Efficiency of AIMS: A 4‐Week Recovery Oriented Suicide Prevention Pathway

ABSTRACT

The global rise in presentations to emergency departments (EDs) for suicidal crises has created significant challenges for healthcare systems. Traditional approaches often emphasise containment and risk aversion, leading to prolonged ED stays and resource‐intensive inpatient admissions. A large Australian metropolitan mental health service introduced a Wellbeing Team (WBT), and trialled the recovery‐oriented AIMS (assessment, intervention, monitoring, step up/down) pathway. Grounded in the PROTECT framework, its focus is on person‐centred care, integrating positive risk‐taking and collaborative safety planning to stabilise individuals and reduce reliance on public mental health services. This study analysed 552 people referred to the WBT over 32 months, primarily from EDs (47.1%) and acute care teams (47.5%). The population predominantly consisted of women (63.2%), with a mean age of 27.9 years. The most common diagnoses were adjustment disorders (30.4%), depressive episodes (22.3%) and emotionally unstable personality disorder (14.7%). The WBT provided tailored interventions, including motivational interviewing, safety planning, distress tolerance techniques and psychopharmacological optimisation, guided by tools like the DESPAIR safety formulation. Outcomes revealed significant system efficiencies, with only 3.8% of participants requiring ongoing public mental health support. Most participants were successfully transitioned to primary care. Six‐month post‐intervention data showed 76.3% of individuals with no prior public mental health involvement did not re‐present, and 60.7% with prior involvement did not require further input from secondary mental health services. These findings demonstrate the efficiency of recovery‐oriented care in reducing systemic pressures while fostering sustainable outcomes, underscoring the potential of short‐term, intensive, structured interventions like AIMS to transform suicide prevention pathways.

1. Introduction

Globally, presentations to emergency departments (EDs) for mental health crises, including suicidal distress, are rising sharply, posing significant challenges for healthcare systems. Between 2009 and 2018, ED visits for suicidal ideation and suicide attempts increased by 414% in the United States (Ahmad et al. 2021). In Australia, over 287 500 individuals presented to public EDs with mental health‐related crises in 2022–2023, representing 3% of all ED presentations (Australian Institute of Health and Welfate 2024). The ED environment is ill‐suited for individuals in suicidal crisis, with overstimulating settings, lack of privacy and unmet basic needs compounding patient distress (Clarke et al. 2007). Resource constraints in EDs, inadequate inpatient psychiatric bed stock and lack of alternative community‐based crisis services often results in extended ED lengths of stay (ALOS). Nationally, 90% of mental health‐related ED presentations in Australia exceed 12.5 h, with many patients waiting 8 h or more for inpatient admission (The Long Wait: An Analysis of Mental Health Presentations to Australian Emergency Departments 2018).

At one large Australian metropolitan public hospital, 60% of mental health presentations to the ED centred around suicidality. Traditional approaches to managing suicidal distress in EDs emphasise containment, prolonged monitoring and/or inpatient admission, perpetuating a cycle of dependency and disempowerment and potentially heightening suicidality through the helplessness engendered by these restrictive practices.

Our approach to addressing the growing demand for ED crisis care shifted fundamentally in 2019 with the embedding of recovery‐oriented practices for suicide prevention as postulated by the PROTECT (PROactive deTECTion) framework (Kar Ray et al. 2023). Recognising that recovery and risk are inseparable, we moved from traditional, deficit‐focused risk management practices, such as prolonged ED stays to contain distress or automatic inpatient admission to contain risk, and embraced a recovery‐oriented philosophy centred on positive risk‐taking and person‐centred care. The focus shifts from a hierarchical ‘fixer’ mindset, where clinicians aim to eliminate risk through restrictive practices, to a collaborative ‘enabler’ role, in which the therapeutic relationship acts as scaffolding for safety and recovery. Using tools such as the 1‐2‐7 safety planning conversation aid (Appendix S1), clinicians engage individuals in structured, strength‐based dialogues, exploring their emotional pain, internal and external coping strategies and pathways to hope. These conversations prioritise relational safety, recognising the power of nonjudgmental acceptance and shared decision‐making in helping individuals navigate their distress (Kar Ray and Lombardo 2021).

The shift was a complex intervention requiring leadership, governance and innovation to create systemic change. The intervention redefined safety planning as a process of guided discovery, enabling individuals to reconnect with their strengths, regain a sense of control and collaboratively chart a path toward recovery. These efforts had a transformative impact. Average length of stay in the ED dropped from 17.3 to 8.6 h, with a 68% reduction in patients staying over 24 h and a 16% decrease in inpatient psychiatric admissions over 2019–2020 (Kar Ray et al. 2023), a trend that has continued with ED ALOS further dropping to 1.2 h in 2023. More importantly, the intervention demonstrated that safety and recovery can coexist through a person‐centred, values‐driven approach that fosters both hope and sustainable outcomes.

Although these innovations significantly alleviated pressures within the ED, they inadvertently shifted substantial workload to community mental health services. People diverted from psychiatric admission often required intensive follow‐up by the acute care team (ACT), a team with a maximum of six clinicians working any given shift whose caseload had already surpassed 200 patients per month by 2019. Many of these people presented with high levels of distress, particularly in terms of suicidality. Managing these complex cases increased demand on the ACT, challenging its capacity to provide the intensive, short‐term support necessary for patients in crisis.

Following their time with the ACT, people requiring ongoing care have typically been referred to the community care teams (CCTs) for longer‐term management and recovery support. However, the CCTs already faced substantial pressure, with clinicians managing average caseloads of over 30 patients. This workload limited the ability of the CCTs to proactively address the needs of people in suicidal distress, strained resources and diminished the capacity to provide meaningful longer‐term support to individuals with enduring mental health conditions such as schizophrenia or bipolar disorder.

The Wellbeing Team (WBT) was established in 2020 as a recovery‐oriented solution addressing the systemic pressures created by rising mental health presentations, particularly suicidal crises, and the changes in ED approach to these. Grounded in the PROTECT framework, the WBT introduced the AIMS (assessment, intervention, monitoring, step up/down) pathway as a structured, intensive, short‐term intervention aimed at stabilising individuals in suicidal distress and reducing their reliance on public mental health services. Central to its philosophy is the belief that recovery is not possible without risk. The WBT focusses on positive risk‐taking, empowering individuals to become active participants in their recovery by recognising and building on their inherent strengths. By moving from a deficit‐based approach of ‘what's the matter with you?’ to an asset‐focused inquiry into ‘what matters to you?’ the WBT fosters hope and connection, helping individuals rediscover the values that underpinned their distress and using those as a foundation for recovery (Kar Ray et al. 2019).

The AIMS pathway, which operationalises relational safety via structured, strength‐based conversations, translates this recovery philosophy directly into practice. Individuals engage in collaborative safety planning that promotes autonomy and resilience. The inclusion of lived experience staff reinforces the philosophy of shared humanity and mutual empowerment, fostering a culture of trust, transparency and mutual understanding. Their contributions help dismantle perceived power imbalances, creating an environment where individuals feel heard, supported and empowered to take ownership of their recovery.

Initial evaluation of this approach was promising, showing that individuals on the AIMS pathway experienced a 51.7% improvement in wellbeing as measured by the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) (Keetharuth et al. 2024), with significant gains across all seven prompts, including dealing with problems (+73.5%) and feeling relaxed (+60.2%) (Kar Ray et al. 2025). These findings underscore the WBT's central hypothesis: that intensive, short‐term, recovery‐oriented care can stabilise individuals in crisis and reduce long‐term reliance on public sector services. By focusing on collaborative safety planning and connection to community resources, the WBT empowers individuals to draw on their strengths, families and communities. This approach not only supports recovery and reduces suicidality but also enhances system‐wide efficiency by diverting individuals away from resource‐intensive public services toward sustainable, person‐centred networks of care. Although the WBT's effectiveness in improving individual wellbeing is well documented, the claim of a broader impact on clinical efficiency remains unclear. This study seeks to evaluate whether the WBT has successfully reduced pressures on EDs, acute care teams (ACTs) and community care teams (CCTs) by addressing the following questions:

1. Referral sources: Where did patients accessing the WBT come from? Were they primarily diverted from EDs or acute care teams (ACTs), thereby alleviating these high‐pressure points?

