A study of a text-message based, brief intervention after hospitalisation for self-harm, a suicide attempt or suicidal thoughts.

INTERVENTION: RAFT is an SMS‐based intervention for people discharged from hospital for self‐harm, suicidal ideation, or a suicide attempt. RAFT sends a series of ‘caring contact’ text messages with links to online therapeutic content that targets proximal risk factors for self‐harm and suicide, specifically: distressing thoughts, safety planning, emotional regulation, suicidal thoughts, interpersonal relationships, and alcohol consumption. The therapeutic content was developed with input from lived experience representatives and clinical experts and is designed to be ‘low intensity’. It provides suggestions for distraction techniques, safety planning templates, information on mindfulness, and a number of case studies that challenge unhelpful thoughts and behaviours in line with cognitive behavioural therapy. This optimisation trial will assess the benefits of receiving links to the RAFT therapeutic content relative to just receiving SMS ‘caring contact’ messages. The ‘caring contact’ text messages express the hope that the individual is doing well and invites them to reconnect with services if needed. Participants who receive links to the online resources are free to engage with them as little or as often as they wish. This trial will also assess whether providing online information to a nominated support person is beneficial. Participants will be randomised between two arms of the study: (a) a waitlist control group who will receive treatment as usual (TAU), and (b) an intervention using a 2x2 factorial design. Participants in the intervention group will be randomised between two factors: (a) participant receiving text messages Vs participant receiving text messages with links to online content, and (b) participant CONDITION: Mental Health ‐ Suicide Public Health ‐ Health promotion/education Suicidal ideation;Self harm;Suicide attempt; ; Suicidal ideation ; Self harm ; Suicide attempt PRIMARY OUTCOME: Suicidal ideation as measured by the Suicidal Ideation Attributes Scale (SIDAS).[Baseline; 5 weeks; 3 months (primary endpoint).] INCLUSION CRITERIA: Individuals are eligible to join the study if they: ‐ Are currently aged between 16‐65 years old. ‐ Presented at a hospital within the last 7 days for self‐harm, suicidal ideation, or a suicide attempt. ‐ Have a smart phone with an Australian phone number. ‐ Provide their consent to participate, including consent to allow the research team to access their hospital medical records for 12 months prior to enrolment and 12 months post enrolment in the study. SECONDARY OUTCOME: Psychological distress as measured by the Distress Questionnaire‐5 (DQ5).[Baseline; 5 weeks; 3 months. ] Psychosocial functioning as measured by the Recovery and Functioning Scale (RFS).[Baseline; 5 weeks; 3 months. ] Repeat hospital presentations for self‐harm, suicidal ideation or a suicide attempt. This is a composite outcome. Staff at each recruitment site will conduct an audit of Emergency Department records at their hospital. We will assess: number of presentations, date of presentations, reason for presentation, whether they were admitted, and to which department/ward they were admitted. [12 months post‐enrolment. ] Self‐reported episodes of self‐harm via online questionnaire. The questionnaire (designed for this study) includes 3 items; frequency of life‐time self‐harm, frequency of recent self‐harm, and frequency of recent suicide attempts.[Baseline; 5 weeks; 3 months.]