Table 3.

Q1 results: lived experience perspectives of STARS-p.

Category	Sub-categories	Quotes
STARS philosophy
	Person-centredness of the protocol	“Allows deeper conversation with person and covers comprehensive list of topics, I like that it’s person-centred and allows someone to tell their story and assess how personally significant different items are….”
	Promotes (or challenges) engagement	“As a risk assessment tool goes, it seems OK. The focus of any risk assessment should be measured by how the person receiving the care feels about that care. Its efficacy would depend largely on the person delivering it. It needs to have a co-form around practicalities of connection to be able to deliver this and capture the information effectively.”
	Collaborativeness	“Truly a mutual collaborative protocol which honors the expertise of the lived and living experience of the help seeker. Co-authoring of information, analysis and strategies for protecting the individual empower the resilience and other strengths of them and their naturally determined supports….”
	Communication/narrative focus	“…Self-awareness, analysis and construction of safety planning is inherent in choice and control over the life that is reflected in the narrative of the individual - the worker is witness, reflection guide and coach. How powerful this might be if the worker has Lived Experience to deepen the connection and sense of belonging.”
	Facilitates transparency in relationship	“Liked how it’s open transparent / note taking – and about them seeing we GET THEIR STORY, not just some table/grid/rating.”
What STARS aspires to	Importance of how protocol is administered (how questions are asked, introduction and consent process, and giving power to the person).	“Its efficacy would depend largely on the person delivering it. It needs to have a co-form around practicalities of connection to be able to deliver this and capture the information effectively.”
		“It does not go far enough AWAY from risk assessment. I feel the person needs to be in control of their story. The interviewer is the one with the power - give that power to the person.”
		“Like most things, I think this could be a great tool or a poor tool depending on how it is used. I can see that the goal is for it to not be a checklist, but it would still very much depend on the way it’s administered as to whether it ends up feeling like a check-list or not.”
	Social factors/big picture recognition	“I love the inclusion of socioeconomic risk factors. However, how do you address these? e.g., Someone is there due to financial issues- are you going to find them help to address these issues?”
		“Recognizes systemic issues / social justice aspects around mental health. Removes sense of “blame” on the person. Reveals mental health as often a societal issue over and above the individual. I think the protocol is great.”
	Importance of training	“Proper training for the staff is imperative - can see that the process could also de-escalate the crisis exponentially - Good for everyone concerned - personalized it for the consumer….”
	Comparison to other tools	“Very comprehensive and very person centred; better than existing tools and very important for all workers - clinical and non clinical”
		“Amazing. Clear, poignant and relevant questions. Existing protocols are patronizing, not person-centred and largely useless because they do not reveal enough about what is actually going on for the person nor do they create a sense of confidence in the process and therefore people often lie or obscure their responses….”
	Multi-disciplinary/cross-service utility	“I think that the best potential for success with this tool is to look at the roles of the people that are going to utilize it with individuals. There are roles like mine that are community-based suicide prevention - have the time to have the conversation and follow up in the short and longer term. And importantly it’s the connection and ability to work collaboratively (with consent of course) to keep GP’s etc. involved”
	Comprehensiveness of protocol	“I think the explicit nature of the questions is important. I like the flow of the protocol as well. Great that it is asking about everything in a person’s life.”
	Availability of protocol	“I agree but I’m concerned about how readily available this protocol is. For example, how many people know about it?”
Continuity of care and meeting needs
	Delivery time concerns	“…Completing the document to the quality needed relies on having enough time and space for the person to feel comfortable & willing to share which could be a real challenge in busy services.”
	Recognition of diversity issues	“…there is also a lack of LGBTIQAP+ recognition in it. Sexual identity and gender identity are two different things and come with different risks and safety factors.”
		“…It does not really address intersectionality that exists between disadvantaged groups (LGBT+, disability, multicultural, etc.) and how they impact suicidality, also somewhat inaccessible for ND people in some questions (a common problem for psych measures in general)….”
		“…For LGBTIQ populations it needs to be introduced properly to actually have people open up and confide in the person interviewing. I.e., often useful to state pronouns on intro to person which allows a safe space for the person to confide if they have a diverse sexuality or gender”
	Use of SRA information for planning	“Ideally it could be used as a collaborative tool and shared between services so there’s an actual plan to address the issues raised - it could be hard for the person to identify all these needs and not have anyone help them actually meet them.”
	Setting dependent	“I cannot see this ever happening in an ED, but I think it would be great in a Safehaven type setting.”
	Relevance and follow-on to other services	“It’s a great risk assessment tool, but I’m still concerned about support & follow-up as I feel this would still be at the clinician’s/health facility’s/service’s discretion”