Is your crisis line's suicide-prevention communications effort working well enough? What should you be doing differently? Little research has been conducted to establish what kinds of communication campaigns work best. Research can take a long time and your crisis line may need answers to these questions now. While research is still evolving, some help is available through a checklist we developed that was published earlier this year in the scientific journal CRISIS. The 46-item checklist consists of best practices that can be used to guide the design, implementation and evaluation of suicide-prevention communication campaigns. Our goal was to provide a tool that crisis centers can use to help design new communication campaigns or determine whether existing ones are worth keeping.
We developed the checklist through a process that combines what we deemed to be the best available scientific evidence and the collective judgment of 14 experts with marketing, public health and suicide prevention expertise. We reviewed 58 relevant articles published in scientific journals to identify an initial list of best practices. We then found experts who had published multiple articles or seminal pieces of work in the area of suicide prevention, suicide media campaigns, or broader media campaigns. These experts reviewed the initial list of best practices and rated each practice's importance and validity. Only those practices that experts agreed were both important and valid remained in the final published checklist.
The list aims to be comprehensive. It covers what kinds of content campaigns should include and suggests specific language for communicating about suicide warning signs, risk factors and ways to protect against suicide. Some items on the list are meant to help determine what visuals and language should be included or avoided in the campaign. For instance, using the term “commit suicide” can add to the stigma of dying by suicide since “commit” is seen as inferring blame or intentionality while that is not the case with other public health issues (for example, you do not “commit” cancer). The checklist also contains best practices for developing, implementing and evaluating campaigns.
If you are developing a campaign, the checklist may prove useful in helping you assess the appropriateness of including certain components in your campaign. For example, as you are selecting imagery, you might follow this advice: Avoid using stereotypical imagery (such as photos of people who look sad or are clutching their heads) that implies you can tell someone is in pain by how they look.
If you have a campaign in place, the checklist can be used to determine the extent to which your campaign aligns with the best practices covered by the checklist. During our evaluation of Know the Signs—a California suicide prevention communication campaign—14 experts in suicide prevention and communication campaigns rated the campaign materials using our 46-item checklist.
While the checklist provides some guidance, we also have other tools to help crisis lines like yours evaluate your suicide prevention efforts on a recurring basis.
For instance, we published the RAND Suicide Prevention Program Evaluation Tool Kit several years ago to help community organizations working to prevent suicide detect whether they are producing beneficial effects and determine where improvements are needed. To accomplish these goals, the toolkit uses checklists, worksheets and templates to inform users about the latest evaluation research from similar suicide prevention efforts and to help them design and conduct an evaluation that is appropriate based on available resources and expertise. This includes selecting or augmenting evaluation measures and providing basic guidance to users on how to analyze evaluation data and improve the effectiveness of their work.
One goal of the toolkit is to give you a better idea of how to allocate scarce resources to gain the best possible outcomes from your programs. The toolkit is also based on recent scientific literature and feedback from a dozen staff members of suicide-prevention programs.
Both the media checklist and evaluation toolkit are free. Both are aimed at promoting quality in an evolving field with a limited evidence base. Those putting together campaigns need to be aware of these cutting-edge and evidence-informed tools, because campaigns that are implemented poorly can have unintended consequences — including increasing suicide risk.
Sponsors for this work include the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and the California Mental Health Services Authority.
Rajeev Ramchand and Joie Acosta are senior behavioral scientists at the nonprofit, nonpartisan RAND Corporation.
This commentary originally appeared on Lifeline Network on October 16, 2017. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.