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

Suicide rates are high among individuals with schizophrenia spectrum disorders (SSDs) and community mental health (CMH) settings have potential to play a critical role in suicide prevention efforts. Crisis lines, such as the 988 Lifeline, are found to positively impact mental health and suicide outcomes, yet data show utilization rates are low among high-risk individuals, such as those with SSDs. This qualitative study employs community-engaged methods to modify a brief single-session Crisis Line Facilitation (CLF) intervention for individuals with SSDs in CMH to increase the likelihood of engagement with the 988 Lifeline and reduce suicide outcomes. Participants (n = 10) included consumers with SSD diagnosis, mental health providers, peer support specialists, and leadership in CMH. Data were collected in qualitative interviews to learn about perceptions of CLF, barriers and facilitators of CLF implementation, and suggested modifications to CLF for SSD tailoring. Interview questions were informed by the Consolidated Framework for Implementation Research and a hybrid analytic approach with inductive and deductive coding was used to identify themes and subsequent modifications. Themes pertained to the need for CLF in CMH, help-seeking and psychosis symptoms as implementation barriers, and provider preparation and CMH awareness as implementation facilitators. Modifications and study implications signal the importance of provider training, proactively addressing consumer help-seeking barriers, and embedding CLF within routine CMH workflows for sustainability. Study efforts emphasize CLF's potential to prepare SSD consumers for suicide crises, motivate future 988 engagement, and prevent premature suicide death.