Suicide Prevention Interventions Research Articles

Interventions aimed at preventing suicide in the healthcare workforce: a systematic review.

Healthcare workers are exposed to various factors in the workplace that may put them at an increased risk of suicide, but there is a lack of evidence reviewing interventions put in place by employers that may modify this risk. The authors undertook a systematic review to identify and assess organisational interventions aimed at preventing suicide in the healthcare workforce. Databases were systematically searched between January 2022 and August 2022. Eligibility for inclusion in the review was determined using a population, intervention, comparison, outcome framework, and 12 studies met the inclusion criteria. Studies were summarised using narrative synthesis and interventions included education, screening, modification of the workplace, referrals for support and/or therapy and peer support. Outcomes included: uptake, satisfaction, pre-training and post-training knowledge, symptoms, risk of suicide and economic costs. It was identified that various suicide prevention interventions are feasible in healthcare organisations and likely to have positive effects for staff. However, there is a lack of robust evaluation of these interventions, so further research is warranted.

Understanding international, practice-based, stakeholder perspectives on implementation of complex suicide prevention interventions: A qualitative exploration.

Complex interventions combining multiple evidence-based strategies have gained substantial traction in suicide prevention across the world. However, implementing these interventions in real-life settings is fraught with several challenges, significant resource demands, and evidence on the merits of implementing complex interventions remains a topic of debate. This study explores the real-world experiences of implementing complex interventions, including challenges, lessons learned, and the way forward. Sixteen participants (nine leaders, five implementors, and two lived experience advocates) from varied professional backgrounds and experiences were purposively recruited from six high-income countries and one low- and middle-income country. Participants were encouraged to reflect on their experiences of implementing complex suicide prevention interventions in their specific country contexts. Thematic analysis was conducted to identify, organize, and offer real-world insights into challenges, lessons learned, and what is needed as the way forward. Important themes related to challenges and lessons learned emerged: (a) stakeholder characteristics, engagement, and dynamics; (b) resources such as funding priorities and capacity; (c) contextual factors including larger sociocultural beliefs, policies, and legislation surrounding suicide and its prevention; (d) nature of lived experience engagement; (e) design and approach to interventions; (f) delivery of interventions; and (g) the scope of evaluation. The study yielded important insights into practice recommendations related to the implementation of complex suicide prevention interventions on the ground. Important pathways for designing interventions, collaboration, and stakeholder engagement for future implementation efforts were discussed. These real-life experiences and lessons learned from international experts are critical in understanding and bridging the know-do gap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Understanding International, Practice-Based, Stakeholder Perspectives on Implementation of Complex Suicide Prevention Interventions: A Qualitative Exploration

Supplemental Material for Understanding International, Practice-Based, Stakeholder Perspectives on Implementation of Complex Suicide Prevention Interventions: A Qualitative Exploration

Suicide and suicidality among collegiate student-athletes: A scoping review

Objective: Participation in college athletics has traditionally been presumed to counter poor mental health outcomes including death by suicide. While previously reported incidents generally involve male football players, recent incidents suggest changing trends in frequency, sport, and sex. This research aims to summarize the breadth and limitations of existing research on death by suicide among U.S. collegiate student-athletes. Participants and Methods: This scoping review followed Joanna Briggs Institute guidance. A final sample of 19 research studies were identified through a comprehensive search including APA PsychINFO, PubMed, MEDLINE Complete, SPORTDiscus, and CINAHL databases and Gray Literature sources. Results: Most studied outcomes were suicidal ideation and attempt. Research on assessment of suicide prevention interventions for student-athletes is lacking. Conclusions: The paucity of research found on suicidal behaviors among collegiate student-athletes, including a lack of intervention research, in conjunction with recent trends suggest the need for a renewed focus on this topic.

