The Broad-Minded Affective Coping (BMAC) intervention is a theory-driven cognitive therapy aiming to reduce suicidal ideation through guided positive mental imagery. We explored the feasibility and acceptability of a randomised controlled trial to evaluate the BMAC intervention in university students. The trial was a two-arm, randomised (ratio 1:1) controlled feasibility trial comparing risk assessment and signposting with or without the BMAC intervention (ISRCTN 13621293; ClinicalTrials.gov NCT05296538). Participants had recent suicidal ideation or behaviour. Feasibility outcomes concerned recruitment, retention, intervention adherence, completion of a suicidal ideation assessment, and the safety of the procedures. Clinical outcomes and putative mechanisms were recorded at baseline and after eight, 16, and 24-weeks. All feasibility criteria were met. Sixty-five participants were randomized (99 % of target sample). Retention to follow-up was high at all timepoints (89-91 %). In the treatment arm, 30 out of 33 participants (91 %) attended ≥2 sessions of the BMAC. Retained participants completed a suicidal ideation assessment with no missing data. There were 19 serious adverse events, but none were related to the trial procedures or intervention. Effect estimates for suicidal ideation favoured the intervention. The trial and intervention were acceptable, feasible, and safe. The efficacy of the intervention requires evaluation in a definitive trial.

Going to university is an important milestone in many people’s lives. It can also be a time of significant challenge and stress. There are growing concerns about mental health amongst student populations including suicide risk. Student mental health and counselling services have the potential to prevent suicide, but evidence-based therapies are required that fit these service contexts. The Broad-Minded Affective Coping intervention (BMAC) is a brief (6 sessions), positive imagery-based intervention that aims to enhance students access to past positive experiences and associated emotions and cognitions. Pilot data provides preliminary support for the BMAC for students struggling with suicidal thoughts and behaviours, but this intervention has not yet been evaluated in the context of a randomised controlled trial (RCT). The Mental Imagery for Suicidality in Students Trial (MISST) is a feasibility RCT that aims to determine the acceptability and feasibility of evaluating the BMAC as an intervention for university students at risk of suicide within a larger efficacy trial. Key feasibility uncertainties have been identified relating to recruitment, retention, and missing data. Intervention acceptability and safety will also be evaluated. MISST is a feasibility randomised controlled trial design, with 1:1 allocation to risk assessment and signposting plus BMAC or risk assessment and signposting alone. Participants will be university students who self-report experiences of suicidal ideation or behaviour in the past 3 months. Assessments take place at baseline, 8, 16, and 24 weeks. The target sample size is 66 participants. A subset of up to 20 participants will be invited to take part in semi-structured qualitative interviews to obtain further data concerning the acceptability of the intervention. The BMAC intervention may provide an effective, brief talking therapy to help university students struggling with suicidal thoughts that could be readily implemented into university student counselling services. Depending on the results of MISST, the next step would be to undertake a larger-scale efficacy trial. The trial was preregistered (17 December 2021) on ISRCTN (ISRCTN13621293) and ClinicalTrials.gov (NCT05296538).

Suicide is a serious public health problem but,a problem that is preventable. This complex and challenging problem is particularly prevalent among prisoners, who are associated with a five foldincrease in risk compared to the general community. Being in prison can lead people to experience fear, distrust, lack of control, isolation, and shame, which is often experienced as overwhelming and intolerable, with some choosing suicide as a way to escape. Few effective psychological interventions exist to prevent suicide, although cognitive behavior therapies appear to offer some promise. Offering cognitive behavior suicide prevention (CBSP) therapy to high-risk prisoners may help to reduce the likelihood of self-inflicted deaths. In this paper we present three cases drawn from a randomized controlled trial designed to investigate the feasibility of CBSP for male prisoners. Implications of the current findings for future research and clinical practice are considered.