Research shows that text messages help young people at risk of suicide feel supported after discharge

As the nation’s youth mental health crisis continues, providers continue to find ways to address gaps in care. Patients receiving care for suicidal thoughts and behaviors need additional support during the transition after being discharged from inpatient or emergency care.

Caring Contacts validates messages sent to patients via text messages, postcards, or letters to provide patients with ongoing care and support without making demands (such as reminders to attend their next appointment). At Nationwide Children’s, Caring Contacts has been implemented in a text-based format as part of the hospital’s Zero Suicide quality improvement work.

Zero Suicide is a framework of best practices in suicide care that has been shown to reduce suicides in health care systems. It includes elements such as routine screening of patients for suicide risk, followed by an evidence-based assessment and safety plan when patients test positive.

In a study published today in the JMIR Pediatrics and ParentingFaculty from the Center for Suicide Prevention and Research (CSPR) at Nationwide Children’s Hospital described the implementation of an automated Caring Contacts text message system and found that the intervention helped youth at risk for suicide feel hopeful and supported during a time of increased risk. According to the study, this intervention and similar efforts to improve care transitions are critical to improving suicide prevention outcomes in youth.

“Previous research has shown that patients are approximately 300 times more likely to commit suicide in the first week after hospital discharge, and 200 times more likely in the first month compared to the general population,” said John Ackerman, Ph.D., a pediatric clinical psychologist and clinical manager of suicide prevention for the CSPR at Nationwide Children’s.

“Reaching patients where they are in their daily lives is critical to supporting them before, during and after a crisis. That also means making sure messages of hope and affirmation are accessible on the technology they use most: their phones.”

The study used the content of Caring Contacts messages in Nationwide Children’s most acute behavioral health services. Patients were enrolled at the time of their discharge from services they were seeking due to a suicidal crisis.

Sets of supportive text messages with accompanying images designed to promote hope, inclusivity, and connection were automatically sent to enrolled patients over a four-month period beginning the day after patients left the hospital. Each message also included crisis resources. There were three phases to this initiative, with message content development beginning in 2018 and full implementation and data collection completed in 2021.

More than 1,700 patients completed the Caring Contacts program during the study period. As a result of post-text satisfaction surveys, 83% of respondents reported feeling moderately to very hopeful, and 88% reported feeling moderately to very supported.

Notably, 92% of respondents said that these text messages would help their peers, and 86% said they would continue to receive messages in the future if given the option. The lowest sign-up rate was seen among 13-year-olds, while the highest sign-up rate was seen among 18-year-olds, and females signed up more often (54%) than males (48%).

“There is more work to be done to measure clinical effectiveness and improve enrollment rates. However, as the first children’s hospital to explore and integrate this approach as part of an overall quality improvement framework, we are encouraged by what we have seen in terms of implementing this approach at our hospital,” said Glenn Thomas, Ph.D., lead author of the study, a clinical psychologist and director of Behavioral Health Services at Nationwide Children’s. “Patients need to know that we are here for them even after they leave our walls.”