Telehealth Suicide Prevention Strategies for Suicidal Thoughts

Overseen By Megan Reilly, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Disqualifiers: Imminent suicide risk, Acute psychosis, No phone, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

2814 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this study is to evaluate the effectiveness and implementation of a suicide prevention strategy delivered via telehealth in Emergency Departments. We will compare implementation of the Safety Planning Intervention plus follow-up calls (SPI+) delivered by Emergency Department (ED) staff to SPI+ delivered via ED referral to an off-site Suicide Prevention Consultation Center (SPCC).

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment SPI+ Delivered by ED Staff and SPI+ Delivered by SPCC Clinicians for suicide prevention?

Research shows that the Safety Planning Intervention (SPI), when combined with structured follow-up, is seen as helpful and increases safety for suicidal individuals, especially in emergency department settings. Additionally, telehealth delivery of similar interventions has been found to be acceptable and feasible, enhancing convenience and access for high-risk patients. ^{1 2 3 4 5}

How is the SPI+ telehealth treatment for suicidal thoughts unique?

The SPI+ telehealth treatment is unique because it involves delivering a safety planning intervention through telehealth, which enhances access and convenience for high-risk individuals without compromising safety. It also includes structured follow-up and monitoring by telephone, making it particularly suitable for those who do not require hospitalization. ^{1 3 4 6 7}

Research Team

Gregory K Brown, PhD

Principal Investigator

University of Pennsylvania

Eligibility Criteria

This trial is for adults who visited the emergency department (ED) for suicide-related issues or are at risk of suicide, can communicate in English, and have access to a phone. They must be willing to consent and not require immediate psychiatric hospitalization. It's not for those admitted as inpatients right after their ED visit or who are acutely psychotic.

Inclusion Criteria

Aim 2: Able to communicate in English

Aim 2: ED clinician or leader at one of our participating sites, or ED patient who was referred to the SPCC

Aim 1/Aim 3: ED visit at one of our participating sites for a suicide-related event or determined to be at risk for suicide per the Electronic Health Record (EHR) and ED clinical staff

Exclusion Criteria

Aim 2: Patients who are at imminent risk of suicide or acutely psychotic at the time of the interview, requiring emergency services and/or precluding ability to provide informed consent

Aim 2: Patients without a phone for contact

I was admitted to the hospital after my emergency department visit.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

At index ED visit

Enhanced Usual Care

ED staff deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to suicidal patients who are not admitted to an inpatient unit

1 - 1.75 years

Suicide Prevention Consultation Center

ED staff refer suicidal patients not admitted to an inpatient unit to the off-site Suicide Prevention Consultation Center (SPCC). SPCC clinicians deliver SPI+ via telehealth

2.25 - 3 years

Follow-up

Participants are monitored for safety and effectiveness after treatment, including follow-up calls and outpatient treatment engagement

6 months

Treatment Details

Interventions

• SPI+ Delivered by ED Staff
• SPI+ Delivered by SPCC Clinicians

Trial Overview The study compares two ways of delivering a suicide prevention plan with follow-up calls (SPI+) in EDs: one by the ED staff directly, and another via referral to an off-site Suicide Prevention Consultation Center (SPCC). The goal is to see which method works best when using telehealth services.

Participant Groups

Group I: Suicide Prevention Consultation Center Experimental Treatment 1 Intervention

ED staff refer suicidal patients not admitted to an inpatient unit to the off-site Suicide Prevention Consultation Center (SPCC). SPCC clinicians will deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to patients via telehealth.

Group II: Enhanced Usual Care Active Control 1 Intervention

ED staff deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to suicidal patients who are not admitted to an inpatient unit.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

The SAFE VET intervention, which combines Safety Planning Intervention (SPI) with structured follow-up and monitoring, was found to be highly acceptable among 100 participants in five Department of Veterans Affairs medical center EDs.

Participants reported that the intervention was helpful in preventing further suicidal behavior and encouraging engagement in treatment, indicating its potential effectiveness in supporting individuals at high risk after an emergency department visit.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Emergency Department Intervention and Follow-Up to Reduce Suicide Risk in the VA: Acceptability and Effectiveness. Stanley, B., Chaudhury, SR., Chesin, M., et al.[2022]

The study successfully implemented the Safety Planning Intervention (SPI) for adolescent suicidality in emergency services, showing that training significantly improved providers' attitudes and knowledge about the intervention.

Collaboration with stakeholders and brief training were effective strategies for integrating structured safety planning into pediatric emergency settings, which is crucial for enhancing care for suicidal youths.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. Bettis, AH., Donise, KR., MacPherson, HA., et al.[2022]

A meta-analysis of 6 studies involving 3536 participants found that safety planning-type interventions (SPTIs) significantly reduce suicidal behavior, with a relative risk of 0.570 compared to control groups, indicating they are effective in preventing suicide attempts.

However, the same analysis showed no significant effect of SPTIs on reducing suicidal ideation, suggesting that while SPTIs are beneficial for preventing actions, additional strategies may be necessary to address thoughts of suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety planning-type interventions for suicide prevention: meta-analysis. Nuij, C., van Ballegooijen, W., de Beurs, D., et al.[2022]

The telehealth suicide safety planning intervention (SPI) was found to be highly acceptable and feasible among high-risk Veterans, with participants rating it positively on acceptability (M=17.50), appropriateness (M=17.25), and feasibility (M=18) on a scale of 1 to 20.

Participants reported enhanced suicidal disclosure and improved management of urges, indicating that the SPI effectively supported their mental health needs while also addressing barriers like privacy and technology issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force". Patel, SR., Sullivan, SR., Mitchell, EL., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

An Emergency Department Intervention and Follow-Up to Reduce Suicide Risk in the VA: Acceptability and Effectiveness. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Safety planning-type interventions for suicide prevention: meta-analysis. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force". [2023]

5. England pubmed.ncbi.nlm.nih.gov

Staff Views of an Emergency Department Intervention Using Safety Planning and Structured Follow-Up with Suicidal Veterans. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Managing suicidality in home-based telehealth. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Addressing suicidality safety risk in students through a hospital-school-community telepartnership program. [2023]