Service user experiences and provider attitudes towards a caring contacts suicide prevention intervention : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand

Figures 1, 2 and 3 are re-used with the publishers' permission.Suicide prevention is a global public health priority. Caring contacts (CC) is a suicide prevention intervention that has shown promise and increasing research interest. However, there has been a lack of clarity as to ideal intervention protocols, with service users having limited opportunities to meaningfully contribute to the design and development of the intervention. This study aimed to identify factors that could lead to improved implementation of CC delivered via text messaging in a New Zealand crisis mental health context. The primary study recruited 20 people who presented to the Wellington Emergency Department (ED) due to suicidal ideation or behaviour and agreed to receive 12 supportive one-way text messages over a period of 6 months. Of those recruited, 11 people completed follow-up interviews. Thematic analysis abstracted four themes related to participants’ experiences of receiving the messages: Caring Connection, Safety and Security, Reflections on Recovery, and Limitations. The secondary study explored service provider attitudes towards features of the intervention, suicide prevention and workplace culture towards research utilisation and implementation. Interviews with seven crisis mental health team members were conducted. Content analysis of interviews identified staff concerns about how service users may experience CC via text messaging, concerns about responsibility and possible flow-on effects. These concerns were underpinned by significant time constraints and resourcing pressures that also formed barriers to research engagement and service improvement efforts. This study has implications for understanding the mechanisms driving CC interventions and specific implementation considerations at the level of the innovation, provider, and organisation