The use of digital interventions in clinical care settings for young people at risk of suicide

Best practice for integrating digital interventions into clinical care for young people at risk of suicide: a Delphi study

by Eleanor Bailey, India Bellairs-Walsh, Nicola Reavley, Piers Gooding, Sarah Hetrick, Simon Rice, Alexandra Boland and Jo Robinson

Published 24 January 2024

What's the issue?

In Australia, suicide is the leading cause of death for young people aged 15 to 25 years [1]. Although many young people who experience suicidal thoughts and behaviours don’t reach out for support, many do so consideration needs to be given to the best way of supporting these young people. As they are increasingly using digital information to seek information about their mental health, this provides an opportunity to connect in clinical practice. The emerging evidence shows promise for the use of digital technologies as an intervention supporting the prevention of suicidal thoughts and behaviours in young people when delivered alongside standard clinical care. Although there is potential to use digital interventions as a part of this clinical care, there is limited knowledge or guidance available on how to incorporate digital interventions safely and effectively into clinical care for young people at risk of suicide.

What was done?

Researchers aimed to develop a set of best-practice guidelines for integrating digital interventions into clinical care for young people who experience suicidal thoughts and/or engage in suicide-related behaviour (including self-harm).

Researchers engaged with a range of stakeholders including experts in mental health and mental health professionals, and young people with lived experience to inform the development of the guidelines. A Delphi methodology was used (a method of reaching a consensus between stakeholder groups usually undertaken by presenting a series of statements that are rated by a panel representing stakeholder groups over multiple rounds until consensus is reached). Each stakeholder group formed one of the Delphi panels.

To develop the Delphi statements, researchers searched peer-reviewed and grey literature to identify a series of action items that would inform the statements relating to the use of digital technologies in clinical care.

49 Delphi panel members were presented the statements over two rounds, with panellists rating each statement using a five-point Likert scale consisting of the following response options: essential, important, unsure/depends, unimportant, should not be included.

What was found?

Delphi panel members agreed that 188 out of 326 items should be considered for inclusion in the proposed guidelines. The statements were across three areas:

• Incorporating digital tools into clinical care
• Identifying and managing risk of suicide; and
• Actions for services.

Areas of disagreement between the ‘professionals’ panel and the ‘consumer’ panel were regarding:

• Clinicians' permissions to look at young person's social media pages; and
• Clinicians thought that descriptions of suicide, and images of suicide and self-harm on social media platforms are harmful (aligning with existing evidence-based guidelines suggesting the potential of harm from viewing these images), however young people did not think them to be harmful in the right context.

Why are findings important?

The results of the Delphi study informed the development of the first evidence-informed guidelines for integrating digital interventions into clinical care for young people at risk of suicide.

It is hoped that the guidelines will help reduce barriers to incorporating digital technologies in clinical care for young people with suicidal thoughts and behaviours, and ensure the digital tools recommended are safe and appropriate. Further work about ways to implement these guidelines is a recommendation of the authors.