Can a text message help save a life?
Local health care providers are trying to find out, with help from a $3.4 million grant.
St. Luke’s Health System will launch a study next year — with university researchers from Idaho, Washington, New York and Pennsylvania, and Idaho mental health organizations and advocates — to test a theory that reaching out to mental health patients by text can reduce the likelihood of them attempting suicide.
It also will test another theory: that patients who build a safety plan with specially trained providers, even without the follow-up messages, can be at less risk of suicide.
“There truly is a question about the best way to reach people who are experiencing suicide,” said Anna Radin, an applied research scientist for St. Luke’s and the co-principal investigator on the study.
It’s one of the first studies of its kind to include adolescents and many rural patients, Radin said.
The study’s core question is whether a safety plan, or a safety plan with a phone call and some thoughtful text messages can help patients who are at risk of suicide.
“We are here if you ever want to talk,” one text message might say. Or something like, “Sending good vibes your way today.”
The power of just checking in
Suicide is not a common occurrence, but Idaho has one of the highest rates in the nation.
About 393 Idahoans died by suicide in 2017, according to the Idaho Department of Health and Welfare. That year, Idaho’s suicide death rate was 66% higher than the national average, according to data from the American Foundation for Suicide Prevention. It is the second leading cause of death for Idahoans age 15 to 34, Health and Welfare says.
“Suicide is preventable,” Sam Pullen, psychiatrist, St. Luke’s medical director for behavioral health and the study’s co-principal investigator, said in a news release. “Our goal with this research is to determine the best way for health systems to help their patients who may be struggling with suicidal thoughts to live happier, healthier lives.”
Do you or someone you know feel suicidal? Just need to talk? Text or call the Idaho Suicide Prevention Hotline at (208) 398-4357.
Mental health researchers have known for decades that follow-up messages may keep someone from taking their own life.
In the late 1960s, psychiatrist and suicide researcher Jerome Motto used a grant from the National Institute of Mental Health to study whether a simple form letter could help suicidal patients stay alive.
“He would track patients who had been discharged from one of San Francisco’s nine psychiatric facilities following a suicide attempt or an extreme bout of suicidal thinking — and he would focus on the ones who refused further psychiatric treatment and therefore had no relationship with a doctor,” journalist Jason Cherkis reported in a 2018 story for HuffPost.
The patients in Motto’s study — more than 3,000 of them — were randomly split into two groups, both “subject to a rigorous interview about their lives,” Cherkis wrote.
One group of patients would receive letters in the mail over the next four years, saying things like, “Just a note to say that we hope things are going well, as we remain interested in your well being. Drop us a line anytime you like,” according to Cherkis.
“In the first two years following hospitalization, the suicide rate of the control group was nearly twice as high as that of the contact group,” Cherkis wrote.
Motto’s discovery that “caring contacts” may prevent suicide helped pave the way for part of the new Idaho study.
But the other approach being tested — the one without the texts and phone call follow-up — is effective, too, Radin said.
The Suicide Prevention Research Center says “individuals with higher-quality safety plans are less likely to be hospitalized in the year after safety planning.” One study of 100 veterans found that 61% of the veterans reported using their safety plan, the center says.
So, one group in the Idaho study will get that approach: a suicide prevention safety plan that those patients have created with a specially trained health care provider.
“It’s a difference between a provider spending five minutes with a patient, versus with this (approach) they might be spending an hour with the patient,” Radin said.
One study, two approaches
The St. Luke’s research will test two different approaches to suicide prevention, and measure their outcomes. Will patients have less suicide risk? Will they be more able to safely get through a period of suicidal thinking? Will their quality of life improve?
“Both interventions are evidence-based, so there’s no group getting something we think doesn’t work,” Radin said.
The study expects to work with about 1,460 patients — including 500 adolescents — who receive health care at various St. Luke’s emergency departments and primary care clinics in Boise, Meridian, Nampa, Wood River, McCall, Mountain Home, Fruitland and the Magic Valley.
All patients in the Idaho study will work with health care providers to create a safety plan they can use if they have suicidal thoughts in the future.
One group of patients also will receive a phone call within days of their St. Luke’s visit, followed by a series of up to 25 text messages over the next 12 months.
“Patients can respond to those and initiate a conversation if they want to,” Radin said.
The approach is “non-demanding for patients,” Radin said. “Just a check-in. ... So if a patient reaches out for additional support, then it’s there for them.”
The Idaho Suicide Prevention Hotline will make the phone calls and send the text messages, with the grant helping to fund some employees to work on that, Radin said.
Radin and Pullen worked hard to get the grant, which was extremely competitive. Radin said only about 6% of grant applicants were awarded funding.
“Most places that get funding (for large studies like this) are typically large academic centers,” Pullen said. So it was remarkable, he said, “for us to be able to do a study of this magnitude, here at a health system that ... reflects a lot of health systems across the country, and a lot of health systems here in the Intermountain West states, where suicide risk is so high.”
Pullen and Radin hope the study can help inform how hospitals, clinics and other mental health providers approach suicide prevention.
The study will begin enrolling patients next summer.
If someone you know is in emotional crisis
Call the Idaho Suicide Prevention Hotline at 1-800-273-8255.
WARNING SIGNS TO WATCH OUT FOR:
- Talking about wanting to die.
- Talking about feeling hopeless or having no reason to live.
- Talking about feeling trapped or in unbearable pain.
- Talking about being a burden to others.
- Increasing use of alcohol or drugs.
- Acting anxious, agitated or recklessly.
- Sleeping too little or too much.
- Withdrawing or isolating themselves.
- Showing rage or talking about seeking revenge.
- Extreme mood swings.
OTHER THINGS YOU CAN DO TO HELP:
- Do not leave the person alone.
- Be direct. Talk openly and matter-of-factly about suicide.
- Listen. Allow expressions of feelings. Accept the feelings.
- Be nonjudgmental. Don’t debate. Don’t lecture on the value of life.
- Don’t act shocked. This will put distance between you.
- Don’t be sworn to secrecy. Seek support.
- Offer hope that alternatives are available but do not offer glib reassurance.
- Take action. Remove means, such as guns or stockpiled pills.
- Get help by calling the hotline or visiting idahosuicideprevention.org.
Source: Suicide Prevention Lifeline