International Journal of Environmental Research and Public Health

Research

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15 pages, 797 KiB

Open AccessArticle

Peer Intervention following Suicide-Related Emergency Department Presentation: Evaluation of the PAUSE Pilot Program

by Mandy Gibson, Nick Moreau, Eschleigh Balzamo and David Crompton

Int. J. Environ. Res. Public Health 2023, 20(4), 3763; https://doi.org/10.3390/ijerph20043763 - 20 Feb 2023

Viewed by 2563

Abstract

The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of [...] Read more.

The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program’s effect on suicidal ideation and hope, and to explore the acceptability and participants’ experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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13 pages, 678 KiB

Open AccessArticle

Suicide Risk, Alcohol Consumption and Attitudes towards Psychological Help-Seeking among Lithuanian General Population Men, Conscripts and Regular Active Duty Soldiers

by Egle Mazulyte-Rasytine, Dovile Grigiene and Danute Gailiene

Int. J. Environ. Res. Public Health 2023, 20(4), 3457; https://doi.org/10.3390/ijerph20043457 - 16 Feb 2023

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Abstract

The aim of this study was to investigate the relationship between suicide risk, alcohol consumption, and attitudes towards professional psychological help among Lithuanian general population men, conscripts, and regular active duty (AD) soldiers. In total, 1195 Lithuanian adult males participated in the study: [...] Read more.

The aim of this study was to investigate the relationship between suicide risk, alcohol consumption, and attitudes towards professional psychological help among Lithuanian general population men, conscripts, and regular active duty (AD) soldiers. In total, 1195 Lithuanian adult males participated in the study: 445 men from the general population, 490 conscripts, and 260 regular AD soldiers from the Lithuanian Armed Forces. The study’s measures included: general suicide risk, alcohol consumption levels, frequency of using alcohol as a means to suppress difficult thoughts and feelings, and attitudes toward psychological help. Both military samples showed significantly lower suicide risk than men from the general population. Alcohol use as a means to suppress difficult thoughts and feelings was the most significant predictor of suicide risk and a significant mediator between alcohol consumption and suicide risk in all study groups. Another significant suicide risk predictor and mediator between alcohol consumption and suicide risk—i.e., the value of seeking psychological treatment—was found only in the conscript sample. Results of the current study suggest that there is an opportunity for intervention aimed at the attitudes toward seeking professional psychological help for conscripts. However, that might not be the case for regular AD soldiers, nor the general population of Lithuanian men. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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16 pages, 1084 KiB

Open AccessArticle

Suicidal Ideation in the Australian Construction Industry: Prevalence and the Associations of Psychosocial Job Adversity and Adherence to Traditional Masculine Norms

by Simon Tyler, Kate Gunn, Adrian Esterman, Bob Clifford and Nicholas Procter

Int. J. Environ. Res. Public Health 2022, 19(23), 15760; https://doi.org/10.3390/ijerph192315760 - 26 Nov 2022

Cited by 5 | Viewed by 2203

Abstract

Background: Suicide in the Australian Construction Industry (ACI) is a significant issue, however minimal understanding of suicidal ideation prevalence, as well as the potential role psychosocial job adversity and increased adherence to traditional masculine norms may play in its presence, is apparent. Method: [...] Read more.

Background: Suicide in the Australian Construction Industry (ACI) is a significant issue, however minimal understanding of suicidal ideation prevalence, as well as the potential role psychosocial job adversity and increased adherence to traditional masculine norms may play in its presence, is apparent. Method: A representative sample of Australian men (n = 11,132) were used to create initial understandings of prevalence of suicidal ideation (past two weeks), psychosocial job adversities and level of adherence to traditional masculine norms for the ACI (n = 1721) in comparison to a general population comprised of the remaining employed males from Other Industries (n = 9411). Additionally, due to their reported increased suicide vulnerability investigation of associations between suicidal ideation, psychosocial job adversities and adherence to traditional masculine norms for the ACI were undertaken. Results: No difference in suicidal ideation prevalence was reported between the ACI and those employed in Other Industries (p > 0.05), however, increased prevalence of psychosocial job adversities (p ≤ 0.001) and adherence to traditional masculine norms (p ≤ 0.001) for the ACI was seen. Significant multivariate associations between suicidal ideation, psychosocial job adversities (OR = 1.79, 95%CI [1.12–2.85]) and two domains of traditional masculine norms, self-reliance (OR = 1.29, 95%CI [1.09–1.51]) and risk-taking (OR = 1.20, 95%CI [1.01–1.41]), were reported. Conclusion: Results suggest need for increased understanding of later stage suicidal trajectory drivers in the ACI. Findings indicate need for prevention group/industry concentration on mitigation of psychosocial job adversities, as well as a more nuanced and increased discussion of the negative role of self-reliance and risk-taking domains of traditional masculine norms may play in ACI suicidal ideation, as opposed to the construct as a whole. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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15 pages, 1653 KiB

