Brown professors offer a program to reduce suicide in high-risk individuals

A new guide for clinicians, researchers and mental health practitioners details an evidence-based suicide prevention program to save lives and reduce strain on an overtaxed mental health care system.

PROVIDENCE, R.I. [Brown University] For every person who died by suicide in 2020, 25 more made an attempt, according to the U.S. Centers for Disease Control and Prevention. But a new book, based on 15 years of clinical work and research by three Brown professors, presents a roadmap to reduce suicidal behavior in high-risk patients before it’s too late.

“In the two decades prior to the COVID-19 pandemic, there was a steady rise in the rate of suicide, despite the growing armamentarium of treatment approaches for suicide and suicide risk factors,” said Lauren Weinstock, a professor of psychiatry and behavior at Brown.

In response, Weinstock collaborated with fellow professors of psychiatry and behavior Ivan W. Miller and Brandon Gaudiano to develop the Coping Long-Term with Active Suicide Program (CLASP) in 2005. In 2014, the group launched a pilot study of the program at Butler Hospital, a Brown teaching affiliate.

For patients admitted to hospitals after suicide attempts, CLASP acts as a bridge between acute care and outpatient treatment in the community, Miller said. This transition period can be a tenuous time for people in crisis; suicide rates after discharge from psychiatric hospitals are approximately 15 times higher than the national rate, according to a 2017 analysis in JAMA Psychiatry.

CLASP, which is administered by treatment advisors who have a master’s-level degree in a mental health or related field, combines in-person counseling sessions before hospital discharge with telephone check-ins for several months thereafter, Miller said, and enlists the support of patients’ family, friends or significant others. This approach reduces barriers to care including transportation, cost of treatment, and timing of appointments. But CLASP’s predominant objective is to instill hope in patients by prompting them to describe their personal values and set forward-thinking goals.

“We thought an approach that focused on values would be most effective and useful for people struggling with suicidal behavior,” Gaudiano said. “The goal is to help patients build a life worth living, in addition to suicide prevention.”

Their book, "The Coping Long Term with Active Suicide Program (CLASP): A Multi-Modal Intervention for Suicide Prevention," is a resource for clinicians, researchers and mental health practitioners who are interested in implementing a cost-effective and proven suicide prevention intervention. Published by Oxford University Press as part of the Treatments That Work series, the book describes the research support for the program and also provides implementation guidelines for clinical practice.

In an interview, Gaudiano, Miller and Weinstock discussed the factors that make CLASP unique and effective as well as why the new clinician guide arrives at such a critical moment for practitioners and the public alike.

Q: How effective is CLASP in reducing suicidal behavior?

Ivan W. Miller: In one of the largest studies of suicide prevention conducted in the United States, CLASP reduced suicidal behavior by 30% in high-risk patients discharged from emergency departments over a 52-week follow-up period. In smaller trials, CLASP produced significant decreases in suicidal behavior of recently discharged inpatients with diagnoses of major depression and bipolar disorder. Additional large studies involving high-risk Veteran Administration inpatients and adolescents and young adults from emergency departments are ongoing.

“ The goal is to help patients build a life worth living, in addition to suicide prevention. ”

Brandon Gaudiano Professor of Psychiatry and Human Behavior, Brown University

Q: How is CLASP different from other suicide prevention programs?

Ivan W. Miller: CLASP represents a middle ground between intensive psychotherapies and very brief one-session interventions with psychiatrists or psychologists. It was designed to be offered in addition to other treatments that a patient may be receiving to reduce suicidal behavior at times when they are moving between different levels of treatment and may be at especially high risk of falling through the cracks in our health care system. The program targets multiple risk factors for suicide using a combination of strategies over a period of months: a series of in-person and telephone check-ins that not only identify a patient’s suicide risk factors and help them engage with a treatment plan, but also help them clarify their values and goals and plan for the future. A person the patient designates as their significant other also receives phone check-ins.

Q: Why do you think the program works?

Brandon Gaudiano: CLASP builds upon elements that have been shown to work best for patients at risk for suicide: individual therapy, family therapy and case management approaches. It is also an adjunctive intervention, meaning it allows — and encourages — patients to maintain their own treatment providers.

Lauren Weinstock: CLASP also encourages people to look toward the future during a difficult time in their lives by helping them identify their personal values and use those as a springboard to create personal goals for the short-term and the long-term. It is designed to instill hope.

Q. Is there something about this moment that makes it a good time to introduce CLASP to a wider audience through the new book?

Lauren Weinstock: Absolutely. Although data on recent suicide rates continue to emerge, it is evident that the ongoing pandemic — and its accompanying social isolation, illness, anxiety, loss and life stress — has had a profound psychological and social impact on people’s lives. There are growing reports of a surge in people seeking mental health treatment, combined with a shortage of mental health professionals available to meet the needs of the community. CLASP is designed to address suicide risk directly with people as they transition between different levels of care — not replacing, but rather supplementing the range of treatments available, providing support to patients and also their families as they navigate our often-fractured systems of care.