JMIR Publications

ABSTRACT

Background:

To date, mental health intervention services, both online and in-person, have been conceived in the traditional model whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention and has been shown to be effective in other areas of healthcare[1-3]. Live for Tomorrow chat (LFT) was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidal ideation.

Objective:

The aim of this qualitative study was to explore how counselors engaged young people in a proactive online intervention and how risk assessment was conducted in this context.

Methods:

Thirty-five transcripts of conversations between counselors and young people aged 13-25 were analyzed using the six-step approach of Braun and Clarke’s reflexive thematic analysis[4]. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention.

Results:

Seven themes emerged: Using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality follow a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions.

Conclusions:

The findings highlight the importance of the counselor’s role to listen, empathize, validate, and empower young people – and that all these skills can be transferred to an online text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practice to meaningful conversations about suicidality. This study demonstrated that a proactive, person-centered approach is possible within an online text-based environment. This research highlights the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively.