Personalised and contingency-based interventions for suicide risk.

Open Arms - Veterans & Families Counselling (Open Arms) is Australia’s leading provider of high quality, nationally accredited, mental health care for veterans and their families. A key service delivery arm of the Department of Veterans’ Affairs, Open Arms provides free and confidential 24-hour counselling and support. Any current and former Australian Defence Force (ADF) member with one day continuous full-time service can receive support through Open Arms, as can their partners and children. There is no limit on the number of counselling sessions a person receives through Open Arms, support is provided based on clinical need. Open Arms services include: counselling for individuals, couples and families; care coordination for clients with more complex needs; group programs to develop skills and enhance support; lived experience mental health peer support; after-hours telephone counselling and telehealth; mental health literacy and suicide awareness training; information, education and self-help resources; and referrals to other services or specialist treatment programs, as needed. Clients receiving care from an Open Arms clinician (psychologist or accredited mental health social worker), in the intervention condition, will be assessed for suicide risk utilising the Open Arms Risk Assessment (OARA) template. The OARA is a tool developed by Open Arms to deliver a personalised and contingency-based response to suicide risk. The template contains the Columbia Suicide Severity Rating Scale (C-SSRS) and standardised assessment questions related to risk of harm to self. The OARA tool supports clinicians in the development of a risk formulation and safety plan. For this research, the personalised and contingency-based approach being utilised is the SafeSide Framework for Recovery-Oriented Suicide Prevention (SafeSide). SafeSide is a formulation-based approach to suicide risk assessment with a focus on planning rather than prediction. It is widely accepted that suicide cannot be predicted, therefore this model aims to assess the vulnerability and strengths of individual clients; and develop plans to mitigate risk and extend supports. The Framework unites mental health professionals through a shared framework that focusses on four core goals of person-centred suicide care: Connect – Assess – Respond – Extend. Risk formulation is an approach to suicide risk assessment, which comprises a concise synthesis of empirically based suicide risk information regarding a client’s immediate distress and resources at a specific time and place. The goal of this synthesis is not to predict behaviour but to promote communication and collaboration among professionals, client, and families to reduce risk in the short and long term. This study is a cluster randomised controlled trial (CRCT) whereby clinicians are randomly allocated to two conditions, a) standard care, without training (control group), and b) standard care, with training and implementation support (intervention group). Clinician and client outcomes between groups, and within groups, will be compared. InPlace Learning is SafeSide’s approach to sustainable, engaging work-force training by combining video-based instruction with live group interaction. Video instruction is delivered by Dr Pisani and co-led by lived experience consultant and patient advocate, Kristina Mossgraber. Open Arms will provide the core training online to clinicians across two half day sessions. Upon completion of the training: • Clinicians will be able to name three foundational goals for forming productive collaborations with clients and their families to address suicide risk. • Given a scenario, clinicians will be able to communicate a prevention-oriented risk formulation, orally and in writing. • Clinicians will be able to name four key domains to document in a short-term response to suicide risk to facilitate care and minimize liability. • Clinicians will be able to state at least two steps their own organization or program can take to strengthen care transitions. Following training, clinicians join the SafeSide community of practice which provides them access to expert supervision during monthly Office Hours, as well as regular updates, new modules and refreshers throughout the year.