Suicide is the tenth leading cause of death in the United States, killing over 48,000 people each year. A promising augmentation to traditional treatment is peer support (i.e., services provided by individuals with lived experience). To date, studies suggest that peer-delivered interventions are effective and produce small but significant effects on quality of life and hope. Our preliminary data indicate that suicidal individuals are enthusiastic about having peers help them through suicidal crises. Nevertheless, suicide prevention has been relatively slow to incorporate peer support compared to severe mental illness populations with psychotic disorders.
Peer specialists are individuals with lived experience who receive formal training to deliver behavioral health services. Barriers to their inclusion in suicide prevention efforts include a lack of specialized training in suicide-specific techniques as well as lack of role specificity. Furthermore, healthcare systems have not been comfortable allowing peer specialists to provide open-ended support and guidance to suicidal clients. As a first step to incorporating peer specialists in the support system of suicidal individuals, we propose that peers could be trained to deliver a concrete, brief, suicide-specific intervention, the Safety Planning Intervention (SPI), a widely-used evidence-based brief intervention to prevent suicidal crises. This project will adapt SPI training for peers and will train 50 peer specialists in SPI and determine their competency in developing safety plans with suicidal patients. If competency can be achieved, peer specialists can be deployed to deliver this intervention with suicidal individuals. While SPI is feasible for both professional and lay personnel across a variety of settings, no studies have examined the feasibility of peer support specialists conducting SPI, nor are there any studies determining whether peers can be trained to deliver this intervention in a competent manner. In this project, we aim to address this gap.
The goals of this study are: 1) to train peer specialists in SPI; 2) to determine what aspects of training need to be adapted for peers; 3) to assess the competence, feasibility and acceptability of peer specialists conducting safety planning; and 4) to assess if peers are comfortable delivering the intervention and/or if they become distressed themselves. Ten peer specialists will undergo an interactive training to adapt the SPI training for peers. Fifty peer specialists from RI International, an organization committed to utilizing peer specialists that provides crisis and recovery services, will be trained and evaluated in SPI. Additionally, assessment of knowledge, attitudes, self-efficacy, feasibility, and acceptability will be administered prior to training, post-training, and at 6-month follow-up after trained peer specialists begin conducting safety planning. At post-training and follow-up, an assessment will be done to determine whether participation in safety planning elicits distress for peer specialists.
Results from this study will inform a randomized control trial of the effectiveness of peer-led safety planning. With the national movement towards incorporating peer providers into other fields of mental health, it is both relevant and timely to study the potential of peer support specialists, fulfilling the recommendation of the National Action Alliance to integrate suicide attempt survivors in all aspects of treatment design, provision, and evaluation.
