The impact of motivational interviewing or dialectical behaviour therapy pre-commitment on motivation to engage in therapy for suicidal youth prior to admission to a youth mental health subacute unit.

Participants will be assigned to one of three intervention arms. All three interventions will be delivered in a 1-hour single timepoint face to face meeting at the Youth Step Up Step Down (YSUSD) facility. Where a young person is unable to attend the facility in person (eg. due to geographic distance) a Telehealth appointment will be offered. Motivational Interviewing. A one-hour individual Motivational Interviewing session which uses standard MI tools such as reflection, eliciting change talk, scaling and making a plan before going on to do programme orientation and giving homework. The type of Motivational Interviewing skills utilised will be building rapport, reflection, summarising, eliciting change talk, scaling of change, reinforcing change statements and planning what comes next. Dialectical Behaviour Therapy (DBT) pre-commitment (DBT-PC). A one-hour DBT pre-commitment individual session which introduces DBT as the primary therapy type at YSUSD, orients the young person to the programme and discusses the commitment involved. Several specific commitment strategies can be used. The DBT bio-psycho-social model is explained, the modules are explained as well as the concept of dialectics. The DBT treatment hierarchy is discussed (DBT treatment hierarchy is 1. life threatening behaviours as priority one, 2. therapy interfering behaviours as priority 2 and 3. quality of life threatening behaviours as priority 3), behaviour therapy as a whole is outlined (explanation that all behaviours are learned and that ineffective behaviour can be changed through new learning) and the idea of crisis coaching is raised (crisis coaching helps use distress tolerance skills during intense emotional distress). Expectations of commitments to group and individual work are discussed. Both interventions will include homework including a question about building a “life worth living” as well as a diary card (to record distressing thoughts and assign numerical value). They will also include a tour of the facility, description of the programme and rules as per TAU but will not receive full TAU intervention (eg. mental state exam and risk assessment) The interventions will be delivered by mental health practitioners with appropriate qualifications (e.g., Occupational Therapy, Social Work, Nursing, Psychology) and/or training in the requisite trial arm interventions (MI, DBT-PC) and who are employed within the YSUSD service. To reduce the likelihood of cross-over or slippage of content between clinicians, the YSUSD Social Worker (who is responsible for the DBT program during admissions) will implement the DBT-PC arm while the YSUSD Team Leader (discipline: Occupational Therapy) will implement the Motivational Interviewing pre-session arm. Two additional clinicians, one per active intervention arm, will be trained as cover for absences. Treatment as Usual pre-sessions will be delivered by other YSUSD clinicians (mental health nurses) as per normal rostering. The MI and DBT-PC sessions will be implemented according to the program manual and clinicians will receive ongoing supervision throughout the trial with their respective Discipline Lead or a senior clinician with expertise in the specific intervention. The three interventions have a fidelity checklist built into the intervention manual . After each session the staff member responsible for that session will complete the fidelity checklist. Sessions that deviate more than 60% from the fidelity checklist will be removed from the study. Clinicians will also be required to report regularly, via a monthly meeting, to the research members of the project team on the progress of recruitment and implementation. This will ensure the interventions are being delivered according to the protocol.