A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT)

Mark Erik Larsen; Fiona Shand; Kirsten Morley; Philip J Batterham; Katherine Petrie; Bill Reda; Sofian Berrouiguet; Paul S Haber; Gregory Carter; Helen Christensen

doi:10.2196/mental.7500

A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT)

JMIR Ment Health. 2017 Dec 13;4(4):e56. doi: 10.2196/mental.7500.

Authors

Affiliations

¹ Black Dog Institute, University of New South Wales, Sydney, Australia.
² National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.
³ Centre for Mental Health Research, Australian National University, Canberra, Australia.
⁴ Brest Medical University Hospital at Bohars, Adult Psychiatry, IMT Atlantique, Lab-STICC, UBL, F-29238 Brest, France, EA 7479 SPURBO, Université de Bretagne Occidentale, Brest, France.
⁵ Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia.
⁶ Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, Australia.

Abstract

Background: Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated.

Objective: The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system.

Methods: To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group.

Results: Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption.

Conclusions: The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway.

Keywords: Internet; continuity of patient care; emergency service, hospital; suicide, attempted; text messaging.

©Mark Erik Larsen, Fiona Shand, Kirsten Morley, Philip J. Batterham, Katherine Petrie, Bill Reda, Sofian Berrouiguet, Paul S. Haber, Gregory Carter, Helen Christensen. Originally published in JMIR Mental Health (http://mental.jmir.org), 13.12.2017.