Project 1: Syncing Screening and Services for Suicide Prevention across Health and Justice Systems

PROJECT SUMMARY
As suicide rates in the United States continue to rise, with nearly 50,000 suicide deaths and over 1 million
suicide attempts annually per most recent data, increased attention has been paid to how to best integrate and
coordinate suicide risk identification and prevention across multiple sectors, where some of our most vulnerable
community members “fall through the cracks” in the continuum of care. Perhaps nowhere is this need for
coordination and integration more pronounced than at the intersection of the US jail system, with over 10 million
admissions per year, and the community healthcare system; an intercept known to impact individuals at
disproportionately high risk for suicide. Given that roughly 10% of all suicides in the US with known
circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide
risk in the year after jail detention could have a noticeable impact on national suicide rates. There is thus a vital
need to develop suicide risk care pathways between jails and healthcare systems to offer immediate access to
care. Yet this process has been stymied by major fissures in the integration of data and clinical information
between jails and health systems, preventing effective coordination of care between these community sectors.
To address these needs, the proposed Signature Project is a Hybrid Type I effectiveness-implementation trial
that harmonizes local jail booking and release data with healthcare records at two large healthcare systems in
Minnesota and Michigan, to identify health system patients who are released from jail, and to pair the data
linkage with randomization into usual care or a multi-level health system suicide prevention care pathway
(consisting of care coordination, Safety Planning, Caring Contacts, and a telehealth delivered Coping Long-
Term with Active Suicide Program). In so doing, this project leverages the study team’s experience in health
system data linkage in the NIMH-funded Mental Health Research Network, from which the participating
healthcare systems were chosen, as well as in suicide prevention around the period of jail detention and
release (i.e., in the SPIRIT Trial), and in telephone-based suicide prevention intervention (i.e., in ED-SAFE).
The proposed project will randomize 1050 individuals into the 5S intervention at both sites (comparing to more
than 60,000 people in a usual care no contact comparison arm). Findings on suicide attempt and death
outcomes, healthcare utilization mechanisms, cost- effectiveness, and implementation factors will provide data
for a future fully scaled implementation trial and widespread adoption in community settings. Notably, the
proposed Signature Project will be the first trial of a comprehensive health system intervention to prevent
suicide in response to patients’ justice involvement.

Grant Number: 5P50MH127512-04
NIH Institute/Center: NIH
Principal Investigator: Brian Ahmedani