Conference Agenda

Introduction:
The U.S. launch of the 9-8-8 Suicide and Crisis Lifeline in 2022 marked a significant policy intervention intended to transform crisis response. Yet little is known about how frontline crisis counselors understand the contextual drivers of suicide among callers.

Methods:
This qualitative study employed narrative inquiry and reflexive thematic analysis to examine the perspectives of 17 crisis counselors across eight U.S. states. Semi-structured interviews explored their insights regarding why callers contemplate or attempt suicide.

Results:
Counselors described suicide drivers as emerging less from psychiatric pathology and more from multi-contextual suffering rooted in relational disconnection, systemic racism, economic precarity, and structural violence. Participants highlighted tensions between the promise of 9-8-8 and systemic limitations, including uneven implementation, lack of resources, and declining trust among marginalized populations. Findings underscore the importance of affirming, justice-oriented, and contextually responsive crisis interventions.

Conclusions:
This study reframes suicide as a socially and structurally patterned phenomenon and highlights the need for policy reforms, counselor training, and prevention strategies that extend beyond crisis containment toward systemic transformation. The findings contribute to critical suicide studies and suggest pathways for more equitable, justice-oriented crisis care.

Introduction:
In November 2023, Canada launched 9-8-8, a national suicide crisis helpline offering trauma-informed and culturally affirming support. From inception, equity-focused service delivery and meaningful community engagement has been a priority for 9-8-8. This commitment is reflected through the early establishment and operations of the 9-8-8 Lived Experience Advisory Team (LEAT); comprised of individuals across Canada with personal and/or family experiences related to suicide, distress, and crisis line use.

Methods:

A structured model for engagement was co-created with advisors through an iterative, consensus-driven process. Model components included supports, impacts, and values; building on principles of equity, diversity, inclusion and accessibility. A mixed methods outcome evaluation was used to assess the effectiveness of the LEAT model in engaging people with lived experience and to examine the impact of LEAT contributions to 9-8-8 service design and delivery. Data was collected through surveys and focus groups with LEAT advisors, 9-8-8 staff and leadership.

Results:

Preliminary findings indicated that the engagement model operationalizes meaningful involvement through clearly defined governance, roles, responsibilities, and compensation, supporting the inclusion of people with lived experience while fostering psychological safety. 9-8-8 case examples demonstrated tangible contributions to service design and public communication strategies. Thematic and statistical analyses are ongoing, and will further examine advisor and staff perceptions of influence, engagement quality, and equity impacts, as well as identify facilitators and barriers to effective participation of LEAT members.

Conclusions:

Findings will inform refinements to LEAT structures and engagement strategies, strengthening the integration of lived experience in 9-8-8 decision-making. Results will support more inclusive and empowering engagement practices, reduce risks of tokenism, and inform recruitment and retention strategies to enhance diverse representation. This evaluation contributes to the evidence base on participatory approaches in suicide prevention and offers a replicable, equity-oriented model to inform policy, practice, and evaluation nationally and internationally.

AI is fast emerging in the crisis line context, yet there is limited evidence to guide these integrations. We have recently joined others in advocating for the safe and ethical use of AI in suicide prevention. This presentation will consider how to advance the application of AI within crisis line services, within a developing ethical framework of AI trust and safety.

We will demonstrate the process used by 9-8-8 Suicide Crisis Helpline in Canada, in collaboration with the Vector Institute for Artificial Intelligence, to assess and prioritize use-cases for an AI initiative, aligned with AI trust and safety principles.

This trust-and-safety–guided prioritization process was grounded in established responsible AI principles: privacy and security, fairness and bias mitigation, transparency and interpretability, and human oversight. We operationalized these principles within the context of suicide prevention through structured, multi-stakeholder user design workshops that facilitated discovery and decision-making. Participants included data and operations experts, researchers, and those with lived experience of using a crisis service. Together, we generated six candidate AI initiatives and assessed them using our multi-criteria framework that balanced value and risk. Criteria included potential impact, strategic alignment, urgency, feasibility, sustainability/maintainability, and risks and ethics, with explicit weighting that elevated risk-and-ethics considerations.

We will discuss the two use cases that emerged as priorities: (1) descriptive analysis of 9-8-8 call and text interactions to summarize themes and socially salient trends; and (2) quality assurance auditing of responder approaches against standard operating procedures. We will show how the prioritization process converted high-level principles into concrete requirements such as secure data handling and usable outputs designed for quality improvement.

Finally, we consider how this approach helps crisis systems advance AI responsibly such as maintaining strong data security and privacy protections, ensuring transparency and human oversight, and building safeguards that support sustained public trust.

Background - More people than ever are receiving support for mental health crises, and instances of suicide continue to grow. Mental health funding has recently increased, focusing on improving services that provide an alternative to emergency departments, such as urgent helplines and crisis cafés. However, there is a lack of literature examining the efficacy of these services, despite research suggesting they may be associated with lower hospital admission rates.

Aims - We aimed to evaluate the perspectives of people with lived experience of accessing a variety of mental health crisis services in the United Kingdom.

Method - One-to-one interviews were conducted with 25 individuals as part of a qualitative grounded theory analysis.

Results - The following themes were identified as important for recovery: more than a diagnosis (a need for person-centred care); instilling hope for the future (access to creative spaces and community); and a safe space for recovery (out-of-hours crisis cafés). Many credited crisis cafés with saving their lives and felt there should be increased funding provided for collaboration between the National Health Service (NHS) and the third sector. Participants highlighted the need for interim support for those awaiting therapy via the NHS and continuity of care as key areas for improvement.

Conclusions - NHS services are struggling to meet the mental health needs of the population, resulting in lengthy waiting times for therapy and an over-reliance on the third sector. While crisis cafés are currently provided at a low cost and appear to result in satisfaction, policymakers must ensure they receive adequate funding and do not become overburdened.

National policy frameworks, including the UK Government’s Suicide Prevention Strategy, emphasise person-centred, relational approaches that prioritise therapeutic engagement, collaborative safety planning, and a flexible understanding of psychosocial risk. Community-based suicide crisis support emphasising rapid access, person-centred care, and lived experience integration was established by a service in North-West England (Martin Gallier Project [MGP]) to provide immediate support with no clinical criteria, barriers to access, or waiting lists.

This study used a mixed-methods approach to evaluate the outcomes of individuals (n=9801) referred from the NHS (n=2929, 30%) or other non-NHS/self-referrals (n=6872, 70%) between 2019-2025. A sub analyses of 1387 (14%) client interventions showed significant improvements across all mental health recovery domains (p<0.05), particularly among older clients (65+ years). While NHS referrals initially scored slightly higher, final-stage outcomes were comparable across referral sources, indicating consistent effectiveness regardless of pathway. Demographic analysis showed MGP primarily serves adults aged 18–54, with balanced gender representation and inclusivity across identities. The high proportion of referrals without recorded diagnoses underscores MGP’s open-door ethos, challenging assumptions that suicidal crisis is confined to those with formal mental health conditions. Fifty interviews with clients, carers, staff, and referrers reinforced these results, highlighting rapid access, continuity of care, and person-centred support as critical factors in crisis intervention. Themes included the value of lived experience integration, holistic recovery approaches, and carer empowerment. Clients reported high satisfaction, with all interviewed participants recommending the service.

This research demonstrates that MGP delivers a life-saving, trauma-informed model bridging gaps between primary and secondary care. Its proven impact on mental health, coping skills, and social functioning supports replication and scaling as best practice in suicide prevention. Recommendations include leveraging evidence for sustainability and enhancing data quality through standardised processes. MGP represents an innovative, accessible framework with strong potential for regional, national and international adoption.