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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to evaluate the effectiveness of a suicide prevention strategy delivered through telehealth in Emergency Departments (EDs). It compares two approaches: one where ED staff provide safety planning and follow-up calls, and another where patients receive the same support from a specialized Suicide Prevention Consultation Center. Individuals who visited the ED for suicide-related reasons and were not admitted to a hospital may be suitable candidates. The goal is to identify the most effective way to support individuals at risk of suicide after an ED visit. As an unphased trial, this study offers a unique opportunity to contribute to innovative strategies that could enhance support for those at risk of suicide.

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 prior data suggests that these telehealth suicide prevention strategies are safe?

Studies have shown that the Safety Planning Intervention with follow-up services (SPI+) is a promising method to help prevent suicide. Research indicates that telehealth connections between patients and clinicians at an outside Suicide Prevention Consultation Center (SPCC) are well-received. Reports have not identified any major negative effects from this method.

Simple interventions like SPI+ during or after emergency visits reduce the risk of suicide, decrease hospital stays, and increase participation in follow-up care. This suggests that the intervention is both effective and safe for patients. Overall, evidence supports SPI+ as a safe approach for those at risk for suicide. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these suicide prevention strategies because they leverage telehealth to deliver the Safety Planning Intervention (SPI+), ensuring patients receive critical follow-up care after an emergency department visit. Unlike traditional methods that might rely on in-person follow-ups, this approach can be more accessible and convenient for patients, potentially increasing adherence and effectiveness. The involvement of Suicide Prevention Consultation Center (SPCC) clinicians adds a specialized touch, ensuring that patients receive expert care tailored to their needs. This trial aims to find out if these remote interventions can effectively reduce suicidal thoughts and behaviors, offering a promising alternative to standard in-person care.

What evidence suggests that this trial's telehealth suicide prevention strategies could be effective?

Studies have shown that the Safety Planning Intervention plus follow-up calls (SPI+) can help reduce suicidal behavior. Research in the Department of Veteran Affairs' Emergency Departments found that SPI+ led to fewer suicidal actions and hospital visits. This approach also increased the likelihood of patients receiving regular help outside the hospital. Another study found that people using a digital safety plan were 50% less likely to return to the Emergency Department. In this trial, participants will receive SPI+ either from ED staff as part of Enhanced Usual Care or from SPCC clinicians via telehealth. These findings suggest that SPI+ delivered through telehealth can be a strong tool in preventing suicide and keeping people safe. ^{1 2 3 4 5}

Who Is on the Research Team?

Gregory K Brown, PhD

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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 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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11071175/

Safety Planning Intervention and Follow-up: A Telehealth ... Studies conducted in the Department of Veteran Affairs' (VA) EDs found that SPI plus follow up calls (SPI+) resulted in lower suicidal behavior rates and ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1551714424000661

Safety planning intervention and follow-up: A telehealth ... Brief, evidence-based interventions during or following ED visits can reduce suicide risk, decrease hospitalizations, and increase outpatient engagement [15].

3. clinicaltrials.gov clinicaltrials.gov/study/NCT05307432

Safety Planning Intervention Telehealth Service Model in ... The purpose of this study is to evaluate the effectiveness and implementation of a suicide prevention strategy delivered via telehealth in Emergency Departments ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38484793/

A telehealth service model for suicidal individuals in ... - PubMed Effectiveness data sources are electronic health records, administrative claims, and the National Death Index. Primary effectiveness outcomes ...

5. mental.jmir.org mental.jmir.org/2025/1/e70253

Impact of Digital Safety Plan Activation on Subsequent ... Results: At follow-up, participants who activated the digital safety plan showed a 50% lower likelihood of returning to the ED, when compared to ...