Today, World Suicide Prevention Day,  is dedicated to raising awareness on suicide prevention. It’s essential to highlight impactful research taking place in the Amsterdam Psychiatry network. Suicide prevention is a complex challenge that requires innovative solutions and compassionate care. Partners in our network are studying suicide prevention from various angles and collaborate in multiple research projects.

One promising example is the SAVE implementation study – a project focused on integrating digital safety planning into psychiatric care. By combining technology with personal support, SAVE aims to measure the success of safety planning and digital interventions for patients experiencing suicidal thoughts.

SAVE implementation study

Previous research has shown the risk on suicidal behaviour or fatal suicide is at its peak after discharge of psychiatric hospital care (1,2). A safety plan is an intervention that reduces the risk on suicidal behaviour with 40% (3). However traditionally safety plans are made with pen and paper, and therefore an easy target of loss and decay. E-health tools however, especially app for mobile phones, are long lasting and easily accessible. Building on that, researchers at Amsterdam UMC launched the SAVE implementation study. This is carried out at selected inpatient clinics of Arkin, GGZ inGeest, GGZ Rivierduinen and Amsterdam UMC Psychiatry.

SAVE brings digital safety planning to life in psychiatric clinics. It offers patients a simple, supportive way to co-create a safety plan during their admission and using an E-health app with their safety plan after discharge.

Study objective

The main goal is to measure the success of implementing safety planning in a digital fashion. Researchers are looking at uptake rates; how many patients actually received a digital safety plan compared to how many could have.

But that’s just the beginning. SAVE also explores other aspects. What do nurses really think about using digital tools for safety planning and how do they integrate it into their daily routines? Are the patients satisfied with the digital safety planning process and what is their experience after they leave the clinic? Additionally researchers monitor how often the intervention is used across different clinics and patient age groups. Finally, they will interview a number of patients who received digital safety plans (in depth interviews). This is important information to know what can be done to enhance the usage of digital safety plans and keep more patients safe in the future by developing targeted strategies to improve engagement and effectiveness.

The overarching goal? Every patient admitted with suicidal thoughts creates a personal safety plan—with support from loved ones—before leaving the clinic. This plan then lives on their smartphone, ready when they need it most.

“What I am hugely enthusiastic about in this study is that we can inform our patients of this risk by creating a safety plan with them, and also give their loved ones a heads up. It’s not only the intervention itself, but also the proactive step we take to make their transition back home easier.”

Focus groups

Together with MIND, the SAVE study has recently launched with several focus groups among people with lived experience and among family members and friends of suicide attempt survivors. Aiming to learn first-hand from stakeholders about optimal implementation of digital safety planning on inpatient psychiatric clinics.

Risk of suicidal behaviour

Jet Heering leads the SAVE project. She is a clinical psychologist in training at GGZ inGeest,  and as postdoctoral researcher affiliated to Amsterdam UMC and 113 Dutch Suicide Prevention Foundation.

Jet explains: “I can readily imagine why the risk of suicidal behaviour after discharge is so astronomically high for patients with psychiatric conditions. Coming down from a crisis, surveying your life or perhaps the damage that was done before admission, or simply having to deal once again with daily life – I am sure it can be quite overwhelming. What I am hugely enthusiastic about in this study is that we can inform our patients of this risk by creating a safety plan with them, and also give their loved ones a heads up. It’s not only the intervention itself, but also the proactive step we take to make their transition back home easier. And of course, by storing the plan on their phone, safely secured within the E-health platform of their mental health care institution, I sincerely hope this gives patients and their families the confidence to survive a possible suicidal crisis in the days to come.  

Lastly, and certainly not least, this implementation study really focuses on supporting the nurses working on the selected inpatient clinics. They are, in my opinion, the best caregivers to conduct safety planning with their patients, as they earn patients’ trust and reliance during a very vulnerable period. Making an effort to provide them with optimal implementation support is something that I am very proud of.”

Jet Heering recently got awarded a small fund of Amsterdam Public Health research institute . With this fund she will start the SPARC special interest group: ‘Suicide Postprevention Approaches: Research to Community benefits’.

References  

1. Forte, A., Buscajoni, A., Fiorillo, A., Pompili, M., & Baldessarini, R. J. (2019). Suicidal Risk Following Hospital Discharge: A Review. Harvard Review of Psychiatry, 27(4), 209–216.
2. Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide Rates After Discharge From Psychiatric Facilities. JAMA Psychiatry, 74(7), 694.
3. Nuij, C., van Ballegooijen, W., de Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., O’Connor, R. C., Smit, J. H., Kerkhof, A., & Riper, H. (2021). Safety planning-type interventions for suicide prevention: meta-analysis. The British Journal of Psychiatry, 219(2), 419–426. https://doi.org/10.1192/bjp.2021.50