I did CAMS, but my client STILL needed the hospital. What did I do wrong? Maybe nothing at all. I've gotten this question quite a few times over the years. And it's a completely understandable one. Setbacks and potential hospitalization questions in suicide-focused care are among the more challenging and feared situations we'll navigate as providers. Isn't CAMS supposed to prevent this? Doesn't "perfect CAMS" mean we keep someone out of the hospital? Not necessarily. Certainly not every time. We often talk about CAMS as a potential alternative to hospitalization. And it is! Especially when we consider the extent to which the standard of care for providers can still boil down to "You have thoughts about suicide? Go right to the hospital!" CAMS's alternative holds that the presence of a thought does NOT mean the necessity of a hospital. Instead, the presence of a thought means the reality of pain. And clients are always worth a conversation around what their pain is, and what the least restrictive level of care is that can facilitate prevention and treatment. Sometimes, when we cull through SSF responses, behavioral observations and collateral contact, we have no choice but to conclude that the level of care this person needs now is a hospital. That can be hard for both people in the dyad to hold. Especially when we work so hard to dig, and dig, and find any other option. In those cases, even if the outcome is not what was desired, I encourage clinicians to consider the message they provided by working so hard to offer alternatives. Demonstrating that we want to show up for someone in their pain because they are worth a conversation is one of the most therapeutic things we can offer. And showing that there are treatment options available and waiting post-hospital that can actually make life worth living is invaluable.
Allen Tien, MD, MHS mdlogix.com 94,698 田一彦