Evaluating the acceptability, feasibility, and appropriateness of treatment engagement strategies for primary care patients at risk for suicide: a pilot study.

Introduction: Many patients at risk for suicide do not initiate mental health treatment following referral by a primary care provider. The Collaborative Care Model, an evidence-based approach to integrating mental health services within primary care, is a promising approach for identifying and managing patients at risk for suicide. This study sought to develop strategies for increasing Collaborative Care treatment engagement in partnership with key interest-holders. Methods: In this multi-arm non-randomized feasibility pilot trial, we used a behavioral mapping and rapid prototyping process to develop and then pilot four strategies for engaging primary care patients at risk for suicide in Collaborative Care: Caring Contacts, reminders, an informational poster, and motivational interviewing. Strategies were rolled out sequentially via routine care and their acceptability, feasibility, and appropriateness were rated by patients using validated measures. Results: Primary care patients (n = 29) with documented risk for suicide who were exposed to a strategy completed research measures. Strategies were rated as moderately to highly acceptable, with reminders and Caring Contacts being rated most acceptable, feasible, and appropriate. Motivational interviewing was rated least acceptable, feasible, and appropriate, and few patients interacted with the informational poster. Discussion: Results suggest personalized electronic communications, such as reminders and Caring Contacts messages, may be perceived more favorably by patients at risk for suicide. Future research that tests these promising strategies in a fully powered trial design is needed. Trial registration: https://clinicaltrials.gov/, identifier NCT05021224.