Expanding Access to Evidence-Based Suicide Risk Assessment and Intervention in a Crisis Stabilization Setting

Healthcare systems represent an essential setting for suicide prevention, as among individuals who make a suicide attempt, 24.6% had a mental healthcare visit within the prior week, 43.9% within the prior four weeks, and 73.3% within the prior year. Crisis mental health care is the “first line of defense” in preventing loss of lives and reducing escalating costs that result from lack of access to care. However, crisis mental health care is inadequate, leading to restrictive longer-term hospital stays, hospital readmissions, and overuse of law enforcement. Thus, providing good crisis care is considered an effective strategy for suicide prevention. In fact, new bipartisan legislation has been introduced to expand evidence-based stabilization care for people with serious thoughts of suicide (STOP Suicide Act). It is essential to learn how to best implement evidence-based suicide treatments into crisis care facilities. Integrating an intervention such as Jaspr into crisis care workflows will only be successful if it is done in ways that work for both patients and providers. The overarching goal of this project is to expand access to evidence-based suicide risk assessment, safety planning, and intervention among patients at elevated suicide risk by implementing Jaspr in a real-world psychiatric setting: The Providence Center’s Crisis Stabilization Unit (CSU), which provides short-term crisis care for adult patients in need of psychiatric or substance use disorder support as an alternative to, or step-down transition from, hospitalization. We will conduct a pilot randomized controlled trial (N = 80) of Jaspr compared to CSU treatment as usual (TAU) to achieve the below aims. In Phase 1, we will conduct a formative evaluation to identify and address barriers prior to Jaspr implementation. We will implement Jaspr in Phase 2, in which we randomize patients to either Jaspr or TAU, collecting baseline and outcome data. Providers will order Jaspr and assign appropriate clinical modules to randomized patients, who can use the app for as little or as long as they would like during their CSU admission, with an at-home companion app available post-discharge. We will examine acceptability, appropriateness, feasibility, adoption, and safety of Jaspr, as well as its impact on suicidal ideation and behavior and rehospitalizations.