Hope as the Remedy for Suicide Risk

As a suicidologist for 40+ years, I think a great deal about hope. Within mental health care, hope can be at once elusive and transformative for patients who suffer and for clinicians who endeavor to care for them. For patients, the abject absence of hope—otherwise known as hopelessness—is at the heart of most, perhaps all, suicidal struggles. For clinicians, the formidable challenge of clinically reducing hopelessness and replacing it with hope can be daunting. Hopelessness is a kind of psychological anvil that can drag a patient down into the deep depths of suicidal despair. In turn, clinicians can be similarly pulled under by the sheer weight of their patient’s hopeless struggles. It follows that suicide can become quite compelling for a patient in the face of unwavering hopelessness.

Unfortunately, the daunting challenge of suicidal risk and its incumbent hopelessness far too often compels many mental health care providers to avoid such patients altogether or to quickly rid themselves of such cases via referral or unnecessary inpatient admission. But here is the thing about hope: it is the remedy for suicidal risk. I certainly mean this in terms of any patient who is suicidal but it uniquely applies to clinicians as well.

In the CatholicU Suicide Prevention Laboratory (SPL) we watch hours and hours of digital recordings for adherence and fidelity purposes. We observe clinicians across several randomized controlled trials (RCTs) endeavoring to master the use of the Collaborative Assessment and Management of Suicidality (CAMS—Jobes, 2023) and our job within these randomized controlled trials is to ensure adherence to the framework and experimental fidelity. CAMS has been developed over 30 years of clinical research and it is one of a handful of evidence-based, suicide-focused, clinical treatments for suicidal risk. It is supported by 11 published open clinical trials and seven published RCTs showing that CAMS is the most effective treatment there is for reducing suicidal ideation and overall symptom distress. More to the point of the present discussion, when compared to control care, CAMS significantly decreases hopelessness while it simultaneously increases hope. Indeed, in a rigorous meta-analysis of nine CAMS trials, the single biggest experimental effect of CAMS across trials was on hopelessness and hope (Swift et al., 2022).

What exactly does hope look like in the videos we watch? Hope is reflected in a shy glance that a patient makes towards their clinician. It is a wary look that says, are you for real? Can I trust you? Do you really care about me? In later interim sessions of care, hope can be seen in a patient who sits up just a little bit straighter than they did in their first session. We see hope reflected when a patient shows genuine interest in their clinician’s comments. Hope is also seen in the flicker of smiles between patient and therapist as the dyad reviews “a really good week.” And hope is routinely seen in outcome-disposition final sessions when CAMS comes to a close as both parties knowingly gaze at each other reflecting on how far they have come.

But beyond instilling therapeutic hope in patients, I have recently become aware of the importance fostering hope in clinicians. In previous blogs and published articles, I have critiqued the state of contemporary clinical care for those with suicidal risk. I contend that far too many mental health providers embrace a custodial, paternalistic, medical-model approach. Such an approach to suicidality overly relies on a medication-only course of treatment along with emergency department (ED) and inpatient admissions that are insufficiently focused on suicide and can actually make matters worse for suffering patients (Jobes & Barnett, 2024; Jobes & Chalker, 2019). Too often driven by fear of malpractice, clinicians’ default to non-evidence-based and controlling interventions for suicidality that often shame, blame, and invalidate people who struggle. Critically, these approaches do not work and can foster profound states of hopeless despair.

While such practices are common in response to suicidal risk, there are nevertheless innovative approaches that flip the script of suicidal care. For example, there are emerging models of retreat centers, respite care, and mobile crisis responses that endeavor to keep people who are suicidal out of EDs and inpatient care. Outpatient crisis clinics are increasingly emerging that embrace the use of CAMS and also DBT skills groups. I have been indirectly involved in four such clinics in Ohio, Arizona, Georgia, and Colorado with more on the way. When meeting with the staff at these suicide-focused clinics, I have experienced a most remarkable thing. Instead of clinicians who are wary of patients who are suicidal, these clinicians are eager to engage such patients! Rather than doing all they can to rid themselves of such patients, These providers relish the chance to work with suicidal risk and take obvious pride in keeping such patients out of EDs and hospitals. And you can see it in their eyes—these providers are remarkably hopeful! They are excited about using evidence-based and complementary treatments that reliably and effectively reduce suicidal ideation and behaviors (Jobes & Rizvi, 2024). And I have borne witness to the contagious nature of hope; when providers are hopeful, patients become hopeful, and their hopefulness further fuels the providers’ passion for pursuing effective suicide-focused care.

"Hope" is a simple word. Yet hope has transformative power for patients who struggle and for providers who care for them. When there is hope, providers can evolve from a clinical stance rooted in fear, avoidance, and control to offering a therapeutic embrace brimming with validation, competence, and confidence. Hope is the essential remedy within clinical suicidology for both patients and their providers. For when there is hope, there is always the potential to decrease suicidal suffering, perhaps helping to save a life, and the promise of opening a door to a life worth living.