A Novel Peer-Delivered Recovery-Focused Suicide Prevention Intervention for Veterans with Serious Mental Illness

Background: Suicide is a major public health concern, particularly among Veterans with serious mental illness
(SMI, i.e., psychotic disorders or bipolar disorders). These Veterans have among the highest rates of suicidal
ideation and behavior among U.S. and Veteran populations. Yet, an SMI diagnosis is often an exclusion
criterion for suicide-focused clinical trials, and people with SMI are frequently disengaged from care, have
cognitive impairments, and have limited social supports. These factors may likely impact the feasibility and
usefulness of current suicide prevention interventions such as suicide safety planning – a VHA standard of
care. This proposal refines and pilots SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT) –
the first suicide prevention intervention tailored to Veterans with SMI to improve participation in their lives and
society.
Significance/Innovation: Suicide prevention is a top clinical priority for VA/DoD and RR&D. This research is
innovative for several reasons: 1) SMI diagnoses have frequently been excluded from suicide prevention
research and this proposal seeks to tailor a novel suicide-focused intervention specifically to Veterans with
SMI; 2) this proposal is one of few studies that includes Veterans with SMI to enhance safety planning, which
is crucial given that it is an existing suicide prevention standard of care in VHA; 3) this proposal integrates the
recovery model and best practices into suicide prevention; 4) SUPPORT is delivered by Peer Specialists,
which the 2019 VA/DoD Clinical Practice Guidelines for the Assessment and Management of Patients at Risk
for Suicide highlighted a priority for future research to explore “post-acute care approaches,” such as safety
planning, and that such approaches could be peer-delivered; 5) this is the first intervention to integrate
cognitive learning strategies in a suicide-focused intervention to accommodate cognitive impairments in SMI.
Methodology: The proposed 5-year study aims to refine and pilot a peer-delivered intervention to improve
functional and social recovery to decrease suicide risk; the proposal consists of two phases. Phase 1 (1.5
years) employs a user-centered design approach to refine SUPPORT aided by scientific and consumer (n=8)
advisory board stakeholders as well as training our PSs to fidelity on pilot cases in an open trial (n=15) and
qualitative interviews. SUPPORT is a 4-week peer-delivered intervention intended to augment safety planning
by addressing functional and social goals personalized to each Veteran’s recovery following a suicidal crisis
while including cognitive learning strategies to enhance recall and salience of intervention material. Following
adaptations from Phase 1, Phase 2 (3.5 years) includes a pilot (n=50) randomized controlled trial (RCT) of
SUPPORT compared to an enhanced standard care (ESC) condition that contains the elements of standard
practice suicide prevention delivered at VHA, which include: 1) suicide risk assessment, 2) VA Safety Planning
Intervention, 3) timely referral to VA mental health outpatient care, and 4) Suicide Prevention Coordinator
follow-up contacts. Veteran participants in both phases will be quantitatively assessed at baseline, mid-
treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed at post-treatment; Peer
Specialists delivering the intervention will also be qualitatively interviewed post-treatment). The primary
outcomes to be evaluated is improvement in personal recovery and reduction in suicidal ideation severity.
Secondary outcomes concern changes in various domains of personal and social functioning.
Next Steps: This CDA-2 is the first step toward developing a program of research within VHA focused on
enhancing suicide related care by tailoring recovery-informed suicide-focused interventions to Veterans with
SMI. Pending confirmation of feasibly and preliminary impact, Dr. Chalker would submit for an RR&D Merit to
explore a multi-site, adequately powered RCT of SUPPORT versus ESC. We would emphasize 1) examination
of moderators or groups of interest (such as women Veterans) and 2) SUPPORT mechanisms of change.

Grant Number: 5IK2RX004239-04
NIH Institute/Center: VA
Principal Investigator: SAMANTHA CHALKER