Every 13 minutes, someone in the United States (U.S.) chooses to end his or her life, resulting in over 40,000 suicides in the US each year. The economic cost of suicide in the U.S. was $34.6 billion annually in 2005; when adjusted for present day inflation, the economic toll rises to $42.2 billion. The combined cost of medical and work loss is estimated at $34.6 billion annually. In 2011, 487,700 people were treated in EDs for self-inflicted injuries. Beginning in 1999 with the Surgeon General's Call to Action to Prevent Suicide, millions have been devoted annually - both publicly (approximately $40 million from NIH) and privately (approximately $20 million from American Foundation for Suicide Prevention) - to prevent suicide. Yet, despite this significant and sustained effort, there is no evidence of a decrease in suicides or suicide attempts in the U.S. Our overarching goal is to create a tool that could reduce suicide rates, increase delivery of efficacious suicide interventions, and decrease overall costs associated with suicidal behaviors. With this in mind, we intend to: (1) develop and scientifically validate a relational agent for suicidal patients that delivers Collaborative Assessment and Management of Suicidality (CAMS), an efficacious and cost-effective intervention developed by David Jobes, PhD; and (2) to create an integrated software system (CAMS Relational Agent System; CAMS-RAS) that assists medical personnel by synthesizing the CAMS intervention findings into an easy-to-interpret report and providing empirically-derived clinical decision support; integrates into the health care system's electronic health record (EHR); enhances the patient's coping capability by including psychoeducational skills training modules for use during and after hospitalization; and automates the delivery of caring contacts, an efficacious and brief suicide prevention intervention provided after discharge. Our initial target will be EDs, as they are often the initial point of contact and where personnel must make the decision whether to hospitalize or discharge the suicidal patient. We will also conduct testing in other medical and outpatient mental health settings to ensure public health impact and commercial success. Phase I project aims include: (1) creating an advisory board to guide the development of CAMS-RAS; (2) iteratively design and develop relational agent ("Dr. Dave") modeled after the gestures, expressions, and mannerisms of CAMS treatment developer, David Jobes, PhD; and (3) conduct feasibility tests to determine whether CAMS-RAS is acceptable, easy to use, and liked by target end-users: acutely suicidal patients admitted to hospital EDs, psychiatric inpatient units, and medical floors for treatment of injuries sustained during a suicid attempt; hospital medical personnel, administrators, and other stakeholders including peer advocates; and outpatient suicidal patients, clinicians and administrators.
Public Health Relevance Statement: Public Health Relevance: Suicide is the tenth leading cause of death among Americans of all ages. Over 40,600 suicides occurred in the U.S. in 2012 - one suicide every 13 minutes. In the same year, over a million U.S adults reported attempting suicide; 483,596 were treated in emergency departments (EDs) for self-inflicted injuries, and 332,833 were hospitalized. The cost of suicidal behaviors in the U.S. was $33 billion in 2012. The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based, cost-effective, suicide-specific intervention that facilitates engagement, assessment, and treatment of suicidal risk. Unfortunately, most ED and outpatient mental health clinicians do not know CAMS and lack knowledge in how to effectively assess and intervene with suicidal individuals. The CAMS Relational Agent System seeks to facilitate the delivery of CAMS and other evidence-based procedures to reduce suicide.
Project Terms: Accident and Emergency department; Administrator; Adult; Advocate; Age; Ambulatory Care Facilities; American; base; care delivery; Caring; Cause of Death; Client; Clinic; Clinical; commercialization; coping; cost; cost effective; cost effectiveness; Decision Making; design; Development; Doctor of Philosophy; economic cost; Economic Inflation; Educational workshop; effective intervention; Electronic Health Record; Elements; Ensure; Event; evidence base; Feeling hopeless; Feeling suicidal; Floor; formative assessment; Foundations; Gestures; Goals; Health; Health Personnel; Healthcare Systems; Hospital Departments; Hospital Readmission; Hospitalization; Hospitals; Human; Human Resources; improved; Injury; innovative technologies; Inpatients; Intervention; Knowledge; Life; Medical; Mental disorders; Mental Health; Mind; Modeling; Names; National Institute of Mental Health (U.S.); Nurses; Outcome; Outpatients; Patients; peer; Phase; phase 1 study; Physicians; prevent; Preventive Intervention; Procedures; prototype; Provider; Psychiatry; psychoeducational; public health medicine (field); public health relevance; Randomized Controlled Trials; reducing suicide; Reporting; Risk Assessment; Risk Management; satisfaction; Self Efficacy; skills training; software systems; success; suicidal; suicidal behavior; suicidal individual; suicidal patient; suicidal risk; Suicide; Suicide attempt; Suicide prevention; suicide rate; Surgeon; System; Testing; tool; Training; Training Activity; trial comparing; United States; United States Agency for Healthcare Research and Quality; United States National Institutes of Health; usability; Vision; Work
