Treat
Interventions & Treatments
Once your system or organization has plans to identify, screen, and assess individuals at risk for suicide, the next step is to provide evidence-based (or empirically supported) and culturally appropriate interventions and treatments.
In a Zero Suicide approach:
All individuals with suicide risk, regardless of setting, receive interventions and treatments that directly address suicidal thoughts and behaviors (and if applicable and appropriate, also receive treatment for other behavioral health issues). Individuals with suicide risk are collaboratively engaged and offered treatment in the least restrictive setting possible.
Effort is made to find or adapt interventions and treatments to be culturally appropriate for the individual in care. Cultural humility should be the foundation of any treatment provided. Historically, health and behavioral health care providers believed that the most effective way to address suicidal thoughts and behaviors was to address underlying mental health concerns, such as depression or anxiety. The assumption was that resolving these would decrease or eliminate suicidality.1
However, the research strongly supports addressing and treating suicidal thoughts and behaviors specifically and directly, independent of any additional diagnosis or challenge.2 Solely focusing on the “underlying” mental health concern misses any independent suicidality treatment needs. Further, it ignores that while suicide can be a result of mental health disorders, it can also be brought on or exacerbated by other factors including societal hardships or relationship challenges.
Fortunately, interventions and treatment specifically for suicide have been developed and are being increasingly used in the mental health field. They have typically been tested in a variety of settings under various circumstances and have shown benefits (e.g., symptom reduction, increased wellness) among participants. In addition, there have been numerous systematic reviews and meta-analyses published discussing best practices for treating suicidal ideation and reducing suicidal behaviors.3 4 5 6 7
Multicultural-Responsive Care
It is important to note the field of suicide prevention is lacking cultural adaptations of evidence-based and empirically supported treatments and interventions.8 Studies have shown these to be highly effective in reducing suicide risk in some populations. However, when selecting a treatment approach, it is important to examine which populations were included in the study.
This does not mean these approaches are only useful among these populations. It often means that the research has not been conducted with a particular population (i.e., Black, Asian, autistic, transgender, etc.) in mind or these groups have not been well represented in research studies. The intervention or treatment could work well with a variety of populations if used in ways that honor and respect the cultural context of the individual. It is important for providers to ensure that any treatment or intervention is culturally resonant and tailored to the individual in care.
Lack of cultural competence can also contribute to barriers to engagement or continued utilization of available mental health services.
Lived Experience
When considering approaches to treatment, it is important to center the voices of those with lived experience. This includes people who have struggled with suicidal thoughts and behaviors as well as those who have supported loved ones at risk or lost loved ones to suicide. There should be lived experience representation on the implementation team. These members should be a key part of the conversation regarding treatment.
First-hand accounts about what treatment methods have been helpful and which have been harmful can be pivotal to a provider’s ability to provide meaningful support to individuals experiencing suicide intensity. While it is important that the treatment approach used is evidence-based/empirically supported, it is also important that its efficacy extends beyond the research and into lived experience.
Other sections include information about least restrictive care, interventions, and treatments to directly and indirectly treat suicidal thoughts and behaviors and reduce suicide risk, and what next steps you can take whether you are beginning implementation of Zero Suicide or want to further your implementation.
Research Base of Interventions and Treatments
Suicide prevention researchers spend much of their time determining what works best for individuals at risk of suicide. They study which interventions and treatments work best for who and where (e.g., inpatient, outpatient, adolescents, adults, etc.). Some interventions and treatments have been studied extensively and have multiple rigorous studies that show they work, and who they work for, and where they work. But there are also interventions and treatments that have emerging research with approximately one to three studies that might not be as rigorous.
In addition, emerging research often has not been tested in multiple settings with different populations. It does not mean they do not work in those settings or with those populations, just that they have not been tested, so those questions remain unanswered. Organizations need to choose the interventions and treatments that work best for their staff and individuals in their care. Sometimes the most evidence-based intervention or treatment is not the best fit for an organization’s staff or clients.
In the Direct Care and Indirect Care tabs we have listed here multiple suicide-specific treatments and interventions. Some are considered evidence-based (multiple studies with high rigor) and other are considered empirically supported (fewer studies, potentially less rigor). Also, please note that the supportive research for each intervention or treatment is not always included. The research is constantly evolving and there are nuances within research studies that space precludes us from elaborating on the research for each intervention and treatment. Feel free to review the Evidence Base section of this website for overall research that supports suicide-specific treatment.
- 1.Brown G. K., & Jager-Hyman S. (2014). Evidence-based psychotherapies for suicide prevention: Future directions. American Journal of Preventive Medicine, 47(3 Suppl 2), S186–194. Retrieved from http://actionallianceforsuicideprevention.org/sites/actionallianceforsui
- 2.Ellis, T. E., Rufino, K. A., Allen, J. G., Fowler, J. C., & Jobes, D. A. (2015). Impact of a suicide‐specific intervention within inpatient psychiatric care: The Collaborative Assessment and Management of Suicidality. Suicide and Life‐Threatening Behavior, 45(5), 556-566. Retrieved from https://blogs.uw.edu/brtc/files/2015/01/Ellis-et-al.2015-CAMS-in-inpati…
- 3.A., Oquendo, M. A., Allen, I. E., Franck, L. S., & Lee, K. A. (2016). Direct versus indirect psychosocial and behavioural interventions to prevent suicide and suicide attempts: a systematic review and meta-analysis. The Lancet Psychiatry, 3(6), 544-554.
- 4.Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological bulletin, 146(12), 1117.
- 5.Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., ... & Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646-659.
- 6.Sobanski, T., Josfeld, S., Peikert, G., & Wagner, G. (2021). Psychotherapeutic interventions for the prevention of suicide re-attempts: a systematic review. Psychological medicine, 1-16.
- 7.Jobes, D.A., Au, J.S. & Siegelman, A. Psychological Approaches to Suicide Treatment and Prevention. Curr Treat Options Psych 2, 363–370 (2015). https://doi.org/10.1007/s40501-015-0064-3
- 8.Pham, T. V., Fetter, A. K., Wiglesworth, A., Rey, L. F., Chicken, M. L. P., Azarani, M., ... & Gone, J. P. (2021). Suicide interventions for American Indian and Alaska native populations: a systematic review of outcomes. SSM-mental health, 1, 100029.