INTRODUCTION:
Chronic suicidality, defined as persistent suicidal ideation and behavior over extended periods, is common among people living with chronic pain, serious mental illness, and substance use disorders, and is associated with elevated suicide risk across the lifespan.1-4 Yet frontline clinicians still report uncertainty about how to distinguish chronic versus acute suicidality, how to understand the “function” of suicidal thoughts, and how to intervene without overusing hospitalization or alienating patients. 5,6

METHODS:
This integrative session combines a narrative review of current evidence on chronic suicidality and comorbid conditions (1-4, 7) with case vignettes and lived-experience perspectives. The presenters synthesize findings across psychiatry, pain medicine, and addiction research, highlight emerging psychotherapeutic and pharmacologic approaches, and introduce innovative rehabilitative modalities used at recovery.com, including rehabilitative martial arts, rehabilitative henna, and mental health first aid.

RESULTS:
participants will be introduced to a practical framework to 1) differentiate chronic from acute suicidality in assessment, 2) understand at least two psychological functions of suicidal ideation in chronic presentations, and 3) identify risk thresholds that warrant higher levels of care, including hospitalization. They will learn at least three concrete strategies to engage people with chronic suicidality in ongoing treatment while preserving autonomy and minimizing iatrogenic harm. Case examples will illustrate how combining evidence-based interventions with culturally responsive, strengths-based practices can reduce perceived burdensomeness, deepen engagement, and improve safety planning.

CONCLUSIONS:
chronic suicidality requires more than crisis management; it requires a sustained, person-centered, and culturally attuned approach. by integrating research evidence, outcomes data, and lived experience, this session offers a practical roadmap for clinicians, program leaders, and community partners seeking to respond more effectively to chronic suicidality in the context of pain, mental illness, and substance use, and to transform persistent despair into realistic hope for recovery.