Caring Contacts – Preventing suicide with communication during times of transition
The weeks after leaving hospital are a particularly high-risk period for patients who have experienced suicidal thoughts. Researchers at Sunnybrook have recently completed a Randomized Control Trial to test the effectiveness of an intervention called Caring Contacts to provide regular touch-bases to discharged patients. Department Faculty members Drs. Ayal Schaffer, Rosalie Steinberg, and Mark Sinyor (along with local and international MD and non-MD collaborators) have been leading this initiative to ensure patients feel supported during a difficult transition.
“The past couple of decades has provided accumulating evidence on the beneficial impacts of Caring Contacts,” says Dr. Schaffer. “Our trial set out to establish efficacy within the Canadian health care system. The pandemic provided another motivation to test novel approaches to supporting patients during disruptive and difficult times.”
“Returning to everyday life can also mean a return to sources of stress including isolation, family conflict, as well as financial and housing challenges, all while many patients are also experiencing gaps in the delivery of mental health care,” says Dr. Sinyor. “All of these factors can contribute to worsening mental health and increased risk of suicide during this time.”
Caring Contacts messages are sent to patients after they leave acute care settings such as the Emergency Department or an inpatient unit. Previous Caring Contacts trials used postcards, but subsequent trials have experimented with a variety of formats, including phone calls, texts and emails.
Taking past research into consideration, the Sunnybrook team co-developed their trial with input from current inpatients, the Department’s Patient and Family Advisory Council, and allied health staff. The result was a series of emails specifically designed to break down the barriers between the inpatient and outpatient worlds and to address each of the key challenges patients may face as they return to their lives outside the hospital.
“Our trial sent emails that included a combination of messages of hope, references to coping strategies discussed during inpatient groups, reminders of crisis services, and an invitation to return to the hospital if needed,” says Dr. Schaffer.
The trial soon faced one major disruption that couldn’t have been foreseen: the pandemic. The spread of COVID-19 added a new sense of urgency to the physians' work. Two outbreaks occurred among inpatients, forcing recruitment to be paused. Thanks to quick responses and effective management, the outbreaks were short, and recruitment was able to resume with an accelerated timeline.
The trial’s preliminary results are promising.
“One hundred patients participated in the trial,” says Dr. Schaffer. “Preliminary data shows a 25% attenuation in symptomatic worsening and a 71% attenuation of suicidal thoughts at Day 4 post-discharge in those who received the Caring Contact as compared to a more neutral control email. We are still awaiting all Day 21 and 56 data to be obtained before further analyses examine whether these benefits were sustained. Interviews conducted with study participants confirmed that many patients experienced these benefits, and Caring Contacts helped to foster a positive relationship with our hospital and the mental health care system.“
“These results demonstrate the value of bridging gaps between acute inpatient care and post-discharge recovery during a critical period for some of our highest risk patients.” says Dr. Steinberg. “We know that the time following discharge from a psychiatric admission is associated with worsening mental health symptoms and increased risk for suicide. These results highlight the benefits of maintaining a connection between the mental health care system and our patients, who experience better outcomes and appreciate our follow-up. This trial has established that the Caring Contacts can play an important role in creating this type of continuity.”
The Caring Contacts trial isn’t the only way Sunnybrook is working to prevent suicide.
“The trial is a wonderful example of the broader suicide prevention research being conducted at Sunnybrook, which focuses on the importance of targeted suicide prevention strategies,” says Dr. Schaffer. “With the addition of Caring Contacts to our already implemented Coping Card project (freely accessible in 10 languages online) and ongoing support from the Discharge and Transition team, we have implemented the 3 pillars of suicide prevention in acute care, delivering and also studying these important clinical interventions.”
During and beyond the pandemic, finding effective methods to prevent suicide is one of the most important missions in the field of psychiatry. The Caring Contacts Randomized Control Trial is demonstrating the effectiveness of one method to fight suicide. Along with Sunnybrook’s other studies and work being done across the Department’s hospital sites, the future promises new sources of hope in the battle to prevent suicide.