Open AccessArticle

The Paradox of Suicide Prevention

by Kathryn Turner, Anthony R. Pisani, Jerneja Sveticic, Nick O’Connor, Sabine Woerwag-Mehta, Kylie Burke and Nicolas J. C. Stapelberg

Int. J. Environ. Res. Public Health 2022, 19(22), 14983; https://doi.org/10.3390/ijerph192214983 - 15 Nov 2022

Cited by 4 | Viewed by 3680

Abstract

The recognition that we cannot use risk stratification (high, medium, low) to predict suicide or to allocate resources has led to a paradigm shift in suicide prevention efforts. There are challenges in adapting to these new paradigms, including reluctance of clinicians and services [...] Read more.

The recognition that we cannot use risk stratification (high, medium, low) to predict suicide or to allocate resources has led to a paradigm shift in suicide prevention efforts. There are challenges in adapting to these new paradigms, including reluctance of clinicians and services to move away from traditional risk categorisations; and conversely, the risk of a pendulum swing in which the focus of care swings from one approach to determining service priority and focus (e.g., diagnosis, formulation, risk and clinical care) to a new focus (e.g., suicide specific and non-clinical care), potentially supplanting the previous approach. This paper argues that the Prevention Paradox provides a useful mental model to support a shift in paradigm, whilst maintaining a balanced approach that incorporates new paradigms within the effective aspects of existing ones. The Prevention Paradox highlights the seemingly paradoxical situation where the greatest burden of disease or death is caused by those at low to moderate risk due their larger numbers. Current planning frameworks and resources do not support successful or sustainable adoption of these new approaches, leading to missed opportunities to prevent suicidal behaviours in healthcare. Adopting systems approaches to suicide prevention, such as the Zero Suicide Framework, implemented in a large mental health service in Australia and presented in this paper as a case study, can support a balanced approach of population- and individual-based suicide prevention efforts. Results demonstrate significant reductions in re-presentations with suicide attempts for consumers receiving this model of care; however, the increasing numbers of placements compromise the capacity of clinical teams to complete all components of standardised pathway of care. This highlights the need for review of resource planning frameworks and ongoing evaluations of the critical aspects of the interventions. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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16 pages, 354 KiB

Open AccessArticle

Indigeneity and Likelihood of Discharge to Psychiatric Hospital in an Australian Deliberate Self-Poisoning Hospital-Treated Cohort

by Katie McGill, Amir Salem, Tanya L. Hanstock, Todd R. Heard, Leonie Garvey, Bernard Leckning, Ian Whyte, Andrew Page and Greg Carter

Int. J. Environ. Res. Public Health 2022, 19(19), 12238; https://doi.org/10.3390/ijerph191912238 - 27 Sep 2022

Viewed by 1326

Abstract

Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003–2012) [...] Read more.

Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003–2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge; Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40–0.87) at the univariate level, with little change after sequential adjustment; and AOR 0.34 (0.21–0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

17 pages, 860 KiB

Open AccessArticle

Long-Term Use and Application of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Following Original Training

by Jacinta Hawgood, Kairi Kõlves, Susan H. Spence, Ella Arensman, Karolina Krysinska, Diego De Leo and Tamara Ownsworth

Int. J. Environ. Res. Public Health 2022, 19(18), 11324; https://doi.org/10.3390/ijerph191811324 - 08 Sep 2022

Cited by 1 | Viewed by 2322

Abstract

Background: Understanding the use of Systematic Tailored Assessment for Responding to Suicidality protocol (STARS-p) in practice by trained mental health practitioners over the longer- term is critical to informing further developments. The study aim was to examine practitioners’ experiences of STARS-p and factors [...] Read more.

