Evidence and Clinical Research
A structured, suicide-specific approach backed by clinical trials
CAMS is one of the most researched frameworks for suicide prevention. Over 30 years of evidence, including multiple published randomised controlled trials, have shown consistent outcomes in reducing suicidal ideation, increasing hope, and supporting safer, collaborative care.
Published RCTs on the CAMS framework
Randomised Controlled Trials (RCTs) remain the gold standard for evaluating clinical interventions. CAMS has been studied in seven published RCTs to date, each contributing to the growing evidence base for its safety, effectiveness and adaptability across different populations and care settings.
1. CAMS-Next Day Appointment (NDA) Study
Authors: Comtois, Jobes, O’Connor et al., 2011
Overview:
The study showed statistically significant differences in suicidal ideation, symptom distress, and hope between the two groups. CAMS demonstrated enduring effects even after treatment completion, higher patient satisfaction, and better treatment retention rates.
2. The DIAS RCT: CAMS vs DBT for Self-Harm
Authors: Andreasson, Krogh, Wenneberg et al., 2016
This study compared Dialectical Behaviour Therapy (DBT) and “CAMS-Informed Supportive Psychotherapy” for 108 people who attempted to die by suicide in Copenhagen Denmark with Borderline Personality Disorder traits.
Researchers found no significant differences in treating self-harm and suicide attempts, despite DBT being a proven effective treatment. This is encouraging considering the lower frequency of CAMS sessions.
3. Operation Worth Living (OWL) Study
Authors: Jobes, Comtois, Gutierrez, Brenner et al., 2017; Huh et al., 2018
Funded by the US Department of Defence, this study compared CAMS to Enhanced Care as Usual for 148 suicidal U.S. Army Soldiers.
It found that CAMS significantly reduced suicidal thoughts faster than usual care in 6-8 sessions and maintained this improvement at 3, 6, and 12 months. Additionally, CAMS showed significant benefits for subgroups of patients, including fewer emergency department visits, less overall distress, and increased resilience.
Read Jobes et al., 2017 and Huh et al., 2018
4. Managing Suicidality Within Specialised Care (Norway RCT)
Authors: Ryberg et al., 2019
Researchers in Oslo, Norway conducted this study comparing CAMS to regular treatment for 80 people struggling with suicidal thoughts in various places where they get help.
After 6 months, they found that CAMS had a big effect in reducing suicidal thoughts and overall distress compared to the usual treatment.
5. CAMS for Suicidal College Students Authors: Pistorello et al., 2020
This study compared CAMS and regular counselling for college students with suicidal thoughts and found that CAMS had positive results when used in college counselling centres.
The findings suggest that CAMS, a treatment focusing on suicide, is more likely to help college students with suicidal thoughts and depression, especially those experiencing their first crisis or having acute suicidal thoughts.
Students with Borderline Personality Disorder features and multiple suicide attempts might benefit more from intensive treatments like DBT, which is often considered superior for those with chronic struggles.
6. Aftercare Focus Study RCT Authors: Comtois et al., 2022
The “Aftercare Focus Study” focused on very high-risk patients who had recently left the hospital after a suicide attempt. They split 150 patients into two groups: one getting CAMS and the other getting regular treatment.
Both groups got better over time, but those in CAMS had fewer thoughts about suicide after 12 months compared to those getting regular treatment. Also, CAMS therapists were happier with their treatment than regular therapists.
7. Inpatient CAMS RCT (Germany) Authors: Santel et al., 2023
This feasibility RCT conducted in Germany compared CAMS to enhanced treatment-as-usual (E-TAU) for inpatients in suicidal crisis.
Both groups improved, but CAMS patients reported significantly better therapeutic relationships, greater reductions in suicidal ideation (for treatment completers), and significantly fewer suicide attempts in the first month post-discharge (when comparted to control care).
These findings suggest that inpatient use of CAMS is both a promising and feasible option for inpatient suicide-focused care.
Evaluating CAMS in the UK NHS: Hull University (2018–2021)
Evaluating the impact of embedding the Collaborative Assessment and Management of Suicidality (CAMS) into the NHS, including service user and clinician outcomes
University of Hull, Centre for Clinical and Applied Health Research
April 2018 – March 2021
Overview:
Led by Sophie R. Brown and supervised by Professor Zaffer Iqbal, this evaluation marks the first UK-based study to explore CAMS implementation within an NHS organisation. It combines quantitative service metrics with clinician and service user interviews.
Navigo’s implementation of CAMS as a system of care in the UK: preliminary positive outcomes
CAMS implemented by Navigo across a highly deprived ward of over 165,000 residents in North East Lincolnshire, NHS-commissioned services began integrating CAMS in 2017.
Key outcomes (preliminary):
- Clinicians reported increased confidence in assessing and treating suicidal individuals
- Reduced waiting times for care access
- Fewer individuals requiring crisis contacts
- Lower frequency of crisis interventions and avoidable inpatient admissions
- Preliminary data suggests an 80 % reduction in local suicide rates during the early phase of implementation
Overview:
This early evaluation describes Navigo’s adoption of CAMS as their principal approach to suicidality across community mental health services. Although still in preliminary stages, the findings indicate notable improvements in clinical confidence, service responsiveness, access to care, and – most strikingly – an estimated 80% decrease in suicide within the target area at that time.
Assessing and Managing Suicide Risk among Ireland’s Third-Level Students and Young Adults
Hayley O’Gorman, 2023
Conducted at an Irish university counselling service, this evaluation explores the implementation of CAMS among tertiary students and young adults aged 18–25.
Key insights:
Improved identification of ‘drivers’ of suicidality: The study confirms that CAMS helps practitioners collaboratively explore underlying factors such as academic pressure, social isolation, and relationship difficulties.
Enhanced student engagement: Young adults reported feeling heard and understood, resulting in greater treatment retention and reported hope.
Feasibility in a university setting: CAMS processes – including using the Suicide Status Form (SSF) and co-produced safety plans – were found to be readily adapted for college counselling environments.
Positive clinical trends: Early data indicate reductions in suicidal ideation, distress, and depressive symptoms following CAMS engagement.
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