Peer-Delivered Suicide Prevention for Serious Mental Illness

Overseen By Colin A Depp, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Intoxication, Imminent hospitalization, others

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

Compensation: Varies

Number of Visits: 50

69 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment SUPPORT for suicide prevention?

Research shows that peer support interventions, like SUPPORT, can help reduce suicide risk by improving hope and connectedness. Similar peer-led programs have been effective in reducing psychiatric symptoms and enhancing quality of life for people with severe mental illness. ^{1 2 3 4 5}

Is peer-delivered suicide prevention generally safe for humans?

Research on peer-delivered suicide prevention interventions, like the PREVAIL study, shows they are generally safe and well-received by participants, with positive feedback on peer specialists' ability to provide support and relate to patients. ^{1 4 5 6 7}

How is the SUPPORT treatment different from other suicide prevention treatments?

SUPPORT is unique because it uses peer support specialists—people who have experienced similar mental health challenges—to help others by improving hope and connectedness, which are protective factors against suicide. This approach is different from traditional treatments as it focuses on shared experiences and recovery-based support rather than solely on clinical interventions. ^{1 2 5 8 9}

What is the purpose of this trial?

Suicide is a major public health concern, particularly among Veterans with serious mental illness (SMI, i.e., psychotic disorders or bipolar disorders). Wellness Recovery Action Plan (WRAP) is a well-established evidence-based practice for those with SMI that centers on identifying warning signs of mental illness, developing wellness tools for functional independence, planning for day-to-day effective living within one's community, and building an action plan to create a valued life worth living. This proposed study will refine and pilot SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT), a novel integrated recovery program that is an adaptation of peer-delivered WRAP for Veterans with SMI. In SUPPORT, a Peer Specialist leads a Veteran at increased risk for suicide through recovery planning that is tailored to the Veteran's suicidal experiences with cognitive learning strategies to enhance safety plan recall and improve functioning.

Research Team

Samantha A Chalker, PhD

Principal Investigator

VA San Diego Healthcare System, San Diego, CA

Eligibility Criteria

This trial is for Veterans with serious mental illness (like psychosis or bipolar disorder) who have had suicidal thoughts or attempts recently. They must be able to consent and, if acting as peer specialists, need certification and experience in suicide prevention.

Inclusion Criteria

I am a certified Peer Specialist at VASDHS with training in suicide screening and referrals.

I am a certified Peer Specialist with 2-3 years of experience.

Veteran Inclusion Criteria: Veterans who report present suicidal ideation in the past 1 month and/or a suicide attempt in the prior 3 months as identified by the Columbia-Suicide Severity Rating Scale (C-SSRS)

Exclusion Criteria

Veteran Exclusion Criteria: Inability to complete the assessment battery

Veteran Exclusion Criteria: Current intoxication requiring immediate detoxification or outpatient plan directed specifically to residential substance use disorder services

Veteran Exclusion Criteria: Imminent psychiatric hospitalization

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Phase 1: Intervention Refinement

Refinement of the SUPPORT intervention using a user-centered design approach and training Peer Specialists on pilot cases.

Varies

Phase 2: Pilot Randomized Controlled Trial

Pilot RCT of SUPPORT compared to enhanced standard care, with assessments at baseline, mid-treatment, post-treatment, and 3-months post-treatment.

4 weeks

Weekly, 50-minute sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 3-months post-treatment.

3 months

Treatment Details

Interventions

• SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT)

Trial Overview The study tests SUPPORT, an adaptation of the Wellness Recovery Action Plan led by Peer Specialists. It focuses on recovery planning tailored to a Veteran's experiences with suicidal ideation, aiming to improve safety plan recall and functioning.

Participant Groups

Group I: SUPPORT Experimental Treatment 1 Intervention

Veterans receiving SUPPORT will be offered all modules of the intervention via weekly, 50-minute sessions with a Peer Specialist. Following the completion of a mental health evaluation by a licensed professional, the Peer Specialist leads the Veteran who is at risk for suicide through recovery planning that is tailored to the Veteran's suicidal experiences with cognitive learning strategies to enhance recall of the Veteran's safety plan and improve recovery.

Group II: ESC Active Control 1 Intervention

The enhanced standard care (ESC) condition contains the elements of standard practice suicide prevention delivered at VHA, which include: 1) suicide risk assessment, 2) VA Safety Planning Intervention, 3) timely referral to VA mental health outpatient care, and 4) Suicide Prevention Coordinator follow-up contacts. It is enhanced due to the contact with the research study.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

The PREVAIL peer support intervention, designed for psychiatric inpatients at high risk for suicide, was found to be feasible and acceptable, with participants attending an average of 6.1 sessions over 12 weeks.

