Developing resteps: a suicide intervention for youth with first-episode psychosis - youth with first episode psychosis (FEP) are at high risk for suicide, especially during transitions from acute care

The National Institute of Mental Health awarded Butler Hospital $781,566 on September 1, 2026, under the Mental Health Research Grants program (CFDA 93.242) to develop RESTEPS, a suicide prevention intervention for youth with first-episode psychosis transitioning from acute care to outpatient treatment.

The study addresses a critical gap: youth with first-episode psychosis face elevated suicide risk during care transitions, yet clinical trials of suicide-focused interventions routinely exclude this population. Existing interventions such as safety planning show lower efficacy in people with psychosis, possibly because they experience reduced social connectedness and heightened exposure to social determinants of health, including mental health stigma. RESTEPS integrates evidence-based protocols targeting safety planning, mental health stigma reduction, and social connection.

The intervention development follows an iterative, mixed-methods design informed by qualitative and quantitative data and continuous feedback from a community advisory board of people with lived experience and clinicians. Phase 1 involves qualitative interviews with youth ages 15–25 (N = 10–15) and significant others (N = 10–15) on core intervention components. Phase 2 recruits youth with first-episode psychosis and suicidal thoughts or behaviors (N = 35) from inpatient or partial hospitalization settings to assess feasibility, acceptability, and preliminary efficacy, informing a future large-scale randomized controlled trial.

The award supports work performed in Providence, Rhode Island, with a period of performance from September 1, 2026, through August 31, 2030.

Yet, clinical trials of interventions targeting suicidal thoughts and behaviors (stbs) often exclude youth with psychosis, limiting our understanding of treatment efficacy for this high-risk population. Further, STB treatment studies that do include people with psychosis have found that these interventions, such as safety planning, are less effective for this population. This may be because people with psychosis experience lower social connectedness and greater burdens from social determinants of health, particularly mental health stigma (a stressor related to FEP that is predictive of stbs in this population). The proposed study seeks to address important gaps in current research by adapting and integrating evidence-based protocols to reduce suicide risk among youth with FEP as they transition from acute care to outpatient treatment. This project will determine the feasibility, acceptability, and preliminary efficacy of a suicide prevention intervention for youth with FEP focused on safety planning, mental health stigma-reduction, and social connection, called resteps (reducing stigma: a treatment for youth with early psychosis and suicidality), to inform a future, large-scale RCT. Intervention development will be an iterative process, with generation of new content and adaptations to current protocols informed by qualitative and quantitative data, as well as through continual feedback from a community advisory board composed of people with lived experience and clinicians. In phase 1, qualitative interviews focused on core intervention components will be conducted with youth aged 15-25 (n = 10-15) and a significant other (so; e.g., family member, partner, friend; n = 10-15). In phase 2, youth with FEP and stbs (n = 35) will be recruited from inpatient or partial hospitalization units and complete the 8-session intervention as adjunctive to their current care. Initial sessions will be completed while the participant is hospitalized, and an so will be included in half the sessions. The proposed approach will include the following components: safety planning, mental health stigma-reduction, enhancing social connection, and linking to outpatient care. In phase 3, clinicians (n = 10-15) who work with FEP patients will complete qualitative interviews focused on core intervention components, target audience, mode of delivery, and service settings, in order to support future implementation and sustainability of resteps. A highly structured training plan will ensure achievement of these aims. Specifically, the PI will receive training in working with patients who have psychosis, suicide intervention development for youth, implementation science, and ethical research practices with high-risk populations. Training will be guided by an exceptional mentorship team with highly relevant expertise, as well as the rich training environments in the brown university, butler hospital, and cross-institute collaborations with harvard medical school, boston university, and john JAY college. This K23 project has important clinical and public health implications and will launch the PI's career as an independent research scientist.