3 - (SYM 74) Developing and Pilot Testing Strategies to Increase Mental Health Treatment Engagement Among Primary Care Patients at Risk for Suicide

Introduction: Primary care is an ideal setting to intervene to reduce suicide risk. People across the lifespan visit primary care more than any other medical specialty and most individuals who die by suicide interact with a primary care clinician in the year prior to death. Increasingly, primary care is called on to identify individuals at risk for suicide, yet only half of referred patients attend an initial mental health visit. Primary care-based strategies to best support engagement in mental health care have not been systematically developed with community partners or rigorously studied.

Method: We conducted semi-structured qualitative interviews with primary care and behavioral health clinicians (n = 18 and 12, respectively), leaders (n = 20), intake coordinators (n = 4) and patients (n = 20; M age = 44; 66% female; 70% White, 16% Black, 9% Asian, 4% other; 7% Latinx) to understand barriers and facilitators to engagement in mental health services following a referral from primary care. We partnered with community clinicians and subject-matter experts to develop a menu of engagement strategies guided by behavioral mapping, our qualitative and quantitative data, a literature review, and expert consensus. We rapidly prototyped and piloted these strategies with 30 patients (M age = 42.3; 87% female; 37% White, 57% Black, 7% other; 7% Latinx) who then completed the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and the Feasibility of Intervention Measure (FIM).

Results: Our menu of strategies included: (1) caring contacts, or non-demanding expressions of care from the primary care team; (2) electronic reminders to follow up on referral; (3) an infographic with a QR link to information about the referral and treatment initiation process; and (4) guiding staff to use motivational interviewing principles when following up about referrals. Acceptability, appropriateness, and feasibility ratings ranged from moderate to high, with highest scores for reminders (M AIM = 4.33, M IAM = 4, M FIM 4.25) and lowest for applying motivational interviewing principles to the intake process (M AIM = 3.34, M IAM = 3.25, M FIM 3.16).

Discussion: Our rigorous community-partnered approach yielded a menu of scalable, low-cost strategies that hold promise for enhancing treatment engagement in primary care patients at risk for suicide. Our pilot findings provide proof of concept and point to the need for future larger-scale testing to evaluate the potential for these strategies to connect at-risk patients to appropriate care.