Self-determination theory and the collaborative assessment and management of suicidality

Published date29 January 2020
DOIhttps://doi.org/10.1108/MHRJ-09-2019-0029
Date29 January 2020
Pages75-83
AuthorÉdua Holmström
Subject MatterHealth & social care,Mental health
Self-determination theory and the
collaborative assessment and
management of suicidality
Édua Holmström
Abstract
Purpose The collaborative assessment and management of suicidality (CAMS) is a first-encounter
suicide-specificbrief intervention that motivates suicidal individualsfor voluntary treatment engagement
and choosing life. How the intervention works, however, has not been theoretically explained. The
purposeof this paper is to explain the effectivenessusing self-determination theory (SDT).
Design/methodology/approach The paper focuses the theoreticalexamination on the philosophy of
care and the clinical proceduresof the CAMS suicide intervention. SDT is used as the theoreticallens of
the examination.
Findings The underlying philosophy of care and the clinical procedures of CAMS enhance the
autonomy, relatedness and competence of the client in the first encounter. The paper proposes that
fulfilling these basic human needs results in the intervention outcomes of treatment engagement and
choosinglife for the time being.
Research limitations/implications The research is limited to the examination of the documented
clinical procedures and philosophy of care. Further research applyingSDT to the design and empirical
testingof therapeutic interventions for suicide preventionis warranted.
Practical implications Clinicians working with suicidalclients need to empathically address suicidal
individuals’ motivationto engage in voluntary treatment and reduce controllingand autonomy-thwarting
approaches.
Social implications Suicidal behaviour is conventionally considered the manifestation of a mental
disorder characterized by limited informed decision-making. The success of CAMS points to the
contrary.Despite their suffering, many suicidal individualsmake informed decisions about treatment with
the supportof an empathetic clinician.
Originality/value CAMS has not previously been theoretically explained. This paper explains the
effectivenessof the intervention in engaging suicidalclients in further treatment through SDT.
Keywords Self-determination theory, Suicidality, Collaborative assessment and management of suicidality,
Treatment engagement
Paper type Conceptual paper
Introduction
Suicide prevention lacks a preventive, strategic framework because of the limited
theoretical understanding of its working mechanisms (Calear et al., 2016;De Silva et al.,
2013). There is evidence for the efficacy of therapeutic interventions for self-harm behaviour
(Ougrin et al.,2015). While suicide-specific interventions show a reduction in suicidal
ideation (Calear et al., 2016), these have not been examined to discover the mechanisms
that deliver the desired therapeutic changes. While motivation is clearly one of the most
essential of these mechanisms, the engagement of suicidal clients on the first clinical
encounter is still a neglected aspectof the research (Lizardi and Stanley, 2010).
E
´dua Holmstro
¨m is based
at the Faculty of Medicine,
Postgraduate Professional
Education, University of
Helsinki, Helsinki, Finland.
Received 7 September 2019
Revised 14 December 2019
Accepted 16 December 2019
DOI 10.1108/MHRJ-09-2019-0029 VOL. 25 NO. 1 2020, pp. 75-83, ©Emerald Publishing Limited, ISSN 1361-9322 jMENTAL HEALTH REVIEW JOURNAL jPAGE 75

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