A web-based video messaging intervention for suicide prevention in men: study protocol for a five-armed randomised controlled trial

BackgroundMore than 50% of people who die by suicide have not been in contact with formal mental health services. The rate of people who fly ‘under the radar’ of mental health services is higher among men than women, indicating a need to improve engagement strategies targeted towards men who experience suicidal thoughts and/or behaviours. In Australia, a range of mental health support services exist, designed specifically for men, yet, a substantial proportion of men do not use these services. The aim of this study is to evaluate whether a brief online video-based messaging intervention is an effective approach for encouraging men with suicidal thoughts and/or behaviours to engage with existing support services.MethodsInformed by a literature review, surveys, and consultation with men with a lived experience of suicidal thoughts and/or behaviours, we designed five video-based messages that will be used in this five-arm randomised controlled trial. A total of 380 (76 per arm) men aged 18 years or older with suicidal thoughts who are not currently accessing formal mental health services will be recruited online and randomly assigned to watch one of the five web-based video messages. After viewing the video, men will be presented with information about four existing Australian support services, along with links to these services. The primary outcome will be help-seeking, operationalised as a click on any one of the four support service links, immediately after viewing the video. Secondary outcomes include immediate self-reported help-seeking intentions in addition to self-reported use of the support services during a 1-week follow-up period. We will also use the Discrete Choice Experiment methodology to determine what aspects of support services (e.g. low cost, short appointment wait times) are most valued by this group of men.DiscussionThis study is the first to evaluate the effectiveness of a brief web-based video messaging intervention for promoting engagement with existing support services among men with suicidal thoughts who are not currently receiving formal help. If found to be effective, this would represent a scalable, cost-effective approach to promote help-seeking for this at-risk population. Limitations and strengths of this study design are discussed.

A web-based video messaging intervention for suicide prevention in men: study protocol for a five-armed randomised controlled trial

BackgroundMore than 50% of people who die by suicide have not been in contact with formal mental health services. The rate of people who fly ‘under the radar’ of mental health services is higher among men than women, indicating a need to improve engagement strategies targeted towards men who experience suicidal thoughts and/or behaviours. In Australia, a range of mental health support services exist, designed specifically for men, yet, a substantial proportion of men do not use these services. The aim of this study is to evaluate whether a brief online video-based messaging intervention is an effective approach for encouraging men with suicidal thoughts and/or behaviours to engage with existing support services.MethodsInformed by a literature review, surveys, and consultation with men with a lived experience of suicidal thoughts and/or behaviours, we designed five video-based messages that will be used in this five-arm randomised controlled trial. A total of 380 (76 per arm) men aged 18 years or older with suicidal thoughts who are not currently accessing formal mental health services will be recruited online and randomly assigned to watch one of the five web-based video messages. After viewing the video, men will be presented with information about four existing Australian support services, along with links to these services. The primary outcome will be help-seeking, operationalised as a click on any one of the four support service links, immediately after viewing the video. Secondary outcomes include immediate self-reported help-seeking intentions in addition to self-reported use of the support services during a 1-week follow-up period. We will also use the Discrete Choice Experiment methodology to determine what aspects of support services (e.g. low cost, short appointment wait times) are most valued by this group of men.DiscussionThis study is the first to evaluate the effectiveness of a brief web-based video messaging intervention for promoting engagement with existing support services among men with suicidal thoughts who are not currently receiving formal help. If found to be effective, this would represent a scalable, cost-effective approach to promote help-seeking for this at-risk population. Limitations and strengths of this study design are discussed.

Characteristics of surveillance systems for suicide and self-harm: A scoping review.

