In our efforts to address adolescent mental health and suicide prevention, integrating Crisis Response Plans (CRPs) with technology can be highly beneficial. CRPs provide a structured approach to help individuals recognize warning signs, identify coping strategies, and establish support networks. Mental health apps have emerged as valuable tools in creating and managing CRPs, offering both students and educators accessible resources for mental health support. This blog explores the significance of CRPs, the role of mental health apps in fostering connectedness and addressing ambivalence and compares three leading apps: the Safety Plan App by Veterans Affairs, the SAMHSA Suicide Safe Mobile App, and the Virtual Hope Box. Utilizing these apps can provide educators with essential tools to better support students and enhance their confidence in managing mental health crises. Unfortunately, the perfect app for adolescents struggling with suicide ideation does not yet exist. However, there are currently some options that can be adapted to work effectively.
The Role of Crisis Response Plans in Suicide Prevention
Crisis Response Plans (CRPs) are essential for providing individuals with personalized strategies to manage suicidal thoughts and behaviors. These plans typically include identifying personal warning signs, listing internal coping strategies, specifying social settings and contacts for distraction and support, outlining steps for contacting family members, friends, and professionals, and highlighting personal reasons for living. CRPs empower individuals to proactively manage their crises, reducing the need for emergency interventions and potentially preventing suicide attempts (Bryan et al., 2017).
Addressing Ambivalence and Connectedness
Ambivalence, the coexistence of conflicting desires such as the wish to live (WTL) and the wish to die (WTD), is a significant factor in understanding and addressing suicidal ideation and behavior. According to Höller et al. (2024), ambivalence, especially when both WTL and WTD are equally strong, can lead to persistent suicidal ideation and an increased risk of suicide attempts over time. CRPs help individuals articulate and explore both their reasons for living and their reasons for dying, enabling more effective interventions by reinforcing the WTL and mitigating the WTD.Connectedness, or the sense of being cared for and supported by others, is a critical protective factor against suicide. Studies have shown that higher levels of school connectedness are linked to reduced reports of suicidal thoughts and behaviors among adolescents (Marraccini & Brier, 2017). Mental health apps that promote connectedness can be particularly effective in preventing suicide by helping students feel less isolated and more understood.
Comparing Mental Health Apps for CRPs
Three mental health apps stand out for their comprehensive features and user-friendly designs in creating and managing CRPs: the Safety Plan App by Veterans Affairs, the SAMHSA Suicide Safe Mobile App, and the Virtual Hope Box. While all three apps offer valuable resources, their suitability varies depending on the user’s age and specific needs.
Safety Plan App by Veterans Affairs
The Safety Plan App by Veterans Affairs is designed to help users create personalized plans to manage suicidal thoughts. It guides users through six steps:1. Recognizing warning signs that indicate they may be heading toward a crisis.2. Identifying personal coping strategies they can use on their own.3. Listing places they can go and people they can call for distraction.4. Noting friends and family members who can provide support.5. Identifying professionals to contact during a crisis.
Ensuring safety by limiting access to dangerous objects.
Additionally, the Safety Plan App includes features for mood tracking, goal setting, and accessing crisis support resources like the Veterans Crisis Line. The app’s structured and methodical approach makes it particularly useful for veterans and older adults who benefit from detailed crisis management strategies. However, while its comprehensive features make it an excellent resource for educators to understand and implement CRPs, it may be less engaging for adolescents due to its clinical and structured format.
SAMHSA Suicide Safe Mobile App
The SAMHSA Suicide Safe Mobile App is another robust tool designed to support suicide prevention efforts, primarily targeting clinicians but also valuable for educators. It provides comprehensive resources for assessing suicide risk, developing safety plans, and offering follow-up care. Key features include structured risk assessment tools with interactive decision trees, templates for personalized safety plans, and modules on best practices and cultural competency. These tools can be integrated into professional development for school staff, aiding in the creation of a supportive and informed school environment.The SAFE-T program within the SAMHSA app stands for Suicide Assessment Five-stepEvaluation and Triage. It is a systematic approach to identifying and addressing suicide risk factors and protective factors in individuals. The five steps are:1. Identify Risk Factors: Note risk factors that can be modified to reduce the risk of suicide.2. Identify Protective Factors: Note protective factors that can be enhanced to counteract the risk of suicide.3. Conduct Suicide Inquiry: Specific questioning about thoughts, plans, behaviors, and intent related to suicide.4. Determine Risk Level/Intervention: Assess the risk level based on clinical judgment and suggest possible interventions.5. Document: Document the risk level, rationale, intervention, and follow-up plan.While the app’s advanced clinical features, such as detailed risk assessments and HIPAA-compliant documentation, are tailored for mental health professionals, educators can leverage its educational resources and guidelines to enhance their suicide prevention strategies. By utilizing the training modules and crisis resources, educators can foster greater awareness, develop effective safety plans in collaboration with school counselors, and implement comprehensive policies to support student mental health.
Virtual Hope Box
The Virtual Hope Box is particularly effective for creating something close to a CRP tailored for adolescents. It offers personalized coping strategies, activities for distraction, and options for relaxation and inspiration. This app helps users manage their emotions and connect with supportive contacts during a crisis. The Virtual Hope Box stands out because it provides comprehensive support that aligns closely with the principles of CRPs while also being engaging and user-friendly for younger individuals.
Why the Virtual Hope Box Stands Out for Adolescents
One of the critical components of the Virtual Hope Box is its focus on engaging reasons for living and addressing ambivalence in suicidal ideation. By helping users focus on positive aspects of their lives, the app strengthens their will to live. Encouraging students to add personal photos, meaningful quotes, and reminders of positive experiences helps build a reservoir of reasons to stay alive. Research by Chen et al. (2018) highlights the effectiveness of including reasons for living in crisis response strategies. Their study demonstrated that focusing on reasons for living significantly reduces suicidal thoughts and behaviors, addressing the ambivalence that often accompanies suicidal ideation.The Virtual Hope Box also includes features for games and other distraction tools, which are particularly appealing to young adolescents. These features help in diverting attention from distressing thoughts and providing a break from emotional turmoil. The app’s modern design and user-friendly interface make it more engaging and accessible for adolescents, enhancing its effectiveness as a mental health support tool.A systematic review by Grist, Porter, and Stallard (2019) found that mobile mental health apps are generally well-received by young people, particularly when they include interactive and engaging features such as games and personalized content. The Virtual Hope Box’s incorporation of these elements aligns with the preferences of adolescents, making it a more effective tool for this age group.
Supporting Evidence for Mental Health Apps
The effectiveness of the Virtual Hope Box and other mental health apps has been supported by various studies. For example, a study by Chen et al. (2018) evaluated the predictors of usage and impact of the Virtual Hope Box among patients with suicidal ideation. The study found that the app was particularly effective in providing distractions and reminders of sources of meaning, highlighting its role in enhancing coping self-efficacy and potentially reducing suicidal ideation.Additionally, Chen et al. (2018) noted that while younger users and those with higher education levels used the app less frequently, overall usage was associated with positive changes in health outcomes. This finding underscores the importance of tailoring app usage encouragement to different demographic groups to maximize its benefits.Another significant finding from the Chen et al. (2018) study was that the most used features of the Virtual Hope Box were those designed to provide distractions and reminders of sources of meaning. These features align closely with the app’s goal of enhancing coping self-efficacy, making it a valuable tool for educators seeking to support students in distress.
Enhancing Educator Comfort and Confidence
Implementing CRPs and utilizing mental health apps can significantly increase educators’ comfort and confidence in addressing student mental health crises. The structured and evidence-based approach of CRPs provides a clear framework for educators to follow, reducing uncertainty and anxiety when dealing with at-risk students. Mental health apps like the Safety Plan App, SAMHSA Suicide Safe Mobile App, and Virtual Hope Box offer valuable resources and tools that educators can use to support students effectively.By familiarizing themselves with these apps and integrating them into their mental health strategies, educators can feel more equipped to handle mental health crises. The guided steps, comprehensive resources, and user-friendly features of these apps can help educators build their confidence in creating and implementing CRPs, ensuring that students receive the support they need.
How to Use the Virtual Hope Box to Create a CRP
The Virtual Hope Box provides a flexible and user-friendly platform for adolescents to create a CRP. Here’s how educators can guide students in using the app:1. Narrative Assessment: Encourage students to chronologically assess their suicidal crisis, including thoughts, feelings, behaviors, and coping strategies. This can help them understand their patterns and triggers.2. Warning Signs: Use the “Remind Me” section of the app to record warning signs, such as feelings of hopelessness or irritability. This section can also include reminders of reasons for living, such as photos and videos that remind the student of loved ones or reasons for living.3. Self-Management: The “Relax Me” area offers self-management tools like deep breathing exercises and positive affirmations. Encourage students to regularly use these tools to manage stress and emotional distress.4. Social Support: In the “Contacts” section, students can list supportive individuals they can reach out to, including family members, friends, and school counselors. This ensures they have a readily accessible support network.5. Crisis Services: The app provides easy access to emergency hotlines and other crisis services, ensuring students can quickly reach out for help when needed.While the Safety Plan App by Veterans Affairs is an excellent resource for creating detailed and structured CRPs, particularly for older individuals, the Virtual Hope Box offers a more engaging and user-friendly platform for adolescents. The Virtual Hope Box’s modern design, distraction tools, and focus on reasons for living make it an ideal choice for young students. Although the perfect CRP app for adolescents does not yet exist, the Virtual Hope Box comes close by providing comprehensive support and engaging features that align with the principles of CRPs.As educators and administrators, integrating these tools into our daily practices can create a proactive and supportive environment that prioritizes the well-being of our students. By leveraging existing resources like the Virtual Hope Box, we can significantly enhance our ability to support adolescents facing mental health challenges and prevent suicide. Implementing these apps and strategies will also boost educators’ comfort and confidence in managing mental health crises, ultimately creating a safer and more supportive school environment.
References
Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., & Maney, E. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64-72. https://doi.org/10.1016/j.jad.2017.01.028
Chen, J. I., Hossain, M. M., & Mullick, T. H. (2018). Evaluation of the Virtual Hope Box among patients with suicidal ideation: Randomized clinical trial. JMIR Mental Health, 5(4), e10030. https://doi.org/10.2196/10030
Grist, R., Porter, J., & Stallard, P. (2019). Mental health mobile apps for preadolescents and adolescents: A systematic review. Journal of Medical Internet Research, 21(5), e13051.
Höller, I., Wagner, G., Bauer, A., & Bosshardt, A. (2024). Ambivalence in suicidal ideation: The role of reasons for living and dying in the persistence of suicidal thoughts. Suicide and Life-Threatening Behavior, 54(1), 23-34. https://doi.org/10.1111/sltb.12868
Marraccini, M. E., & Brier, Z. M. F. (2017). School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis. School Psychology Quarterly, 32(1), 5-21. https://doi.org/10.1037/spq0000192