Preparing an Intervention to Increase Engagement with the 988 Suicide and Crisis Lifeline Resource among Community Mental Health Consumers with Schizophrenia Spectrum Disorders.

The rate of suicide death in the United States have increased by 35% from 1999 to 2022 (Martínez-Alés et al., ). Notably, suicide is the largest contributor to heightened premature mortality among individuals with schizophrenia spectrum disorders (SSDs; Sher et al., ), with data showing a lifetime rate of suicide death being approximately 20 times greater than that of the general population (Nordentoft et al., ; Too et al., ; Zaheer et al., ). Despite the well-documented risk for suicide among individuals with SSDs, there remains a gap in suicide prevention-focused interventions and a need for tailoring efforts to better meet specific psychosis symptom and SSD illness experiences (Bornheimer et al., ; Chong et al., ; Comendador et al., ; Sicotte et al., ; DeVylder et al., ). Given community mental health (CMH) settings are among the largest mental health providers in the United States and deliver the majority of care to individuals with SSDs (Adamou, ), it is critical that interventions are designed for and delivered to consumers with SSDs in CMH. A longstanding approach to suicide prevention involves the use of emergency crisis hotlines that aim to provide emotional support, crisis intervention, and resources to help individuals in distress (Litman et al., ; Shneidman et al., ). Crisis lines, such as the 988 Suicide and Crisis Lifeline, are considered a best-practice approach within the CDC’s technical package of programs and practices for suicide prevention (Stone et al., ). A recent study indicates that the vast majority of individuals who engaged with the 988 Lifeline during a suicide-related crisis found the call to be helpful (98%) and stopped them from engaging in suicide behavior (88.1%; Zaheer et al., ), providing strong evidence of 988’s utility. Although literature shows support for crisis line use in reductions of suicidal ideation, hopelessness, psychological pain, and psychological distress (Kilbourne et al., ; McCarthy et al., ), data also indicate that only approximately 5% of people experiencing distress have used a crisis line (Purtle et al., ). Ultimately, the effectiveness of crisis lines is limited by low rates of use from individuals who could benefit most from the resource (Ilgen et al., ), such as the high suicide-risk SSD population. Crisis Line Facilitation (CLF) is an intervention to increase use of the 988 Lifeline during periods of high suicide risk. Originally designed and delivered in the Veteran Affairs (VA) healthcare system with more recent modifications made for substance use treatment settings (Ilgen et al., ), CLF is a single-session intervention that involves components of Motivational Interviewing and behavioral rehearsal to encourage use of 988 during a crisis (Ilgen et al., ). The intervention involves four core steps: (1) review of a prior suicide crisis (i.e., ideation and attempt), (2) 988 psychoeducation, (3) discussion of barriers and facilitators of 988 use, and (4) a 988 practice call and processing of the experience. Although CLF literature indicates that participants perceive the intervention to be helpful, express greater comfort and confidence in calling 988 when in crisis, and report fewer suicide attempts after the intervention (Ilgen et al., , ), it is unknown if CLF is appropriate and useful for individuals with SSDs receiving care in CMH settings.