2. Patient profiles: What are the demographics and diagnostic characteristics of the population served by the WBT? Are these individuals representative of those previously reliant on more resource‐intensive care pathways?

3. Post‐discharge outcomes: Where were patients transitioned to following their time with the WBT? Did they re‐present in crisis within 6 months? This will help determine whether the WBT has effectively reduced long‐term reliance on public mental health teams or merely created a temporary shift in demand.

By addressing these questions, this study seeks to evaluate whether the WBT's recovery‐oriented approach has achieved both individual stabilisation and system‐wide efficiency. Specifically, it examines whether the structured, short‐term AIMS pathway based on the PROTECT framework enables individuals in suicidal crisis to chart a path toward recovery while optimising resource allocation across the mental health system. The findings will offer critical insights into the potential of recovery‐driven, collaborative interventions like the WBT to create sustainable, person‐centred alternatives that alleviate systemic pressures.

2. Methods

The study protocol was reviewed and approved by the Human Research Ethics Committee. Data on referrals to the WBT over a 32‐month period from January 2020 until September 2022 were systematically collected through a review of electronic medical records. Information included demographic and clinical data, referral sources, length of contact, discharge destinations and re‐presentations to public mental health services within the 6 months post‐intervention. All data were recorded in Microsoft Excel and coded for comparison.

Referrals that were not actioned (consumer declined, cancelled or could not be contacted) were excluded from the study. A total of 552 clinical records were included in the analysis. Data were analysed using descriptive statistics to evaluate the demographics and outcomes of participants, referral patterns and post‐intervention service utilisation.

3. Results

Over the 32‐month study period, 552 individuals participated in the AIMS pathway. Most participants were referred from EDs or the ACT, with much smaller contributions from tele‐triage and self‐referral. Primary diagnoses assigned during ED assessment revealed a high prevalence of mood, personality and anxiety disorders.

Demographic, referral and diagnosis data are summarised in Table 1.

TABLE 1.

Who came, from where, with what?

Demographics
	Mean	Range
Age (years)	27.9	18–66
Length of contact (days)	34.2	14–87

	Number	Percentage (%)
Male	192	34.8
Female	349	63.2
Transgender/gender non‐conforming	11	2
Referral source
ACT	262	47.50%
Emergency department	260	47.10%
Tele‐triage (MHCall)	17	3.10%
Self‐referred	7	1.20%
Other	6	1.10%
Primary diagnosis assigned in ED
Adjustment disorder	168	30.4
Depressive episode	123	22.3
Emotionally unstable personality disorder	81	14.7
Anxiety with depressed mood	34	6.1
Mental/behavioural disorder due to substance misuse	22	4
Suicidal ideatio a	20	3.6
Panic disorder	18	3.3
Accentuation of personality traits	17	3.1
Anxiety disorder	11	2
PTSD	10	1.8
No diagnosisF a	10	1.8
OCD	8	1.4
Bipolar disorder	7	1.3
Dysthymia	6	1.1
Depressive episode severe	5	0.9
Other a	12	2.2

^a Persistent mood disorder NOS, ADHD, schizophrenia, acute intoxication, acute stress reaction, somatisation disorder, cyclothymia, mood disorder NOS, hypochondriacal disorder and overdose/self‐poisoning or Suicidal ideation All patients presenting to pathway were in suicidal distress, the subgroup of 20 did not have any primary diagnosis documented in the diagnosis field other than Suicidal Ideation, for no diagnosis please add This is an issue of missing diagnosis in the Electronic Patient Records than the absence of a clinically diagnosable condition.

3.1. Discharge Destinations

Following intervention, most individuals were transitioned to external supports, with only a small proportion requiring public mental health services. Discharge referral data are detailed in Table 2. Note that many patients were referred to more than one discharge destination at step down.

TABLE 2.

Referral destinations on discharge.