Suicide is a complex public health issue. Surveillance systems play a vital role in identifying trends and epidemiologic needs, informing public health strategies, and tailoring effective context-based suicide prevention interventions. To identify and summarise the characteristics of specific surveillance systems and general health behaviour that include data onsuicide and self-harm. A scoping review following the JBI recommendations and PRISMA-ScR guidelines identified 29 relevant studies on suicide and self-harm surveillance systems. A systematic search was performed on Cinahl, Embase, Lilacs-Latin American and Caribbean Health Sciences Literature, PubMed-US National Library of Medicine, Scopus, and Google Scholar. The eligibility criteria include papers that use qualitative, quantitative or mixed methods with no restrictions on time or language. The following papers were excluded regarding euthanasia and assisted suicide, as well as papers that did not explicitly describe suicide, self-harm, and surveillance systems. Two researchers independently screened the materials for eligibility and extracted data from the included studies. Data analysis was conducted using content analysis. Twenty-nine references were included, and 30 surveillance systems were identified and classified into general health behaviour surveillance (n = 15) and specific systems for suicide and self-harm (n = 15). General health behaviour systems often operate at national data collection level, collecting non-fatal data in healthcare settings, mainly emergency departments. The specific systems exhibited greater variability in terms of context, involved actors, data collection level, data collection procedures, and case classification. Limitations found by the studies pointed mostly to case definitions and data quality. Co-production, intersectoral collaboration, clear case definition criteria and data standardisation are essential to improve surveillance systems for suicide and self-harm. This review identified the characteristics of surveillance systems for suicide and self-harm. Monitoring and evaluation are crucial for ongoing relevance and impact on prevention efforts.

Suicidal ideation, suicide attempts, suicide methods, and correlates of suicidality among Nigerian LGBT persons: The role of minority stress. A narrative literature review

Introduction This paper reviews the literature on suicidal ideation, suicidal behavior, suicide methods and correlates of suicidality among Nigerian LGBT persons. Understanding the suicidality-related issues facing LGBT Nigerians can inform the designing of evidence-based interventions to reduce suicidality. Results Findings revealed that Nigerian LGBT persons experienced self-harm, suicidal ideation, suicide attempts and the repetition of suicidal behavior using suicide methods such as pesticide self-poisoning, jumping, hanging, and overdose of medicines. LGBT persons who attempted suicide more than once reported experiencing different forms of minority stress. Several LGBT suicide attempters and ideators reported experiencing prior internalized homophobia, anti-LGBT bullying in schools and the larger society, anti-LGBT discrimination from family and conversion therapy. Minority stress was found to be linked with self-harm, suicidal ideation and suicide attempts among Nigerian LGBT persons. Additionally, experiencing anti-LGBT discrimination, conversion therapy and depression were found to be correlates of suicidal ideation and suicide attempts among Nigerian LGBT persons. Discussion This study highlights the importance of addressing the minority stress experienced by Nigerian LGBT persons in order to reduce their vulnerability to suicidality. Finally, this study highlights research gaps and discusses the implications of the study findings for suicide prevention interventions, advocacy and policy making in Nigeria.

Impact of a Distress Brief Intervention on Suicidal Ideation, Suicide Attempts and Self-harm in the immediate, short and longer term: a mixed method evaluation study protocol

Background The Distress Brief Intervention (DBI) is a new approach aimed at reducing distress and is embedded in Scotland’s suicide prevention and mental health strategies. People in distress can be referred to DBI by front-line healthcare and emergency service staff. DBI promises to make contact within 24 hours and offers people in distress 14 days of compassionate, community-based, and person-centred support. The development of NHS 24, a new specialist National Health Service Mental Health Hub (MHH) embedded in Scotland’s urgent care service created a new national route to access DBI. Protocol This study is a mixed-method evaluation of the impact of DBI on suicidal ideation, suicide attempts and self-harm in the immediate, short and longer term among people presenting in distress. Evaluation participants include adults who access DBI, DBI staff, individuals who have used NHS 24 MHH, and GPs. A combination of analysis of quantitative survey and linked administrative data, including a comparator group analysis, qualitative interview and focus group data will support understanding of whether and how DBI can reduce suicidal ideation, suicidal behaviour and self-harm among those presenting to front-line services in distress. A survey of General Practitioners and a review of existing literature will be used to model typical care pathways for individuals in distress and at risk of self-harm. Modelled resource use and costs will be explored. All data collected will be triangulated through a summative evidence synthesis to develop evidence-based insights and conclusions to inform policy and practice development. Discussion Understanding whether, how and why DBI has helped prevent future suicidal thoughts and behaviour in those with a history of suicidal risk will provide important insights into how the intervention can be further developed and optimised as a suicide prevention intervention.

A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals

A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals

Development of the Prevention of Suicide Behaviour in Prisons: Enhancing Access to Therapy (PROSPECT) logic model and implementation strategies.

