Evaluating digital suicide prevention functionality

Co-designing, user testing and evaluating digital suicide prevention functionality

Suicide is the leading cause of death for Australians aged 15 – 44 years.

National rates of suicide increased between 2008 and 2017, and the number of deaths from suicide increased by 9% between 2016 and 2017.

In 2015 and again in 2017, the number of deaths from suicide was recorded at 12.6 deaths per 100 000 population — the highest recorded rate in 10 years.

Given the importance of this issue, the National Mental Health Commission (NMHC) National Review of Mental Health Programmes and Services report, published in 2014, recommended a coordinated nationwide introduction of sustainable, comprehensive, whole-of-community approaches to suicide prevention; a greater focus on suicide prevention for people attending health and mental health services; and, specifically, better integration of e-mental health services.

Similarly, the World Health Organization (WHO) has recognised that mobile devices are an important option for providing support and therapy to people at risk of suicide.

Digital tools are particularly appealing in mental health care as they provide new pathways for reaching more people, while also addressing a range of other social and community challenges (such as social isolation and poor physical health). Typically, these tools have been developed for young people, particularly those born after the widespread adoption of technology.

A recent systematic review on technology and suicide prevention highlighted the promise of mobile, computer or web-based apps in improving young people’s outcomes; however, the scarcity of evidence on online and mobile interventions for suicide prevention in young people was also noted. Suicide prevention apps and e-tools can range from useful and engaging to poorly designed and ineffective.

Other general population research identified 123 apps in the marketplace that were related to suicide. Of these, 10% contained what was considered potentially harmful content, 25% had obvious technical faults or reliability issues, and fewer than half (41%) were developed by academics or health care institutions.

One reason for these problems may be that most design of digital content is structured around positive user journeys (steps or processes by which a user may interact with the content), and that more consideration of people who are in crisis is needed when designing the structure of the content.

Our own user experience designer and researcher reviewed available Australian mental health websites and found varying levels of success in designing user experience for crisis. Very few offered more than a simple (often red) call button or urgent help button with a long and static list of services. Only one site was found that offered three levels of immediate support (via a “need help now” option) on the homepage; the three support options were “call us”, “crisis support chat” and “help resources”.

A more recent initiative of the Department of Health is Australia’s digital mental health gateway known as Head to Health. This site was developed in collaboration with the community and the mental health sector, and it includes a more refined “need help now” feature. This functionality has a short list of recommendations that are, importantly, guided by a set of rules developed by users.

These rules include that recommendations must be local to Australia, provide 24-hour access to support, have multiple modes of communication (ie, telephone and web chat) and be sensitive to cultural diversity.

Much work in Australia in suicide prevention over the past two decades has focused on community- level initiatives rather than active engagement of general health and mental health services as key agents in any large- scale response to this major health challenge.

However, some novel applications are starting to emerge; for example, our research group has used new and emerging technologies to identify and respond to suicidality among help seeking young people. By contrast, considerable international effort has been directed to develop and evaluate health system- level strategies (e.g. Towards Zero Suicide).

The NMHC report specifically highlighted the need for Australian health services to actively adopt a “zero suicide in care” philosophy and develop policies and procedures to support this approach.

The objectives of this study were to explore with participants (young people, supportive others and health professionals) how best to assess risk and support active suicide prevention strategies; co-design digital suicide prevention functionality for potential integration with a prototypic online platform; and conduct a national online evaluation of the digital solution.

To find out more, download our supplement ‘Co-designing, user testing and evaluating digital suicide prevention functionality‘ from the peer-reviewed Medical Journal of Australia.