Referral destination	Number	Percentage
General practitioner	471	85.5
Non‐government organisation	272	49.4
Private psychologist	125	22.7
Private psychiatrist	60	10.9
Continuing care team (public)	21	3.8
No referral made	10	1.8
Admission (private)	10	1.8
Admission (public)	9	1.6
Counselling (private)	7	1.3
Continuing care team (private)	1	0.2
Total referrals	976

3.2. Re‐Presentations at 6 Months

The re‐presentation data showed low rates of re‐presentation to public mental health services, particularly among individuals with no prior public mental health service contact. Re‐presentation rates are summarised in Table 3.

TABLE 3.

Re‐presentations at 6 months.

	Presentations pre and post intervention	Number	Percentage by previous presentation	Percentage of total
No previous presentations		249		45.1
	Did not re‐present to MHS	190	76.3	34.4
	Re‐presented to MHS	59	23.7	10.7
Previous presentations		303		54.9
	Did not re‐present to MHS	184	60.7	33.3
	Re‐presented to MHS	119	39.3	21.6
Total		552		100

4. Discussion

The WBT exemplifies a recovery‐oriented, person‐centred model of care designed to meet the needs of individuals in suicidal crisis. Its effectiveness is reflected in the previously published study which showed a 73.5% improvement in wellbeing scores (Kar Ray et al. 2025). By integrating clinical expertise with lived experience, the WBT creates a collaborative framework empowering individuals to take ownership of their recovery while fostering hope and resilience. This approach is operationalised through AIMS (assessment, intervention, monitoring, step up/down), a structured, 4‐week pathway within the PROTECT framework. We will now consider the results of the study in the context of the four core functions of AIMS.

4.1. Demographics and Referral Sources

Over the 32‐month study period, the WBT provided structured, intensive, short‐term care to 552 individuals, with a mean age of 27.9 years and a female preponderance (63.2%). This demographic aligns with the higher prevalence of suicidality and help‐seeking behaviours observed among women (Eaton et al. 2012; Richardson et al. 2023). The primary sources of referral were EDs (47.1%) and the ACT (47.5%), indicating that the WBT effectively functioned as a diversionary pathway for individuals in suicidal crisis. Referrals from EDs directly into the WBT alleviated ED pressures, allowing patients to bypass the need for ACT involvement, whereas those already referred to ACT were transitioned to the WBT for specialised support. This dual diversionary mechanism reduced ED average length of stay and relieved ACT caseloads, illustrating the WBT's capacity to optimise system efficiency.

4.2. Welcome Letters: Setting the Foundation for Containment and Trust

The Welcome Letter (sample in Appendix S2), provided to individuals as they leave the ED, serves as the first step in establishing containment and fostering hope. This letter, which includes an overview of the WBT and a scheduled appointment within 24 h, helps reduce uncertainty and provides individuals with a clear next step in their care journey. By ensuring individuals know they will be seen promptly in a specified place at a specified time, the Welcome Letter instils confidence and mitigates distress, which is critical for those discharged amid suicidal crisis.

4.3. Collaborative Assessment: A Dual Perspective Approach

The initial WBT assessment is a comprehensive, collaborative bio‐psycho‐social evaluation. This assessment is uniquely designed to integrate the expertise of clinicians with the lived experience of peer workers, ensuring a holistic understanding of the individual's situation.

4.4. Clinicians' Role in the Assessment

Clinicians focus on understanding the symptomatology, aetiology and psychosocial factors contributing to the individual's distress. Their role includes identifying triggers, risk factors and protective elements while collaboratively exploring the person's goals and aspirations. This clinical insight ensures the development of a robust foundation for individualised interventions.

4.5. Peer Workers' Role in the Assessment

Working alongside clinicians, peer workers contribute their lived experience to create a sense of relatability and hope. From the outset, peer workers engage individuals in the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), capturing baseline wellbeing and initiating a conversation rooted in shared humanity. The peer worker's role continues through the 1‐2‐7 safety planning conversation, which facilitates a structured exploration of immediate concerns, plans for the next 2 days, and strategies for navigating the following week. Peer workers lead this aspect of the assessment, ensuring that the immediate risks are mitigated while fostering a sense of autonomy and self‐agency in managing distress. Depending on the individual's state of mind, this conversation may be extended into a more comprehensive safety plan, tailored to address their specific needs and concerns. If the person is feeling exhausted after a lengthy assessment, the peer worker will continue the detailed safety planning conversation the next day through telehealth, offering empathetic support and practical insights that enhance the individual's sense of safety and control.

One peer worker reflected on their contribution, stating:

As a peer worker within the Wellbeing Team, we use our lived experience parallel to clinical care. We meet consumers where they are at and role model hope by drawing on our own mental health struggles. We share our stories and coping strategies, experiences with services, and how we are able to persist when we face setbacks. This enhances the transparency, relatability and comfort to assessments and follow‐up.

4.6. Strength‐Based Conversations: Shifting the Narrative

The WBT's assessment process exemplifies a strength‐based approach, shifting the focus from ‘what's the matter with you’ to ‘what matters to you’. This paradigm shift empowers individuals to explore the underlying values and priorities that shape their distress and recovery goals. This collaborative exploration ensures that the individual is seen not just through the lens of their diagnosis but as a whole person with unique strengths and aspirations. The previously published SWEMWBS findings (Kar Ray et al. 2025) highlight the impact of the WBT's recovery‐oriented approach during assessment. The significant improvements in domains such as ‘feeling relaxed’ (+60.2%) and ‘thinking clearly’ (+52.8%) underscore the effectiveness of the initial containment and collaborative dialogue. These early gains lay the groundwork for sustained progress, as individuals are equipped to address their distress with clarity and resilience.

4.7. Diagnosis: A Recovery‐Oriented Perspective

The WBT integrates recovery‐oriented care with the critical role of accurate diagnosis, ensuring interventions are both person‐centred and clinically sound. The three most common diagnoses—adjustment disorders (30.4%), depressive episodes (22.3%) and emotionally unstable personality disorder (EUPD) (14.7%)—align with the typical presentations seen in individuals accessing EDs and acute care teams (ACTs) for suicidal crises, underscoring the generalisability of the WBT model.

4.8. Adjustment Disorders and the Complexity of ‘What Matters’

Adjustment disorders, while often transient, are nonetheless distressing for those experiencing them. These presentations typically reflect acute crises related to significant life stressors—relationships, employment, housing instability, financial issues or trauma. Although these individuals might not meet the criteria for a major depressive episode, their suicidal distress can be equally severe, as it stems from the disintegration of what matters most to them. The WBT's 4‐week intensive intervention offers the focused, time‐sensitive support required to address these crises, equipping individuals with coping mechanisms that facilitate recovery without necessitating prolonged involvement in secondary care services.

4.9. Addressing Enduring Conditions: Depressive Episodes and EUPD

For individuals with depressive episodes or EUPD, the WBT provides an alternative to resource‐intensive pathways such as inpatient admissions or extended community mental health team care. People with EUPD in particular often consume a disproportionate amount of public mental health resources due to their high acuity and complex needs. By stabilising these individuals through structured, recovery‐oriented care, the WBT reduces demand on secondary services while empowering individuals to manage their distress and connect with community and/or primary care supports.

4.10. Beyond Clinical Labels: Integrating Diagnosis and Narrative

In line with the WBT's philosophy, diagnosis is not viewed as a static label but as a dynamic part of an individual's broader narrative. Clinicians and peer workers collaboratively explore how the diagnosis intersects with the individual's lived experiences and values, ensuring that care planning aligns with ‘what matters to you’ rather than being limited to ‘what's the matter with you’. This approach transforms diagnostic processes into opportunities for engagement and empowerment, helping individuals contextualise their struggles within their own unique stories.

4.11. Interventions: Person Centred and Tailored to Unique Needs

At the heart of the WBT's intervention strategy lies the Care Compass (Kar Ray and Lombardo 2021) (Figure 1), a conceptual framework designed to navigate the balance between safety and self‐reliance. The compass operates on two axes: the x axis, representing the person's state, spanning from fragility to resilience, and the y axis, denoting the team's focus, which ranges from prioritising safety to fostering self‐reliance. The goal is to collaboratively guide people from the bottom‐left quadrant of fragility and safety to the top‐right quadrant of resilience and self‐reliance. This movement reflects a recovery‐oriented trajectory where people gradually gain control over their lives.

FIGURE 1.

The Care Compass.

The Care Compass offers a visual and reflective tool that enables shared decision‐making, helping individuals understand their journey while clinicians and peer workers adapt their approaches dynamically. In the initial stages of engagement, the focus may heavily lean on safety. Over time, as the person's resilience grows, the team steps back, facilitating a transfer of agency to the individual while still offering guidance.

4.12. DESPAIR Safety Formulation as a Guide for Action

Interventions within the WBT are guided by the DESPAIR safety formulation (Kar Ray and Lombardo 2021) (Figure 2), a seven‐item framework that evaluates dynamic and modifiable risk factors. The acronym encompasses diagnosis, entrapment, suicidality, past attempts, agitation, intent and risk response. Introduced during the first multidisciplinary team review in Week 1, this tool informs the person's individualised care plan and the ongoing balance between prudent risk‐taking and safety.

FIGURE 2.

The despair safety formulation.

One of the key strengths of DESPAIR is its ability to visually map risk factors, enabling collaborative exploration of scenarios and solutions. For instance, the risk response dimension highlights the ability of the person, their family and their natural support network to manage dynamic risks. This collaborative process ensures that safety planning moves beyond static documents, instead evolving as a living framework tailored to personal circumstances.

The DESPAIR safety formulation informs the selection and prioritisation of interventions:

• Diagnosis and entrapment: Medication initiation/optimisation is based on presenting symptoms, and Mindfulness and Acceptance and Commitment Therapy interventions address feelings of entrapment, providing individuals with tools to reframe their distress and connect with what matters most to them.

• Suicidality and agitation: Distress tolerance techniques and sensory approaches help manage acute emotional states, reducing the intensity of suicidal urges.

• Risk response: Collaborative solution‐focused safety planning engages patients and their natural support systems, ensuring risks are managed sustainably and empowering patients to take ownership of their recovery.

4.13. Interventions Rooted in Recovery and Resilience

The WBT delivers a range of evidence‐based interventions, guided by the AIMS framework and the Care Compass, to empower people to navigate suicidal distress and build resilience. These interventions are tailored to individual needs, informed by the DESPAIR safety formulation, and dynamically adjusted to balance safety and self‐reliance.

4.14. Core Therapeutic and Clinical Interventions

1. Motivational interviewing (MI) and solution‐focused therapy (SFT): These approaches enable individuals to identify their internal strengths and external resources, fostering a sense of agency. MI is particularly valuable for individuals with comorbid substance use issues, helping them explore and address ambivalence about change (Smedslund et al. 2011), whereas SFT emphasises achievable goals (Jerome et al. 2023). The impact of these techniques is directly reflected in the SWEMWBS findings (Kar Ray et al. 2025), especially the 73.5% improvement in ‘dealing with problems well’.

2. Scenario planning and SAFE workshops: SAFE (scenario planning; access to means, alcohol and other drugs; family, friends and follow up; essential plan) workshops provide hands‐on opportunities for people to design safety plans for fictional characters, learning to identify internal and external coping strategies, triggers and early warning signs. This experiential approach equips them to anticipate and manage future crises. Individual coaching sessions for challenging scenarios are provided to people who struggle with a group setting.

3. Psychopharmacological interventions: The WBT often initiates or optimises psychopharmacological treatments for individuals presenting with depressive episodes or emotional instability. Psychoeducation is provided about the purpose, benefits and potential side effects of these medications, helping them make informed decisions. General practitioners (GPs) are guided on continuing prescriptions, ensuring continuity of care post‐discharge. Psychiatric reviews are arranged as necessary to monitor and adjust treatment plans. This clinical support not only stabilises individuals during the 4‐week pathway but also enhances long‐term management in primary care.

4. Distress tolerance and sensory approaches: Distress tolerance skills, essential for individuals with EUPD, are taught using tailored sensory interventions, such as grounding exercises and sensory modulation tools. These approaches help patients manage acute emotional dysregulation and reduce the intensity of suicidal urges.

5. Mindfulness and acceptance and commitment therapy (ACT): Mindfulness practices and acceptance and commitment therapy‐based interventions focus on aligning actions with personal values and cultivating acceptance of difficult emotions using the HOPE Toolkit (Progress Guide 2024) (Appendix S3). For individuals with adjustment disorders, these strategies address the emotional distress caused by external stressors such as job loss, financial strain or relationship breakdowns, providing practical tools to navigate their challenges.

6. SAFER review cycle: A CBT‐based intervention, the SAFER cycle (Progress Guide 2024) (Appendix S4) transforms unconscious stress reactions into conscious stress responses. By understanding the link between thoughts, emotions and behaviours, people learn to manage urges to self‐harm and develop proactive coping strategies. This approach is particularly effective for those experiencing recurrent suicidal ideation or behaviours.

4.15. Monitoring: Building Resilience and Self‐Reliance

The monitoring phase of the AIMS framework focuses on the ability of individuals, their families and their natural support networks to understand and manage suicidal distress effectively. The WBT employs psychoeducation to enhance insight into the episodic nature of suicidality, emphasising that it often comes in waves but can pass. Although the WBT monitors the individual's progress during the intervention, the central goal is to prepare the individual and their support system for ongoing, self‐directed monitoring in the community. The various interventions introduced earlier play a critical role in this phase, helping individuals gain confidence in managing their emotional states and mitigating suicidal urges.

The effectiveness of the insight‐oriented monitoring process is reflected in the re‐presentation data. Among people with no prior public mental health involvement, four in five (76.3%) did not re‐present to public sector services within 6 months. For individuals with prior service engagement, three in five (60.7%) did not re‐present. Importantly, most re‐presentations were to EDs or tele‐triage services, and represented activation of the individual's safety plan. This demonstrates that individuals were not only aware of how to seek help but also capable of doing so constructively when needed.

These outcomes highlight the effectiveness of the WBT in preparing the person and their natural circle of support to maintain engagement in sustainable, person‐centred recovery pathways and monitor any evolving distress.

4.16. Step Up and Step Down: A Responsive, Person‐Centred Approach

The final stage of the AIMS pathway ensures that individuals are transitioned to appropriate care settings, with minimal reliance on resource‐intensive public sector services.

4.16.1. Step Up

Only 19 individuals (3.4%) required psychiatric admission (9 to public and 10 to private hospitals). These step ups were informed by the Care Compass philosophy, which prioritises safety when circumstances demand an intensified focus. The low rate of step ups highlights the responsiveness of the WBT in addressing crises.

4.16.2. Step Down

Most individuals were stepped down to primary care or community supports:

• 85.5% were connected with GPs, ensuring a foundation of continued care in the community.

• 49.4% were referred to non‐government organisations (NGOs), leveraging community‐based resources for additional support.

In total, 976 onward referrals were made across 552 participants, with many individuals linked to multiple services based on their unique needs.

The Goodbye Letter, (Appendix S5) provided at the point of discharge, encapsulates the individual's progress and achievements, serving as both a practical guide and a source of hope. It includes reminders of strategies learned, resources for future challenges, and a recovery toolbox tailored to the individual. This letter becomes a tangible representation of the individual's journey and a reinforcement of their capacity for self‐reliance, an important pillar in assuring the low rates of re‐presentation to and reliance on secondary mental health services.

The number and range of referral destinations demonstrates the WBT's commitment to addressing the diverse requirements of individuals in suicidal distress. By coordinating these connections, the WBT ensured that individuals had access to comprehensive, ongoing community‐based support tailored to their specific circumstances.

4.17. Long‐Term Impact and System Efficiency

The ability of the WBT to discharge individuals with minimal step ups and robust step down pathways contributes significantly to system efficiency. The structured nature of the AIMS pathway enables the WBT to address crises effectively, stabilise individuals, and refer on, reducing dependency on public sector mental health services.

By focusing on self‐reliance and connection to primary care:

• Individuals with adjustment disorders or transient crises received short‐term interventions that were sufficient to restore stability and prevent progression into long‐term care pathways.

• Those with more complex needs, such as people with depressive episodes or EUPD, were provided with intensive support that equipped them with tools to manage their conditions independently and referred on to community care providers as needed, significantly reducing the resource burden on public services.

The WBT's ability to provide person‐centred, recovery‐focused care is evident in the minimal rates of re‐presentation and step ups, and in the substantial engagement with primary care and NGO sectors. The integration of the Care Compass philosophy, operationalised through the DESPAIR safety formulation, ensures that interventions are guided by a balance between safety and self‐reliance, enabling individuals to transition toward meaningful, sustainable recovery.

