Purpose ‘Caring Letters’ is a suicide prevention intervention that involves sending brief messages of care and concern to high-risk patients following psychiatric hospitalisation. This is the only intervention that has been previously shown to reduce suicide mortality rates in a civilian population. A multi-site randomised controlled trial is now underway at US military and VA hospitals. This presentation provides an in-progress report on how the caring contacts trial is providing an active crisis intervention benefit.

Methods and approach This in-progress multi-site study enrolls active duty military personnel and veterans who receive inpatient treatment at six psychiatric facilities. Comprehensive interviews are conducted to assess predictors of treatment effect. Patients are randomised into either ‘usual care’ or ‘Caring Letters’ intervention group. The latter receives 13 scheduled caring emails for two years. Both groups are contacted at end of the study to evaluate the intervention’s effectiveness. Primary outcomes include suicide mortality rates and self-directed violence.

Results VA Palo Alto has enrolled 311 participants and 147 have been randomised to the Caring Emails group. The site has received 44 reply emails from patients. The majority expressed appreciation while 12 patients indicated acute distress due to overwhelming stressors, worsening symptoms, substance abuse relapse, homicidal and suicidal ideation. The research team followed established safety protocol to resolve potential crisis and reconnect patients to care.

Conclusions Caring Letters provide a means to reconnect patients in crisis to care. By following established safety protocols, patients can be reconnected to care who may have otherwise may not have received additional intervention.

Significance These in-process findings provide an essential step to validating a low-cost, high-impact intervention. A standardised Caring Letters program at US military and VA hospitals could provide an effective crisis management process as part of posthospitalisation safety planning.