Exploring barriers to crisis support: Considerations for the design of automated digital suicide prevention interventions.

Suicidal thoughts and behaviors pose a major public health concern and are a leading cause of mortality in young adults. However, formal mental health care utilization remains limited due to attitudinal and structural barriers, including stigma. Digital mental health interventions (DMHIs) offer a promising alternative approach to help-seeking, especially for young adults who prefer self-managing their symptoms. Text messaging-based safety planning interventions can be a scalable approach to seek help that can mitigate many structural barriers and can be useful for young adults. In this study, we conducted two online focus groups (n=15 each) to understand what prevents young adults from seeking help for their suicidal thoughts and behaviors and what might prevent them from engaging with a fully automated text messaging-based safety planning intervention. Participants reported barriers to help seeking both within and outside crisis states. Outside crisis states, the major barriers to help seeking included an unwillingness to burden others, negative prior experiences, inability to verbalize distress, high cost of professional help, fear of repercussions, stigma, and inconsistency with self-image. During crisis, participants reported difficulty following through with a safety plan. Despite a preference for self-management, participants expressed skepticism towards a fully automated intervention, citing privacy concerns, doubts about effectiveness, and a desire for human support. Our findings highlight a key tension in designing DMHIs: while young adults prefer self-managing their problems, they may also disengage from DMHIs that lack human support. Understanding these barriers are critical for developing DMHIs that balance autonomy with perceived effectiveness and support.