery (Labouliere et al., 2018).

Suicide prevention in the workplace is nothing new. What is new, are the ways in which employers are addressing the needs of their employees at risk for suicide. Recognizing a demand for customized employee and family assistance program (EFAP) suicide-specific services to address the most serious threat to employee productivity, attendance, and retention, CAMS-care created CAMS EAP.

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based, outpatient, problem-focused, suicide-specific assessment, and treatment strategy for people at risk for suicide. CAMS treatment focuses on eliminating suicidality and is, therefore, transdiagnostic which allows its use with employees regardless of their specific DSM-5 diagnosis (or lack thereof). Published randomized clinical trials (RCTs) comparing CAMS with enhanced treatment as usual (E-TAU) indicate CAMS treated groups show significantly quicker, better, and sustained reductions in suicidal thoughts compared to E-TAU with fewer self-inflicted injuries at all time points as well (Comtois et al., 2011). In 2017, the CDC released “Preventing Suicide: A Technical Package of Policy, Programs, and Practices” which identified CAMS as an evidence-based treatment for people at risk (Stone et al., 2017). At this critical time, CAMS EAP fills the need for a specialized, short-term, suicide specific EAP solution to help employees at risk for suicide. CAMS EAP trained and accredited counselors can rapidly evaluate the employee’s suicidality and provide customized, evidence-based treatment and case management services carefully curated to address that employee’s unique needs. In most cases, CAMS EAP empowers employees to stay engaged and productive at work as they safely and effectively treat and manage their suicidality in the least restrictive outpatient settings by providing them with:

•  Specific safety actions plans with targeted, voluntary means restriction
•  Continuous 360-degree support to navigate the challenges of accessing external healthcare providers and psychiatric services, including inpatient hospitalization and stabilization when indicated
•  New ways of thinking, feeling, and working through the “drivers” of their wish to die
•  Relapse prevention strategies

CAMS EAP benefits employers, employees, and the EAP counselors treating them via The Suicide Status Form (SSF). The SSF is used both to assess suicidality at intake and then track it during subsequent sessions. In this way, the SSF provides an evidence-based process for the EAP counselor to ask the right questions to tailor a best-fit treatment plan for each employee. Research shows SSF training builds clinicians’ confidence and fluency in assessing, treating, and managing suicidality across a wide range of populations, including indigenous people, Blacks, and youth allowing for the immediate integration of cultural considerations/preferences into treatment. A further benefit of the SSF is that it provides impeccable case documentation to substantially reduce the risk of malpractice litigation.

CAMS treatment has been shown to keep employees out of the hospital in all but the most extreme circumstances and has been shown in multiple RCTs to reduce suicidal ideation, hopelessness, and stress and restore functioning in as few as 6 sessions. Regarding risks, some employees experience a short-term increase in psychological distress and sympathetic hyperarousal as they discuss the drivers of their suicidal thoughts and actions.

Traditionally, EAP counselors have treated the underlying depression or other mental health conditions in employees but have not directly targeted suicidality. Providing direct treatment of suicide risk using evidence-based interventions is vital. While hospitalization is sometimes necessary to ensure an employee’s immediate safety, if it is used solely as a containment strategy, it may prove ineffective or even counterproductive as employees may view it as a disincentive or punishment for acknowledging and seeking help for suicidal thoughts. Consider,

•  Specific safety actions plans with targeted, voluntary means restriction
•  Continuous 360-degree support to navigate the challenges of accessing external healthcare providers and psychiatric services, including inpatient hospitalization and stabilization when indicated
•  Rate of suicide after discharge is more than 100 times the rate of the general population
•  Compliance with routine treatment after discharge has been found to be less than 40%
•  Although many suicidal patients are referred for outpatient treatment post-discharge, only 25-50% attend an appointment
•  Many patients who die by suicide are not rated a high risk at their last contact with a mental health providers and patients do not have resources if the crisis re-emerges

EAPs that incorporate evidence-based CAMS into their lines of service can help reduce suicidal thoughts and behaviors in the workforce while simultaneously keeping at-risk employees safe and connected to their community and directly engaged in their reasons for living.

Citations (Source Materials):

Axios. (2020). Axios/Ipsos Coronavirus Index Wave 1 (Version 2) [Dataset]. Cornell University, Ithaca, NY: Roper Center for Public Opinion Research. doi:10.25940/ROPER-31117246

Comtois KA, Jobes DA, O’Connor S, et al. (2011). Collaborative assessment and management of suicidality (CAMS): feasibility trial for next-day appointment services. Depress Anxiety 28 (11): 963–972.

Keeter, S. (2020, May 7). A third of Americans experienced high levels of psychological distress during the coronavirus outbreak. Retrieved from https://www.pewresearch.org/fact-tank/2020/05/07/a-third-of-americans-experienced-high-levels-of-psychological-distress-during-the-coronavirus-outbreak/.

Labouliere, C. D., Vasan, P., Kramer, A., Brown, G., Green, K., Rahman, M., Kammer, J., Finnerty, M., & Stanley, B. (2018). “Zero Suicide” – A model for reducing suicide in United States behavioral healthcare. Suicidology, 23(1), 22–30.

Stone, D.M., Holland, K.M., Bartholow, B., Crosby, A.E., Davis, S., and Wilkins, N. (2017). Preventing Suicide: A Technical Package of Policies, Programs, and Practices. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

World Health Organization. (‎2014)‎. Preventing suicide: a global imperative. World Health Organization. https://apps.who.int/iris/handle/10665/131056