This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive-behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories. Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the 'change work' stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term. The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.

Workplace interventions to prevent suicide: A scoping review.

To map organisational interventions for workplace suicide prevention, identifying the effects, mechanisms, moderators, implementation and economic costs, and how interventions are evaluated. Suicide is a devastating event that can have a profound and lasting impact on the individuals and families affected, with the highest rates found among adults of work age. Employers have a legal and ethical responsibility to provide a safe working environment for their employees, which includes addressing the issue of suicide and promoting mental health and well-being. A realist perspective was taken, to identify within organisational suicide prevention interventions, what works, for whom and in what circumstances. Published and unpublished studies in six databases were searched. To extract and map data on the interventions the Effect, Mechanism, Moderator, Implementation, Economic (EMMIE) framework was used. Mechanisms were deductively analysed against Bronfenbrenner's socio-ecological model. From 3187 records screened, 46 papers describing 36 interventions within the military, healthcare, the construction industry, emergency services, office workers, veterinary surgeons, the energy sector and higher education. Most mechanisms were aimed at the individual's immediate environment, with the most common being education or training on recognising signs of stress, suicidality or mental illness in oneself. Studies examined the effectiveness of interventions in terms of suicide rates, suicidality or symptoms of mental illness, and changes in perceptions, attitudes or beliefs, with most reporting positive results. Few studies reported economic costs but those that did suggested that the interventions are cost-effective. It seems likely that organisational suicide prevention programmes can have a positive impact on attitudes and beliefs towards suicide as well reducing the risk of suicide. Education, to support individuals to recognise the signs and symptoms of stress, mental ill health and suicidality in both themselves and others, is likely to be an effective starting point for successful interventions.

The effectiveness of telehealth interventions in suicide prevention: A systematic review and meta-analysis.

Suicidal attempt is a significant risk factor for future attempts, with the highest risk during the first-year post-suicide. Telepsychiatry has shown promise by providing easy access to evidence-based interventions during mental health crises. investigation the effectiveness of telehealth interventions in suicide prevention. Four electronic databases (PubMed, Scopus, Web of Science, and Ovid) were systematically searched for studies on patients undergoing telepsychiatry intervention (TPI) up to June 2022. Following PRISMA guidelines, a systematic review and meta-analysis were conducted to investigate the effectiveness of telehealth interventions in suicide prevention. Continuous data were pooled as standardised mean difference (SMD), and dichotomous data were pooled as risk ratio using the random effects model with the corresponding 95% confidence intervals (CI). Sixteen studies were included in the review. Most studies were case-control and randomised controlled trials conducted in Europe and North America. The findings of the studies generally showed that TPIs are effective in reducing suicide rates (odds ratio = 0.68; 95% CI [-0.47, 0.98], p = .04) and suicidal reattempts. The interventions were also found to be well-accepted, with high retention rates. Our results suggest that TPIs are well-accepted and effective in reducing suicide rates and reattempts. It is recommended to maintain telephone follow-ups for at least 12 months. Further research is needed to understand the potential of telepsychiatry in suicide prevention fully.

Partnership building for scale-up in the Veteran Sponsorship Initiative: Strategies for harnessing collaboration to accelerate impact in suicide prevention.

To evaluate the implementation and trust-building strategies associated with successful partnership formation in scale-up of the Veteran Sponsorship Initiative (VSI), an evidence-based suicide prevention intervention enhancing connection to U.S. Department of Veterans Affairs (VA) and other resources during the military-to-civilian transition period. Scaling VSI nationally required establishing partnerships across VA, the U.S. Department of Defense (DoD), and diverse public and private Veteran-serving organizations. We assessed partnerships formalized with a signed memorandum during pre- and early implementation periods (October 2020-October 2022). To capture implementation activities, we conducted 39 periodic reflections with implementation team members over the same period. We conducted a qualitative case study evaluating the number of formalized VSI partnerships alongside directed qualitative content analysis of periodic reflections data using Atlas.ti 22.0. We first independently coded reflections for implementation strategies, following the Expert Recommendations for Implementing Change (ERIC) taxonomy, and for trust-building strategies, following the Theoretical Model for Trusting Relationships and Implementation; a second round of inductive coding explored emergent themes associated with partnership formation. During this period, VSI established 12 active partnerships with public and non-profit agencies. The VSI team reported using 35 ERIC implementation strategies, including building a coalition and developing educational and procedural documents, and trust-building strategies including demonstrating competence and credibility, frequent interactions, and responsiveness. Cultural competence in navigating DoD and VA and accepting and persisting through conflict also appeared to support scale-up. VSI's partnership-formation efforts leveraged a variety of implementation strategies, particularly around strengthening stakeholder interrelationships and refining procedures for coordination and communication. VSI implementation activities were further characterized by an intentional focus on trust-building over time. VSI's rapid scale-up highlights the value of partnership formation for achieving coordinated interventions to address complex problems.