Background: Understanding the use of Systematic Tailored Assessment for Responding to Suicidality protocol (STARS-p) in practice by trained mental health practitioners over the longer- term is critical to informing further developments. The study aim was to examine practitioners’ experiences of STARS-p and factors associated with its use in practice over a 12–24-month period after training. Method: Practitioners who undertook the STARS-p training completed an online survey 12–24 months post training. The survey focused on the frequency of use of STARS-p (in full and each section) as well as perceptions about STARS-p applied in practice. Analyses included correlations, logistic regression and content analysis. Results: 67 participants (81% female, Mage = 43.2, SD = 10.3) were included in the analyses. A total of 80.6% of participants had used the entire STARS-p at some time-point in their practice and less than half (44.7%) frequently used the entire STARS-p (all components in one administration). Parts A, B and C were used frequently in suicide risk assessment (SRA) by 84%, 71% and 82% of participants, respectively. Use of the entire protocol and different sections was most related to male gender, perceived ease of administration and confidence in the use of the protocol. Qualitative results revealed three main themes. Conclusions: STARS-p as a whole or its parts, is frequently used. Advantages of, and barriers to, using STARS-p in practice can inform further developments of STARS-p and STARS training. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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13 pages, 374 KiB

Open AccessArticle

Defeat, Entrapment, and Hopelessness: Clarifying Interrelationships between Suicidogenic Constructs

by D. Nicolas Oakey-Frost, Emma H. Moscardini, Kirsten Russell, Susan Rasmussen, Robert J. Cramer and Raymond P. Tucker

Int. J. Environ. Res. Public Health 2022, 19(17), 10518; https://doi.org/10.3390/ijerph191710518 - 24 Aug 2022

Cited by 3 | Viewed by 2020

Abstract

Psychological theories of suicide posit conceptually similar constructs related to the development of suicidal thinking. These constructs often evince high-magnitude interrelationships across studies. Within these theories, defeat, entrapment and hopelessness standout as conceptually and quantitatively similar. Theoretical improvements may be facilitated through clarifying [...] Read more.

Psychological theories of suicide posit conceptually similar constructs related to the development of suicidal thinking. These constructs often evince high-magnitude interrelationships across studies. Within these theories, defeat, entrapment and hopelessness standout as conceptually and quantitatively similar. Theoretical improvements may be facilitated through clarifying the subscale and item-level similarities among these constructs. Factor analytic and phenomenological work has demonstrated equivocal evidence for a distinction between defeat and entrapment; hopelessness is not typically analyzed together with defeat and entrapment despite evidence of large-magnitude interrelationships. This study explored the interrelationships among the foregoing constructs within a sample of undergraduate students (N = 344) from two universities within the Southeastern United States. Participants, oversampled for lifetime history of suicidal ideation and attempts, completed an online cross-sectional survey assessing defeat, entrapment, hopelessness and SI. Exploratory factor and parallel analyses demonstrated support for a one factor solution when analyzed at subscale level of the three measures as well as when all items of the three measures were analyzed together. Ad hoc exploratory structural equation modeling (ESEM) bifactor results evinced support for the existence of a single, general factor at the item level. Item level communalities and bifactor fit indices suggest that hopelessness may be somewhat distinct from defeat and entrapment. Clinical and theoretical implications are discussed in the context of study limitations. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

14 pages, 330 KiB

Open AccessArticle

A Qualitative Exploration of the Experiences and Perceptions of Interpersonal Relationships Prior to Attempting Suicide in Young Adults

by Heather McClelland, Jonathan J. Evans and Rory C. O’Connor

Int. J. Environ. Res. Public Health 2022, 19(13), 7880; https://doi.org/10.3390/ijerph19137880 - 27 Jun 2022

Cited by 2 | Viewed by 2348

Abstract

Suicide is a leading public health concern. Research studies have identified significant associations between loneliness and suicidal ideation/behaviour both cross-sectionally and prospectively. Despite this, research specifically focusing on identifying the nature of loneliness experienced prior to suicide, and the role it has in [...] Read more.

Suicide is a leading public health concern. Research studies have identified significant associations between loneliness and suicidal ideation/behaviour both cross-sectionally and prospectively. Despite this, research specifically focusing on identifying the nature of loneliness experienced prior to suicide, and the role it has in association with other preceding factors, has not been fully explored. The current study recruited ten participants with a history of suicide attempts (five female, four male and one non-binary; mean age: 22.5, range: 20–25 years) to take part in one-to-one, semi-structured interviews via remote video conferencing to explore experiences of social support and loneliness prior to suicide attempt. Using Interpretative Phenomenological Analysis, several aspects of loneliness emerged as important themes that were present prior to participants’ suicide attempts. Additional themes identified were patterns of social support, personality traits, emotional secrecy and social transition. Evidence suggests that a positive relationship with parents, knowing someone with similar experiences or having membership in more than one friendship group may reduce feelings of loneliness and/or intentions to die. This research makes an important contribution to understanding the role of loneliness in relation to suicide attempts by highlighting the importance of social supports being emotionally available to those experiencing distress. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

