New “Next Day Appointment” Treatment Shows Promise

Katherine Comtois, Ph.D.

Katherine Comtois, Ph.D.

After discharge from the emergency room or a brief inpatient hospital stay for significant suicidal ideation or a suicide attempt, the transition to outpatient care can be difficult. Dr. Katherine Comtois, a Distinguished Investigator Grant recipient from AFSP, examined the feasibility, patient acceptance and improvement related to a treatment focused on managing and alleviating suicidal ideation and behavior called Collaborative Assessment and Management of Suicidality (CAMS). CAMS was developed by Dr. David Jobes, one of AFSP’s Scientific Advisors and an investigator on the study. Dr. Comtois published her results in the journal Depression and Anxiety in November 2011.

In this study 32 patients discharged from the ER or inpatient unit at Harborview Mental Health Services in Washington and given a “Next Day Appointment” (NDA) were randomly assigned to CAMS or Enhanced Care as Usual (E-CAU). Treatment was provided as long as deemed necessary by the treating clinician or until they stopped attending. CAMS used the Suicide Status Form (SSF) as a guide as patient and clinician worked together to address specific issues related to the patient’s suicidal behavior including understanding potential triggers as well as support and options available should suicidal ideation emerge or worsen. Suicidal ideation was monitored throughout the treatment. Participants were assessed with regard to suicidal ideation, behavioral health treatment outcomes, reasons for living and hopefulness at baseline and 2, 4, 6 and 12 months after the pretreatment assessment.

While participants in both groups improved, CAMS demonstrated more rapid and long-lasting improvement. E-CAU reached the same level of improvement as CAMS at 6-months and then the effects of E-CAU treatment declined by 12-months while the improvements with CAMS were maintained. The study demonstrated that CAMS was accepted by patients, easily accessible to clinical staff and feasible in outpatient settings. In sum, CAMS showed promise for assisting recently discharged patients during a difficult transition.

Dr. Katherine Comtois is an Associate Professor at University of Washington’s Department of Psychiatry and Behavioral Sciences and Director of Harborview Mental Health Services Cognitive Behavioral Therapy Services.

Published article from this study:

  • Comtois, K. A., et al. (2011). Collaborative Assessment and Management of Suicidality (CAMS): Feasibility Trial for Next-Day Appointment Services. Depression & Anxiety, 28, 963-972.