Caring Letters Sent by a Clinician or Peer to At-Risk Veterans

Caring letters is an evidence-based suicide prevention intervention in acute care settings, but its outcomes among individuals who contact a national crisis line have not previously been evaluated. To examine the outcomes of the Veterans Crisis Line (VCL) caring letters intervention and determine whether there are differences in outcomes by signatory. This parallel randomized clinical trial compared signatories of caring letters and used an observational design to compare no receipt of caring letters with any caring letters receipt. Participants included veterans who contacted the VCL. Enrollment occurred between June 11, 2020, and June 10, 2021, with 1 year of follow-up. Analyses were completed between July 2022 and August 2023. Veterans were randomized to receive 9 caring letters for 1 year from either a clinician or peer veteran signatory. The primary outcome measure was suicide attempt incidence in the 12 months following the index VCL contact. Incidence of Veterans Health Administration (VHA) inpatient, outpatient, and emergency health care use were secondary outcomes. All-cause mortality was an exploratory outcome. Wilcoxon rank-sum tests and χ2 tests were used to assess the differences in outcomes among the treatment and comparison groups. A total of 102 709 veterans (86 942 males [84.65%]; 15 737 females [15.32%]; mean [SD] age, 53.82 [17.35] years) contacted the VCL and were randomized. No association was found among signatory and suicide attempts, secondary outcomes, or all-cause mortality. In the analysis of any receipt of caring letters, there was no evidence of an association between caring letters receipt and suicide attempt incidence. Caring letters receipt was associated with increased VHA health care use (any outpatient: hazard ratio [HR], 1.10; 95% CI, 1.08-1.13; outpatient mental health: HR, 1.19; 95% CI, 1.17-1.22; any inpatient: HR, 1.13; 95% CI, 1.08-1.18; inpatient mental health: HR, 1.14; 95% CI, 1.07-1.21). Caring letters receipt was not associated with all-cause mortality. Among VHA patients who contacted the VCL, caring letters were not associated with suicide attempts, but were associated with a higher probability of health care use. No differences in outcomes were identified by signatory. isrctn.org Identifier: ISRCTN27551361.

Suicide awareness homophily in adolescent peer support networks: A Swiss cross-sectional social network analysis

ObjectiveSuicide awareness, encompassing knowledge, attitudes, and behaviors related to suicide, plays a critical role in primary suicide prevention, especially among adolescents. However, little is known about how perceived suicide awareness is apparent in peer support networks in this population. This study examined the presence of suicide awareness homophily in adolescent peer support networks. We also explored other patterns of homophily and identified factors associated with the in-degree popularity of adolescents. MethodsWe used baseline data from a non-randomized, cluster-controlled trial assessing the effectiveness of a universal suicide prevention intervention in Swiss secondary schools (n = 194). We assessed perceived suicide awareness, support networks (including in-degree popularity, i.e., receiving a high number of nominations as a supportive peer), and other covariates. Data were analyzed using social network analyses. ResultsWe found evidence of suicide awareness homophily in peer support networks, where adolescents with high suicide awareness were more likely to connect with peers having high suicide awareness (p < .001). The same applied to those with low suicide awareness (p < .001). Age also emerged as a significant homophily factor. Girls (p = .024) and adolescents with high instrumental social support (p = .008) were more likely to be popular in peer support networks. ConclusionsThis study highlighted the homophily of suicide awareness in peer support networks and the need to focus on strengthening peer support networks and promoting suicide awareness in adolescents, particularly for those with low suicide awareness. Future suicide prevention programs, including peer-led interventions, should consider these findings to better target vulnerable subgroups and reduce suicide-related disparities.

