The Suicide Prevention Project
Early intervention is the only way to deliver successful suicide prevention because most people who die by suicide do not express suicidal ideation and in the UK, 40% of children and young people who die by suicide have had no contact with the mental-health system (Rodway, 2020). This means that suicide prevention services which only focus on children and young people who are in crisis, exclude the majority who go on to take their lives (Kessler, 2019).
In September 2022, in collaboration with the University of Bristol, Tellmi conducted a full-day in-person workshop with four young people with lived experience of suicidal ideation to explore how the app could be further developed as a tool for suicide prevention. The Tellmi workshop was also attended by mental health practitioners with expertise in suicide prevention, mental health academics and Tellmi staff with expertise in psychology, safeguarding and digital technology.
“Young people in the workshop disliked the idea of support coming from an automated text messaging system rather than ‘real people’.”
Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support.
In line with the research, young people in the workshop disliked the idea of support coming from an automated text messaging system rather than ‘real people’ (Czyz et al., 2020). Tellmi interactions are all human to human because the benefits of peer support are bidirectional; both the helper and the helped benefit. In contrast, chatbot interactions are unidirectional and empathy from a bot does not feel authentic.
Every suicide is an avoidable tragedy, but it is worth remembering that the vast majority of young people who self-harm or who experience suicidal ideation do not take their own their lives. It’s difficult to establish the exact prevalence but when Bryan et al (2021) looked at outcomes for people who had reported feeling suicidal they found that found that in less than one year after their last suicidal thought, the majority of previously suicidal participants reported average to above-average happiness and meaning in life. Although Tellmi needs to be able to provide in the moment crisis support that keeps young people safe, the suicide project also taught us that we need to give young people a reason to keep going.
The young people in our workshop were also conscious of the difficulties of peer support for suicide. In other research young people have expressed being fearful of distressing other users and giving unhelpful advice, and therefore they refrained from posting and commenting (Bailey et al., 2021). After the suicide project we introduced a daily review where a qualified counsellor assesses all level 3 posts which would not normally go through to a counsellor, to ensure that more complex posts have had a good response. If the counsellor feels that person could benefit from additional support they will send a message and start a conversation.
“SFT is better for the patient and it is better for the therapist too.”
After the workshop we began exploring ways that we could develop our service to help young people to become more resilient and we discovered Solution Focused Therapy (SFT). SFT is interesting because it does not focus on the past, except to elicit past successes and exceptions to problems. Because it is solution rather than problem focused, it eschews the need for detailed discussion of past events and so it is a strengths-based approach which is appropriate for treating trauma survivors and people in crisis (De Jong & Berg, 2013). We worked with a number of SFT experts in the UK and the US to adapt SFT for Tellmi, and in July 2023, we launched the UK’s first text based SFT service.
SFT is better for the patient and it is better for the therapist too. The results of a large-scale research project in Tenerife, Spain, found that implementing a strengths-oriented, solution-focused approach in the child protection system led to a significantly negative correlation with professional burnout scores on the Maslach Burnout Inventory (Medina & Beyebach, 2014).
This project has been a unique opportunity to bring together young people with lived experience of suicidal ideation and academics from Bristol University who specialise in the study of suicide prevention with innovators from Tellmi who were then able to turn that knowledge into real world solutions that increase support for young people who feel suicidal. Tellmi emerges from the project with an app and a web platform that are much better equipped to provide effective crisis and long-term support to high risk young people.
The results of the Tellmi suicide workshop were published in the peer-reviewed journal JMIR in September 2023.
References
Rodway, C., Tham, S. G., Turnbull, P., Kapur, N., & Appleby, L. (2020). Suicide in children and young people: Can it happen without warning?. Journal of affective disorders, 275, 307–310. https://doi.org/10.1016/j.jad.2020.06.069
Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168–179. https://doi.org/10.1038/s41380-019-0531-0
Czyz, E.K., Arango, A., Healy, N., King, C.A., & Walton, M. (2020). Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study. JMIR Ment Health, 7(5):e17345. doi: 10.2196/17345
Bailey, E., Boland, A., Bell, I., Nicholas, J., La Sala, L., & Robinson, J. (2022). The Mental Health and Social Media Use of Young Australians during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19(3), 1077. https://doi.org/10.3390/ijerph19031077
Craig J. Bryan, Annabelle O. Bryan & Marek S. Kopacz (2021) Finding purpose and happiness after recovery from suicide ideation, The Journal of Positive Psychology, 16:1, 46-53, https://doi.org/10.1080/17439760.2019.1676460
de Jong, P. & Berg, K.I. (2013). Interviewing for Solutions. Brooks/Cole.
Medina, A. & Beyebach, M. (2014). The Impact of Solution-focused Training on Professionals' Beliefs, Practices and Burnout of Child Protection Workers in Tenerife Island. Child Care in Practice, 20(1), 7-36. https://doi.org/10.1080/13575279.2013.847058