Family Interventions for Suicide and Self-Harm: A Scoping Review of Definitions, Populations, and Approaches

Suicide is a profound human tragedy that ripples far beyond the individual who takes their own life. It touches families, friends, and entire communities, leaving behind a network of people who must navigate grief, fear, and the complex task of keeping one another safe. For decades, the medical and psychological response to this crisis has focused almost entirely on the person in distress. Treatments have been designed to help that individual manage their thoughts, cope with pain, or change their behavior. While these individual-focused approaches are vital, they often overlook the most immediate environment where a person lives: their home and their relationships. Families are not just a backdrop for suicide; they are often the primary source of emotional security and practical support, yet they can also be a site of conflict or misunderstanding. Recognizing that suicide is a relational experience, researchers have begun to ask whether involving family members in prevention efforts could make a difference. But to answer that question, one must first define what a "family" actually is in a world where family structures vary wildly across cultures and generations.

A new review of research, conducted by a team of scholars from universities in Australia, New Zealand, the United Kingdom, and the United States, set out to map the landscape of family-based interventions for suicide and self-harm. The researchers did not test a new treatment themselves; instead, they gathered and analyzed 135 existing studies published between 1990 and 2025. Their goal was to understand how these programs are built, who they include, and how they are developed. They looked for patterns in the types of therapies used, the settings where they take place, and the specific roles family members play. Crucially, they examined whether the people these programs are meant to help—the families themselves—were actually involved in designing the solutions. The review reveals a field that is active and growing but remains conceptually uneven, often relying on narrow assumptions about who constitutes a family and how they should be engaged.

The most common approaches found in the review fall into three main categories. The largest group involves family-based therapy, where a therapist works directly with the family unit to improve communication and relationships. Another significant portion of the studies focuses on "means restriction" or safe storage, which involves teaching families how to secure dangerous items like firearms or medications to prevent immediate access during a crisis. A third common approach is psychoeducation or gatekeeper training, where family members are taught to recognize warning signs and learn how to respond effectively. These interventions take place in a wide variety of settings, including hospitals, schools, and community clinics, and they range from single, brief conversations to multi-year programs. However, the review found that the duration and structure of these programs are often poorly reported, making it difficult to compare them or understand exactly how long a family needs to engage to see results.

One of the most striking findings concerns the definition of "family" itself. Despite the fact that families come in many forms—nuclear, extended, chosen, foster, or tribal—only four of the 135 studies explicitly defined what they meant by the word. Most studies operated on an unspoken assumption that a family consists of a co-resident nuclear household, typically involving parents and children. This narrow view overlooks the reality of many people's lives. For instance, in many Indigenous cultures, family extends to include elders, clan members, and a wide network of kin who share responsibility for a child's well-being. Similarly, for young people in foster care or those from LGBTQ+ communities, the most supportive figures might be chosen family members rather than biological relatives. By failing to define family explicitly, many studies risk excluding the very people who could provide the most critical support, limiting the effectiveness of their interventions in diverse communities.

The review also uncovered a significant gender imbalance in who is actually participating in these programs. In the studies that reported the gender of the caregivers involved, mothers or female-identified caregivers made up an average of 72 percent of the participants. Fathers or male-identified caregivers were present in only about 27 percent of those cases, and in some studies, they were entirely absent. This pattern suggests that the emotional labor of keeping a young person safe falls disproportionately on women. The researchers noted that this exclusion of fathers is not just a matter of fairness; it can be a safety issue. For example, if a family needs to secure a firearm, and the father is the one who owns or controls it, an intervention that only engages the mother may fail to secure the home effectively. The review suggests that clinical practices often default to contacting the mother because she is the one who brings the child to the clinic, inadvertently reinforcing a system where men are viewed as secondary supporters rather than essential partners in safety.

Another critical gap identified is the lack of "co-design" in these interventions. Co-design is a process where the people who will use a service help to create it from the very beginning, ensuring it fits their needs, culture, and daily lives. The review found that only about 7 percent of the studies used this approach. The vast majority of programs were developed by researchers and clinicians and then handed down to families. The few exceptions where co-design was used were mostly found in digital health apps and programs developed in partnership with Indigenous communities. In these successful cases, the resulting interventions were more culturally relevant and sustainable because the community members themselves had shaped the framework. The absence of this collaborative approach in most studies means that many programs may not be well-suited to the complex, time-pressured realities of the families they aim to help.

The evidence base is also heavily skewed toward young people. More than 80 percent of the studies focused on children, adolescents, and young people transitioning to adulthood. This focus often frames family involvement as a matter of legal guardianship, where parents are responsible for a dependent child. Consequently, there is very little research on how to involve families in suicide prevention for adults, older people, or parents experiencing perinatal distress. The review highlights that while family dynamics matter at every stage of life, the tools and strategies developed for teenagers are rarely tested or adapted for adults who may have spouses, partners, or aging parents as their primary support network.

Ultimately, this review paints a picture of a field that is wide in scope but narrow in its conceptual foundations. Family-based interventions are widely used and show promise, but they are often built on unexamined assumptions about what a family is and who should be involved. The researchers conclude that for these interventions to be truly effective and equitable, the scientific community must move beyond the default nuclear family model. They need to explicitly define family in ways that include diverse kinship structures, actively engage fathers and male caregivers, and involve the communities they serve in the design process. Until these gaps are addressed, the full potential of family as a protective force in suicide prevention will remain unrealized, leaving many families without the specific, culturally attuned support they need to navigate these crises.