SAFETEL: a pilot randomised controlled trial to assess the feasibility and acceptability of a safety planning and telephone follow-up intervention to reduce suicidal behaviour

Abstract

Background A previous suicide attempt is an important predictor of future suicide. However, there are no evidence-based interventions administered in UK general hospital contexts to reduce suicidal behaviour in patients admitted following a suicide attempt. Consequently, the objective of this pilot randomised controlled trial was to explore whether a safety planning and telephone follow-up intervention (SAFETEL) was feasible and acceptable for individuals treated in hospital following a suicide attempt. Methods In this three-phase study with an embedded process evaluation, a safety planning intervention was tailored to the UK context (Phase I), piloted (Phase II, n = 32), and tested in a feasibility randomised controlled trial (Phase III). In Phase III, participants were allocated to either the intervention (n = 80) or control group (n = 40) using telephone randomisation with a 2:1 ratio. The acceptability and feasibility of the trial and intervention procedures were evaluated using both qualitative (interviews and focus groups) and quantitative data. The number of hospital representations of suicidal behaviour was also collected 6 months after study recruitment based on electronic patient records. Results Findings indicated that SAFETEL was both acceptable and feasible. Hospital staff reported the intervention fitted and complemented existing services, and patients reported that they favoured the simplicity and person-centred approach of the safety planning intervention. Conclusions All progression criteria were met supporting further evaluation of the intervention in a full-scale clinical effectiveness trial. Trial registration ISRCT,ISRCTN62181241, 5/5/2017

Supported decision‐making interventions in mental healthcare: A systematic review of current evidence and implementation barriers

“…Organisational resource limitations, culture barriers, risk management priorities and structure can all act as barriers to facilitated decision‐making in mental health treatment planning. For example, limited organisational financial resources and investment in services and staffing affected staff availability, high staff turnover and workloads: ‘we're short of money and … we're short of people’ 28 were issues reported to affect clinicians' ability to undertake shared and supported decision‐making when treatment planning with service users 29–38 . These barriers were further exacerbated by the Covid pandemic 39 .…”

“…Also, training costs can be substantial 35 and, when insufficiently allocated, could mean that ‘the scene was not set for clinicians’, 21 when they did not receive sufficient information, training or support to understand and adopt such new interventions 36,40 . Organisational culture and particularly a lack of readiness to change were also barriers—when organisations and leadership avoided a sustained investment in change, did not involve frontline staff in implementation processes or support the necessary changes to address staff work priorities and availability, IT infrastructure, physical infrastructure (i.e., the need for private spaces), clinical workflows and access to guidelines 29,34,36,38–46 . In addition, balancing organisational risk management priorities with increased service user involvement in decision‐making could be challenging and a concern for practitioners 45,47 .…”

“… Completing a plan In the context that most service users wanted to be involved in planning for their care, much more so than handing over decision‐making to another person 70 —some may feel hesitant, lacking confidence to begin, 46,71,72 and can find aspects of completing a plan to be difficult. Difficulties can be experienced with long, repetitive, detailed or legal documents (i.e., some psychiatric advance directives), challenging language or questions, not understanding the document or knowing what to write, also with problem‐solving, deciding on actual preferences and completing the plans 32,38,42,44,46,52,73–75 . Some healthcare providers can also find some plans to be too long 62 or the process too elaborate 76 …”

“…One obstacle may be that many clinicians believe that they are already doing shared decision‐making in treatment planning 21,30,32–34,46,47,54,97 —although when they describe their practices, it suggests otherwise 97 . Clinicians also acknowledged that they had other priorities, 31,46,60 were sceptical about the associated benefits 21,61,76,97 and found shared decision‐making a challenge, including emotionally 36,38,40,52,58,102 . For example, in one intervention, service users who were trained in shared decision‐making were perceived by clinicians to be ‘more difficult’ 103 .…”

Development of a Brief Intervention for Emergency Department Attendees Presenting With Self-Harm and Co-Occurring Substance Use Problems

“…There is growing evidence to support the use of active contact and follow-up (including brief interventions) to prevent suicide among people presenting to hospital with an identified suicide risk (Doupnik et al, 2020; Miller et al, 2017; O’Connor et al, 2022; Stanley et al, 2018). The effectiveness of these types of interventions for people with substance use problems is, however, currently unknown.…”