Exploring barriers to crisis support: Considerations for the design of automated digital safety planning interventions.

Suicidal ideation is common among young adults in the United States and represents an important mental health concern. However, formal mental health care utilization remains limited due to attitudinal and structural barriers. Digital mental health interventions (DMHIs) offer a promising 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 seeking help that can mitigate many structural barriers for young adults. We conducted two online focus groups (n=15 each) to understand what prevents young adults from seeking help for their suicidal thoughts 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 include an unwillingness to burden others, inability to verbalize distress, 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. Understanding these barriers are critical for developing DMHIs that balance autonomy with perceived effectiveness and support.