Short suicide prevention programme more effective and cost-effective than alternative care

A short suicide prevention  programme in Switzerland, which uses face-to-face therapy, was found to be more effective at lowering repeat suicide attempts and less costly than care as usual and a single suicide risk assessment.

These are the findings of a new study from the London School of Economics and Political Science (LSE) and University of Bern, Switzerland, published in the Journal of the American Medical Association (JAMA) Network Open.

The authors worked out the cost-effectiveness of the Attempted Suicide Short Intervention Programme (ASSIP) retrospectively using data from a clinical trial. In the trial, 120 individuals who had attempted suicide were assigned equally either to a control group or an intervention group.

The researchers found the intervention programme had a 96% chance of being less costly and more effective for individuals who were admitted to the emergency department of a general hospital following attempted suicide, than the control programme.

In the control programme, in addition to treatment for any physical injuries, the individuals received a single suicide risk assessment. A similar service is recommended by the National Institute for Health and Care Excellence (NICE) in the UK. The results of this assessment should be shared with GPs and any necessary mental health services to facilitate timely aftercare.

Individuals in the intervention group were placed on the Attempted Suicide Short Intervention Programme (ASSIP) which, in addition to physical treatment, consists of three 60-minute face-to-face therapy sessions. These are followed by regular personalised letters to the service users over 24 months, alongside a small leaflet providing personal safety strategies and emergency contact details.

After 24 months, five suicide attempts were reported in the ASSIP group compared to 41 in the control group.  Looking at cost-effectiveness, the researchers found the ASSIP group had higher intervention costs due to the increased number of sessions provided.

However, they spent less time in inpatient care (21 days vs. 60 days) and their general hospital costs, which include assessment, consultation and liaison psychiatric services, were much lower (456 Swiss Francs/CHF vs. 4186 Swiss Francs/CHF).

Overall costs for the ASSIP group were also lower (21,302 Swiss Francs/CHF vs. 41,287 Swiss Francs/CHF) making it a more effective and cost-saving treatment for individuals who have attempted suicide.

Although the study was conducted in Switzerland, the authors have called for further research in countries such as the UK. ASSIP has been successfully implemented in countries including Sweden, Finland and Lithuania and the authors note that it is relatively easy to implement as it is brief, structured and straightforward for practitioners to learn and implement.

Given that suicide is the biggest killer of men under 50 in the UK and attempted suicide is one of the most frequent reasons for emergency hospital admissions, the authors argue effective new treatments are urgently needed and ASSIP could help inform UK policy.

Commenting, study author A-La Park from the Personal Social Services Research Unit at LSE said:

“It is time to think differently about suicide prevention. The Attempted Suicide Short Intervention Program (ASSIP) is a brief, effective and cost-effective strategy for people who have attempted suicide. It will be important to explore its cost-effectiveness in different countries with diverse health care systems and cultural contexts at the international level.”