Online versus in-person gatekeeper suicide prevention training: comparison in a community sample

Background Suicide prevention gatekeeper Training (GKT) is a frequently used suicide prevention intervention, however, there is still limited information about its long-term impact and effectiveness of online delivery. Aims The current study aimed to test the effectiveness of online GKT compared to in-person GKT in improving participant training outcomes. Methods A non-randomised comparison of pre-, post- and six-month follow-up data was conducted. In total 545 people participated in GKT, 317 in SafeTALK in-person sessions and 228 in online “Start” GKT by LivingWorks. Main outcome measures included: perceived knowledge; perceived preparedness; gatekeeper efficacy; and gatekeeper reluctance to intervene. Results Linear mixed model analysis demonstrated a significant effect for time for both modes of delivery for all four outcome measures. Post-hoc testing revealed that significant improvement in all outcomes were maintained above baseline at six-months following online and in-person training. Conclusions Online training performed as good, or better than in-person GKT, on measured outcomes demonstrating utility and effectiveness of the modality for use in suicide prevention training practices. Findings additionally indicate that online training may reach participants that in-person programs do not. This study provides evidence that Online GKT has significant utility in addressing a crucial need for online alternatives to evidence-based suicide prevention training.

Safety Planning Intervention Training Among Early Career Mental Health Professionals: Perception of Self-Efficacy, Usefulness and Feasibility

Introduction In 2021, in Argentina there were 3,639 deaths by suicide, equivalent to one death every three hours. Evidence indicates that brief suicide preventive interventions in emergency services, such as the Safety Planning Intervention (SPI), effectively reduce future suicidal ideation and attempts in both adults and adolescents. Objective To evaluate the perception of self-efficacy, and the feasibility and usefulness of a training in SPI in early career mental health professionals. Method Sixty-nine early career mental health professionals from Buenos Aires participated in a 3-hour SPI training. Through an online survey, measurements were taken in three times: before and after the training and 8–10 weeks after the training. Results All participants completed the pre- and post-training measures, and 43 of them completed the follow-up survey. Post-training measures showed an increase in self-efficacy, maintaining the effect at 8–10 weeks. The SPI was found useful and feasible to be implemented in clinical care. More than half of the participants reported having used the SPI during follow-up. Conclusion Results suggest that training in SPI is associated with an increased perception of self-efficacy of early career mental health professionals; this is maintained after 2 months post-training. In addition, the intervention is perceived as feasible, acceptable and useful for professionals in training.

Suicide Prevention Initiatives for Persons Living With HIV/AIDS Are Long Overdue

While human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) researchers have made remarkable strides in the treatment, management, and prevention of HIV/AIDS, one area of research related to HIV/AIDS remains woefully underrepresented in the scientific literature: suicide prevention. The risk of death by suicide among people living with HIV/AIDS (PLWHA) is 100 times higher compared with that among the general population, and the lifetime prevalence of suicide attempts is similarly elevated. Though there have been many suicide prevention studies worldwide and effective interventions have been identified, few prevention strategies have been tested and implemented among PLWHA. A preliminary review of articles published since 2018 revealed only two behavioral interventions designed to address suicide risk in PLWHA, neither of which were based in the United States. No systematic reviews of behavioral interventions for suicide prevention among PLWHA have been published. In this commentary, we call for research to evaluate the effectiveness of suicide prevention interventions and policies that could decrease suicide rates among PLWHA.

"It's like an epidemic, we don't know what to do": The perceived need for and benefits of a suicide prevention programme in UK schools.

Despite emerging evidence for the effectiveness of school-based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known. We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school-based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation. A total of 46 participants took part. Semi-structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15-18 across three state secondary schools. Data were analysed using thematic framework analysis. Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes. Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school-based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff.