Suicide Prevention Intervention for At-Risk Individuals in Transition

There were nearly 12 million admissions to US jails in 2012. Jailed individuals face a
disproportionate risk for suicide. The time of arrest and jail detention represents an acute
stressor that further exacerbates this risk. The epidemic of suicide during jail detention
has been recognized. However, less attention has been paid to the high suicide risk and
mortality in the months following jail release, as individuals re-enter their communities,
are faced with financial, legal, and social stressors, and have increased access to lethal
means (e.g., drugs, cars, firearms). Given that roughly 10% of all suicides in the U.S. 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. Unlike prison, where individuals have already been
sentenced and typically stay from months to years, most pretrial jail detainees are released
within days. Therefore, brief interventions are required. Stanley and Brown's Safety Planning
Intervention (SPI) is a brief, adjunctive suicide risk reduction intervention developed for
suicidal patients presenting to urgent care settings. SPI incorporates evidence-based suicide
risk reduction strategies in a low intensity, low cost intervention that can be delivered by
a broad range of clinicians, making it scalable in the mental health resource-poor justice
system. SPI reduces subsequent suicidal ideation and attempts among at-risk individuals in
emergency rooms. However, there is no previous test of this intervention (or any other) for
reducing suicidality following jail release. This RCT evaluates the effectiveness and
cost-effectiveness of SPI for reducing suicide events (attempts, suicide behaviors, and
suicide-related hospitalizations and emergency department visits) and attempts among 800
suicidal pretrial jail detainees from two jails in the year following jail release. It
assesses critical mechanisms of suicide reduction in our target population: treatment
utilization, suicide-related problem-solving, and belongingness. SPI will consist of safety
planning during jail detention and follow-up phone sessions after jail release. Research with
previously incarcerated individuals and with suicidal individuals in the community has shown
that telephone follow-up intervention is feasible and powerful in building trust and reducing
risk among these disenfranchised, isolated populations. This study will be the first
randomized evaluation of a suicide prevention intervention in the vulnerable year after jail
release. Beyond the human suffering and costs at an individual level, suicidal behavior
incurs high economic costs in terms of health care costs and lost productivity. Jails are a
catchment area for at-risk individuals at a time of high life stress and high suicide risk,
providing an important opportunity for suicide prevention intervention, one that is currently
being missed. This study will provide the data on costs and cost-adjusted outcomes that
systems need to make informed decisions about adoption, speeding implementation. Thus, this
study will contribute to knowledge about both mechanisms of action and system-level
intervention effects.

Inclusion Criteria:

- Unsentenced male and female pretrial jail detainees

- 18+ years of age

- at risk for suicide, operationalized as a response of "yes" on item 4 or greater on
the initial 5 C-SSRS screening questions, indicating the presence of at least some
active suicide ideation with some intent to act in the past month (i.e., individuals
at higher risk, such as those who report intent with specific plan and/or suicide
attempt/s in the last month, will also be included);

- speak and understand English well enough to understand questionnaires when they are
read aloud.

Exclusion Criteria:

- expects to be sentenced and serve their sentence before being released to the
community

- cannot provide the name and contact information of at least two locator persons

- does not have access to any telephone.