Mental health concerns have been on the rise since the onset of the COVID-19 pandemic. The pandemic has worsened risk factors for suicide, including job loss, anxiety, depression, and loneliness. Timely and easy access to mental health services is a dire need, and this study will test the efficacy and feasibility of a brief clinical intervention, Brief Skills for Safer Living (Brief-SfSL), at reducing suicide risk. The goal of this study is to investigate whether Brief-SfSL, delivered online, is a suitable, acceptable and effective method for reducing suicide risk and providing timely mental health services. The results from this study will provide vital insight into effective interventions for suicide risk that are accessible and can be widely distributed.
This study will test a brief online clinical intervention targeting suicide risk that will be
delivered widely, remotely, rapidly and with minimal load on the healthcare system in Canada.
The "Skills for Safer Living" (SfSL) intervention, a transdiagnostic 20-week group therapy
intervention designed to teach concepts, skills and coping strategies through modules
targeting common areas of deficits (Personal Safety, Emotional Literacy, Interpersonal
Relationships and Problem-Solving), will be adapted into a single session "Brief-SfSL" that
can be delivered in an online format. The proposed study will test the effectiveness of
Brief-SfSL on reducing suicide risk, as measured by reductions in suicidal ideation after 3
months, and will provide evidence for a scalable intervention that can broadly reach urban
and rural communities. Lack of suicide intervention services is an immense unmet need that is
especially pronounced during this pandemic and is associated with increased burden on
individuals and on the healthcare system. Considering the long wait times to access
consistent psychiatric services, this proposed intervention is an essential step in providing
evidence-based accessible suicide risk services during and even beyond the pandemic.
Behavioral: Brief Skills for Safer Living
Brief-SfSL is a single-session individual therapy adaptation of the core goals/principles of the 20-week SfSL group therapy. Brief-SfSL incorporates the SfSL guiding principles of emphasizing safety, attending to the therapeutic relationship, recognizing the participant as the expert in their own experience, taking a trauma-informed approach, working with emotions while recognizing the role of alexithymia, and incorporating solution-focused concepts. The goal is to increase a person's understanding and capacity to engage in what would enable them to keep safe, even if thoughts of suicide are present. The intervention procedure is dynamic, but includes 4 core tasks: 1) understanding the individual's suicidal experience, 2) skills building, 3) developing a safety plan, and 4) identifying obstacles to enacting or engaging with the safety plan.
Other Name: Brief-SfSL
- 18 years or older
- Experiencing suicidal ideation in the past week (Beck Suicide Scale>10)
- Ability to undergo psychotherapy in English
- Access to a computer with a camera or a mobile phone with a camera
- Access to internet
- Access to an emergency contact and hospital within commuting distance
- Not receiving other psychotherapy concurrently
- Willing to have the session recorded to review therapy fidelity
- Follow-up visits with a psychiatrist or family doctor where a psychotherapeutic
modality (e.g. DBT, psychodynamic therapy, etc.) is not being used are allowable.
- The presence of cognitive impairment that would limit consent or understanding of
- The presence of active psychosis
- Current substance use disorder
- Unwilling or unable to provide informed consent
St. Michael's Hospital
Toronto, Ontario, Canada
Investigator: Michael Morton, HBSc
Sakina Rizvi, PhD, Principal Investigator
Unity Health Toronto