Review

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25 pages, 1537 KiB

Open AccessReview

Towards the Influence of Media on Suicidality: A Systematic Review of Netflix’s ‘Thirteen Reasons Why’

by Martí Guinovart, Jesús Cobo, Alexandre González-Rodríguez, Isabel Parra-Uribe and Diego Palao

Int. J. Environ. Res. Public Health 2023, 20(7), 5270; https://doi.org/10.3390/ijerph20075270 - 27 Mar 2023

Viewed by 1946

Abstract

Online streaming series ‘Thirteen Reasons Why’ (13RW), released in March 2017, was criticized for its sensationalist portrayal of the main character’s suicide, leading some people to voice fears of a global contagion of self-harm behaviors. The current investigation provides a systematic review of [...] Read more.

Online streaming series ‘Thirteen Reasons Why’ (13RW), released in March 2017, was criticized for its sensationalist portrayal of the main character’s suicide, leading some people to voice fears of a global contagion of self-harm behaviors. The current investigation provides a systematic review of original studies analyzing the role of 13RW as an influencing factor for suicide. Articles were identified through a systematic search of Medline, Web of Science, Scopus, PsycInfo, and a manual search of reference lists from inception until the 16 January 2023. Twenty-seven published articles were identified from an initial search of 496 studies. The positive effects of watching 13RW included a reduction in suicide stigma and a greater likelihood to discuss mental health concerns and seek for help. However, several studies reported negative outcomes, including significant increases in the rate of deaths by suicide in adolescents, the number of admissions for suicidal reasons, and the prevalence and severity of suicidal ideation and self-harm behaviors in vulnerable viewers. Still, due to methodological limitations, no causal relationship could be established. Preventive measures are required to alert of the risk and should be particularly addressed to susceptible subjects. Psychoeducational programs should be focused on this kind of phenomena in vulnerable populations. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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10 pages, 544 KiB

Open AccessReview

What Are Complex Interventions in Suicide Research? Definitions, Challenges, Opportunities, and the Way Forward

by Sadhvi Krishnamoorthy, Sharna Mathieu, Victoria Ross, Gregory Armstrong and Kairi Kõlves

Int. J. Environ. Res. Public Health 2022, 19(14), 8591; https://doi.org/10.3390/ijerph19148591 - 14 Jul 2022

Cited by 4 | Viewed by 2008

Abstract

It has been argued that effective action towards addressing a complex concern such as suicide requires a combination of evidence-based strategies. While these complex public health approaches have recently gained importance, little is known about their characteristics and what contributes to their complexity. [...] Read more.

It has been argued that effective action towards addressing a complex concern such as suicide requires a combination of evidence-based strategies. While these complex public health approaches have recently gained importance, little is known about their characteristics and what contributes to their complexity. The use of interchangeable terms such as multilevel, multicomponent, community based, and inconsistent definitions of these approaches creates confusion around what it is and what it is not. In practice, this disorder is reflected in a substantial variation in the design, implementation, and evaluation of complex approaches in suicide research. While it is impossible to resolve all existing inconsistencies in terminology, this review explores a range of terms and definitions to connote complex interventions. It aims to unpack multiple meanings of these terms and their diverse usage in suicide literature. The potential implications of this fluidity and plausible pathways to make sense of this complexity for suicide research are also discussed. With a shared understanding of what constitutes a complex intervention, we can expect to see an improved representation of the real-world complexities in our efforts to address suicide. This common language can also contribute toward quality implementation and dissemination and thereby advance our understanding of complex interventions. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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20 pages, 770 KiB

Open AccessReview

A Systematic Review of the Experiences and Support Needs of Informal Caregivers for People Who Have Attempted Suicide or Experienced Suicidal Ideation

by George Lavers, Karl Andriessen and Karolina Krysinska

Int. J. Environ. Res. Public Health 2022, 19(9), 5181; https://doi.org/10.3390/ijerph19095181 - 24 Apr 2022

Cited by 9 | Viewed by 2952

Abstract

Informal caregivers include family, friends, and significant others who provide important support for people who have attempted suicide or experienced suicidal ideation. Despite the prevalence of suicidal behaviour worldwide, they remain an understudied population. This review aimed to synthesise the literature on the [...] Read more.

Informal caregivers include family, friends, and significant others who provide important support for people who have attempted suicide or experienced suicidal ideation. Despite the prevalence of suicidal behaviour worldwide, they remain an understudied population. This review aimed to synthesise the literature on the experiences and support needs of informal caregivers of people who have attempted suicide or experienced suicidal ideation. We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, Emcare, Embase, EBM Reviews, and PsycINFO identified 21 studies (4 quantitative and 17 qualitative), published between 1986 and 2021. Informal carers commonly reported symptoms of depression and anxiety, for which they receive little assistance. They also expressed a desire for more involvement and education in the professional care of suicidality. Together, the studies indicated a need to improve the way informal caregiving is managed in professional healthcare settings. This review identified potential avenues for future research, as well as broad areas which require attention in seeking to improve the care of suicidal people and their caregivers. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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Other

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19 pages, 790 KiB

Open AccessSystematic Review

Disclosure of Mental Health Problems or Suicidality at Work: A Systematic Review

by Martina O. McGrath, Karolina Krysinska, Nicola J. Reavley, Karl Andriessen and Jane Pirkis

Int. J. Environ. Res. Public Health 2023, 20(8), 5548; https://doi.org/10.3390/ijerph20085548 - 17 Apr 2023

Cited by 1 | Viewed by 2525

Abstract

Many adults experience mental health problems or suicidality. Mental health and suicidality are associated with stigma and discrimination. Little is known about disclosure of mental health or suicidality problems in workplaces and the role of stigma and discrimination in affecting disclosure. To address [...] Read more.

Many adults experience mental health problems or suicidality. Mental health and suicidality are associated with stigma and discrimination. Little is known about disclosure of mental health or suicidality problems in workplaces and the role of stigma and discrimination in affecting disclosure. To address this gap, we conducted a systematic review following the PRISMA guidelines. Searches for peer-reviewed articles in MedLINE, CINAHL, Embase and PsycINFO identified 26 studies, including sixteen qualitative, seven quantitative and three mixed-methods studies. No studies were excluded based on quality assessment. All studies reported on mental health disclosure; none reported on disclosure of suicidal thoughts or behaviours. The narrative synthesis identified four overarching themes relating to disclosure of mental health problems in workplaces. Themes included beliefs about stigma and discrimination, workplace factors (including supports and accommodation), identity factors (including professional and personal identity, gender and intersectionality) and factors relating to the disclosure process (including timing and recipients), with all influencing disclosure decision making. Significantly, this review found that there is a gap in the existing literature relating to suicidality disclosure in workplaces, with none of the included studies investigating disclosure of suicidal thoughts and behaviours. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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17 pages, 632 KiB

Open AccessSystematic Review

Optimal Care Pathways for People in Suicidal Crisis Who Interact with First Responders: A Scoping Review

by Katelyn Kerr, Ed Heffernan, Jacinta Hawgood, Bronwen Edwards and Carla Meurk

Int. J. Environ. Res. Public Health 2022, 19(18), 11510; https://doi.org/10.3390/ijerph191811510 - 13 Sep 2022

Cited by 2 | Viewed by 2022

Abstract

Background: First responders play a vital role in attending to people in suicidal crisis and influencing their care. Aims: To examine existing care pathways and models of care that could be used for people in a suicidal crisis who have come to the [...] Read more.

Background: First responders play a vital role in attending to people in suicidal crisis and influencing their care. Aims: To examine existing care pathways and models of care that could be used for people in a suicidal crisis who have come to the attention of first responders. Methods: A scoping review of academic and grey literature published between 2009 and 2019 was conducted, supplemented by consultation with experts, service providers and people with lived experience. Results: The search identified 703 studies. Twenty-three peer reviewed and grey literature articles, as well as one personal communication, were considered eligible for inclusion. Six models, covering 22 programs, were identified. No studies were identified that described care pathways, per se. Co-responder and safe haven models were associated with reduced hospital use and police detentions. Aftercare models were associated with improved well-being and reduction in symptoms. Co-responder, safe haven, and aftercare models were all rated positively by service users. No studies measured the impact on longer term suicidality. Limitations: Inclusion criteria were broad resulting in heterogeneity of studies and designs, limiting comparisons. Few studies employed standardised measurement protocols, reducing the ability to draw sound conclusions. Conclusion: Several novel programs have the potential to support individuals in crisis who encounter first responders. Full article

(This article belongs to the Special Issue Advances in Suicide Prevention: Lived Experience, Science and Implementation)

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