Qualitative feedback from participants indicated that peer specialists effectively provided support and fostered discussions about hope and safety, highlighting the potential of peer support in suicide prevention efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and pilot study of a suicide prevention intervention delivered by peer support specialists. Pfeiffer, PN., King, C., Ilgen, M., et al.[2022]

The Wellness Recovery Action Planning (WRAP) intervention, led by peers, significantly reduced psychiatric symptoms in 519 adults with severe mental illness compared to usual care over an 8-week period.

Participants in the WRAP program also reported increased hopefulness and improved quality of life at both the end of treatment and at a 6-month follow-up, highlighting the effectiveness of peer-led self-management strategies in mental health recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Cook, JA., Copeland, ME., Jonikas, JA., et al.[2022]

A study involving 121 peer support specialists found that perceived organizational support significantly enhances job satisfaction through increased autonomous motivation, work engagement, and organizational commitment, accounting for 49% of the variation in job satisfaction scores.

The results suggest that community mental health agencies should focus on providing strong organizational support and interventions to boost motivation and engagement among peer support specialists to improve job retention and career development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists. Wu, JR., Iwanaga, K., Chan, F., et al.[2023]

This study aims to evaluate the effectiveness of a peer worker intervention for individuals transitioning from inpatient to community mental health care, with 590 participants expected to be recruited and followed for 12 months to assess readmission rates.

The trial is designed to improve the quality of evidence on peer support by using rigorous methods, including randomization and blinding, and involves individuals with lived experience in the development of the intervention, ensuring it is relevant and well-defined.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer support for discharge from inpatient to community mental health services: Study protocol clinical trial (SPIRIT Compliant). Gillard, S., Bremner, S., Foster, R., et al.[2023]

Peer-delivered suicide prevention services encompass various roles, including gatekeeping and crisis support, and involve peers from similar backgrounds or shared experiences, highlighting the potential for effective community-based interventions.

Despite the promising nature of these peer support interventions, most studies lacked rigorous methodologies, with only three out of 84 being randomized controlled trials, indicating a need for more robust evaluations of their effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer-based interventions targeting suicide prevention: A scoping review. Bowersox, NW., Jagusch, J., Garlick, J., et al.[2022]

In a study involving 282 patients with serious mental illness, those receiving support from peer specialists (PSs) showed a significant improvement in health self-management activation compared to those receiving usual care, indicating that PSs can enhance patient engagement in their treatment.

While the PS group demonstrated better activation, no other significant differences in recovery, quality of life, interpersonal relations, or symptoms were found, suggesting that while PSs can promote active participation, their overall impact on broader patient outcomes may need further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A cluster randomized trial of adding peer specialists to intensive case management teams in the Veterans Health Administration. Chinman, M., Oberman, RS., Hanusa, BH., et al.[2021]

Peer-based health interventions can potentially improve the physical health of individuals with serious mental illness (SMI), but the evidence supporting their effectiveness is limited due to methodological weaknesses in the studies reviewed.

The most promising strategies identified were self-management and peer-navigator interventions, highlighting the need for further research to establish their efficacy across diverse populations and settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer-based health interventions for people with serious mental illness: A systematic literature review. Cabassa, LJ., Camacho, D., Vélez-Grau, CM., et al.[2022]

Peer support in mental health care, where individuals with lived experiences of mental illness provide support to others, has gained traction since the 1990s, despite facing stigma and stereotypes.

Data from four randomized controlled trials indicate that peer support can yield similar outcomes to conventional care, suggesting that individuals with a history of mental illness can effectively contribute to mental health services, though further evaluation is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer support among adults with serious mental illness: a report from the field. Davidson, L., Chinman, M., Sells, D., et al.[2022]

Peer support in mental health, which has historical roots dating back to the 18th century, is gaining traction and research support for its effectiveness in engaging individuals in care and reducing emergency room visits and substance use.

Peer support programs that include positive self-disclosure and role modeling have been shown to enhance participants' hope, control, and self-care, while also decreasing depression and psychosis levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer support among persons with severe mental illnesses: a review of evidence and experience. Davidson, L., Bellamy, C., Guy, K., et al.[2022]

References

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

Development and pilot study of a suicide prevention intervention delivered by peer support specialists. [2022]

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

Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists. [2023]

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

Peer support for discharge from inpatient to community mental health services: Study protocol clinical trial (SPIRIT Compliant). [2023]

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

Peer-based interventions targeting suicide prevention: A scoping review. [2022]

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

A cluster randomized trial of adding peer specialists to intensive case management teams in the Veterans Health Administration. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Peer-based health interventions for people with serious mental illness: A systematic literature review. [2022]

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

Peer support among adults with serious mental illness: a report from the field. [2022]

9. Italy pubmed.ncbi.nlm.nih.gov

Peer support among persons with severe mental illnesses: a review of evidence and experience. [2022]