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158 Caring letters follow-up assessment provides reconnection to care of at-risk post-hospitalised psychiatric patients
  1. Melody R Cardona,
  2. Saba Rizvi,
  3. Matilda Stelzer,
  4. Kristine Lalic,
  5. Valerija Nikolic,
  6. Patricia An,
  7. Frederick Macrae
  1. US VA Palo Alto Health Care System


Purpose Caring Letters entails sending brief caring messages to patients following psychiatric hospitalisation. The purpose of this multi-site randomised controlled trial is to test a caring emails intervention to determine if it is effective in preventing suicide and re-hospitalisation rates. This in-progress trial fills an important gap in the evidence base for the Caring Letter intervention through a methodologically rigorous research design. This reports preliminary data on the follow-up assessment portion of the intervention.

Methods Participants are recruited from inpatient psychiatry units and randomised to either a group that receives email letters (Caring Letters) or a group that does not receive letters (Usual Care). In the Caring Letters (CL) group, participants are emailed ‘letters’ on a planned schedule. The emails are simple expressions of care and include contact information for crisis intervention resources. The participants in the Usual Care (UC) group do not receive the emails. Both groups are contacted for follow-up assessment after two years. The follow-up assessment evaluates suicidal behaviours, service utilisation, suicidal ideation, acquired capability for lethal self-injury, and measure feelings of thwarted belongingness and perceived burdensomeness. Mortality rates will also be assessed upon study completion.

Results At VA Palo Alto, 341 participants were retained in the study after two years (n=182 UC, n=159 CL). To date, 185 participants completed the final surveys. During the Follow-up Assessment, 12 participants expressed distress or emotional crises. The treatment team was immediately alerted and all participants were reconnected to care.

Conclusion Both groups (CL and UC) benefited from the Follow-up Assessment. The study’s low-cost caring emails and follow-up assessments (either by phone or by mail) demonstrate effective means of providing human interaction that support at-risk individuals in times of crises. Communicating care and concern and creating a sense of connexion may prevent suicide and avert crisis among discharged psychiatric patients.

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