A Novel Peer-Delivered Recovery-Focused Suicide Prevention Intervention for Veterans With Serious Mental Illness

Overview

Suicide is a major public health concern, particularly among Veterans with serious mental illness (SMI, i.e., psychotic disorders or bipolar disorders). Wellness Recovery Action Plan (WRAP) is a well-established evidence-based practice for those with SMI that centers on identifying warning signs of mental illness, developing wellness tools for functional independence, planning for day-to-day effective living within one's community, and building an action plan to create a valued life worth living. This proposed study will refine and pilot SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT), a novel integrated recovery program that is an adaptation of peer-delivered WRAP for Veterans with SMI. In SUPPORT, a Peer Specialist leads a Veteran at increased risk for suicide through recovery planning that is tailored to the Veteran's suicidal experiences with cognitive learning strategies to enhance safety plan recall and improve functioning.

Detailed description

This 5-year study aims to refine and pilot a peer-delivered intervention to improve functional and social recovery to decrease suicide risk; the study consists of two phases. Phase 1 employs a user-centered design approach to refine SUicide Prevention by Peers Offering Recovery Tactics (SUPPORT) aided by scientific and consumer advisory board stakeholders as well as training Peer Specialists to fidelity on pilot cases in an open trial. SUPPORT is a flexibly delivered intervention intended to augment safety planning by addressing functional and social goals personalized to each Veteran's recovery following a suicidal crisis while including cognitive learning strategies to enhance recall and salience of intervention material. Following adaptations from Phase 1, Phase 2 includes a pilot randomized controlled trial of SUPPORT compared to an enhanced standard care condition. Veteran participants in both phases will be quantitatively assessed at baseline, mid-treatment, post-treatment, and 3-months post-treatment (and qualitatively interviewed at post-treatment). Peer Specialists delivering the intervention will also be qualitatively interviewed post-treatment. The primary outcomes to be evaluated is improvement in personal recovery and reduction in suicidal ideation severity. Secondary outcomes concern changes in various domains of personal and social functioning.

Interventions

• Behavioral SUicide Prevention by Peers Offering Recovery Tactics
  Following the completion of a comprehensive mental health evaluation by a licensed VA provider, which includes a suicide safety plan, if a Veteran is having active thoughts of suicide or made a suicide attempt in past three months, they may be eligible for SUPPORT. In SUPPORT, the Peer Specialist and Veteran co-create a personalized suicide-focused recovery plan (SUPPORT Plan) in flexible, 50-minute weekly encounters. The SUPPORT Plan includes modules that focus on valuing recovery, building a h

Primary outcome measures

• Feasibility of recruitment and retention [Time frame: Through study completion, an average of 4 years]
• Acceptability of SUPPORT as measured by the Client Satisfaction Questionnaire-8 (CSQ-8) [Time frame: At the end of the intervention, an average of 4-weeks]

Secondary outcome measures (2)

• Change in the Scale for Suicide Ideation (SSI) [Time frame: Baseline, 2-weeks, 4-weeks, 3-month follow-up]
• Change in Recovery Assessment Scale-41 [Time frame: Baseline, 2-weeks, 4-weeks, 3-month follow-up]

Eligibility criteria

Inclusion criteria

Veteran Inclusion Criteria:

• Veterans who report present suicidal ideation (i.e., Columbia-Suicide Severity Rating Scale (C-SSRS) > 2 ("Active thoughts of killing oneself") in past 1 month and/or a suicide attempt in the prior 3 months as identified by the C-SSRS
• Current SMI diagnosis (i.e., schizophrenia and other psychotic disorders, mood disorders with psychotic features, bipolar disorders)
• Capable of informed consent via the University of California San Diego Brief Assessment of Capacity to Consent (UBACC)

Peer Specialist Inclusion Criteria:

• Certified Peer Specialist employed at VA San Diego Healthcare System (VASDHS) in the Mental Health Care Line (individuals must demonstrate competency in basic suicide screening and referral procedures to be certified)
• 2-3 years of experience post certification as a Certified Peer Specialist
• Interest in being trained in SUPPORT
• Provide verbal or written consent for the research staff to discuss ability to participate in the study with the Peer Specialist's direct clinical supervisor
• Direct clinical supervisor agreement to allow the Peer Specialist to participate. This includes the Peer Specialist's direct clinical supervisor agreement to allow the Peer Specialist time as part of their current scope of practice to 1) participate in the full day (8-hour) SUPPORT training, 2) participate in weekly 1-hour group supervision for the duration of the Peer Specialist's time in the study, and 3) take on a case load of at least one SUPPORT Veteran at a given time.

Exclusion criteria

Veteran Exclusion Criteria:

• Cannot complete the assessment battery
• Current intoxication requiring immediate detoxification or outpatient plan directed specifically to residential substance use disorder (not mental health) services
• Imminent psychiatric hospitalization

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 1 center

• VA San Diego Healthcare System, San Diego, CA — San Diego

Publications

• Chalker S, Carter J, Imai Y, Depp C, Chinman M. A Recovery-Oriented Suicide Prevention Program Led by Peer Specialists for Veterans With Serious Mental Illness: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2025 Aug 20;14:e66182. doi: 10.2196/66182. PMID 40834400
• Chalker SA, Serafez J, Imai Y, Stinchcomb J, Mendez E, Depp CA, Twamley EW, Fortuna KL, Goodman M, Chinman M. Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT) for US Veterans With Serious Mental Illness: Community Engagement Approach. J Particip Med. 2024 May 23;16:e56204. doi: 10.2196/56204. PMID 38781010

Identifiers

NCT: NCT05537376 · D4239-W

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