4.18. Limitations of the Study

While the study provides valuable insights into the WBT's effectiveness and efficiency, several limitations must be acknowledged:

1. Short follow‐up period: The study followed participants for 6 months post‐intervention. A planned two‐year follow‐up study will examine the program's long‐term impact.

2. Qualitative feedback: Additional studies capturing qualitative feedback from both participants and staff are needed to deepen understanding of the program's impact on recovery and relational safety.

3. External data: The study could not access data on participants' use of out‐of‐state or private care settings, limiting the ability to fully evaluate their post‐intervention recovery journeys.

4. Representative sampling: Without data on ED presentations not referred to the WBT, it is unclear whether the study sample is representative of all individuals in suicidal crisis.

5. Control group: The absence of a control group limits the ability to draw definitive causal conclusions about the WBT's effectiveness and efficiency. Ethical considerations make such comparisons challenging in this context.

5. Conclusion

The WBT offers a model for recovery‐oriented care that combines clinical expertise with lived experience to address the needs of individuals in suicidal crisis. Through systematised support and tools from the PROTECT framework, the WBT empowers individuals to regain control, build resilience and connect with their natural support networks. The program's results underscore the potential of short‐term, structured interventions to alleviate systemic pressures while fostering sustainable recovery. Future studies will build on this foundation, providing deeper insights into the long‐term impact of the WBT's AIMS pathway and its role as a transformative solution in mental health care.

6. Relevance for Clinical Practice

• Collaborative and holistic assessment: The integration of professional and peer expertise in the initial assessment allows for a comprehensive understanding of the individual's distress. By utilising tools like the DESPAIR safety formulation, team members collaboratively identify immediate risks and long‐term needs, ensuring care is personalised and recovery‐focused.

• Guided interventions with positive risk‐taking: The Care Compass offers a structured framework to dynamically balance safety and self‐reliance. Interventions such as motivational interviewing, distress tolerance and mindfulness are tailored to individual needs, addressing specific diagnoses while fostering resilience and autonomy.

• Insight‐oriented monitoring: By equipping individuals and their families with psychoeducational tools and emphasising the episodic nature of suicidality, the AIMS pathway empowers patients to manage distress independently post‐intervention. This patient‐centred monitoring reduces re‐presentations and enhances long‐term outcomes.

• Efficient step up and step down processes: The WBT's minimal reliance on public mental health admissions (1.6%) and robust step‐down strategies, including an 85.5% linkage to general practitioners, highlight the effectiveness of the pathway in ensuring appropriate transitions to community‐based care and optimising resource utilisation.

• Relational safety and empowerment: Key elements like the Welcome Letter and Goodbye Letter foster trust, provide hope and reinforce progress. The inclusion of peer workers enhances relational safety, creating a supportive therapeutic environment that reduces perceived power imbalances and strengthens engagement in recovery.

Author Contributions

In accordance with the submission guidelines of the journal, all authors acknowledge that the following applies: made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of data; drafted the article or revised it critically for important intellectual content; approved the version to be published and each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. M.K.R. and C.L. supported the original concept development. M.A. conducted the analysis of data. All other authors critically revised the manuscript and provided expert opinions. All authors are in agreement with the manuscript.

Ethics Statement

Data shared in the paper is approved by the Human Research Ethics Committee of Metro South Health.

Conflicts of Interest

The authors declare no conflicts of interest.

Conflicts of Interest

M.K.R. authored the guidebook and workbook for the PROTECT Suicide Prevention framework referred to in the article and delivers remunerated suicide prevention training internationally for Progress Guide. The other authors declare no conflicts of interest.

Supporting information

Appendix S1.

Appendix S2.

Appendix S3.

Appendix S4.

Appendix S5.

Kar Ray, M. , Groth A., Geffen N., et al. 2025. “Efficiency of AIMS: A 4‐Week Recovery Oriented Suicide Prevention Pathway.” International Journal of Mental Health Nursing 34, no. 3: e70080. 10.1111/inm.70080.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.