Suicide-related behaviours (SRB), including suicide attempts (SA) and suicidal ideation are common among young people. Up to 24% of 12–17 year-olds have reported suicidal ideation, and 7-11% have reported a 12-month prevalence of suicide attempt . These behaviours are one of the greatest concerns for Australian young people  and are associated with a range of negative outcomes including completed suicide and premature mortality via other causes [3, 4]. The prevention of suicide, and the development of a strategic research agenda targeting interventions for suicidal youth have both been cited as national priorities [5, 6], yet there remains a lack of high quality intervention research for suicidal individuals , including youth .
Depression is the most common risk factor for SRB. Suicidal youth are six times more likely to have a psychiatric disorder than non-suicidal youth [9–11]. The most common disorder is depression, with between 60 and 80% of young people having a diagnosis of depression at the time of a SA . Hopelessness has long been linked to increased suicide risk, including among young people, and is believed to mediate the relationship between depression and suicide-related behaviour [13, 14].
Notwithstanding this, not all suicidal young people experience symptoms of depression; therefore interventions that specifically target suicidal young people are required. Good evidence exists regarding the treatment of youth depression , but there is limited knowledge regarding effective interventions for suicide-related behaviour [7, 8]. Of the psychological approaches that have been tested Cognitive Behavioural Therapy (CBT) appears to be the most promising in terms of its ability to reduce suicidal ideation among adolescents and young adults, however further research is required .
CBT is used extensively in the treatment of adolescent depression  and is recommended as a first-line treatment for depressed youth . Components frequently used with depressed adolescents include: basic psycho-education; pleasant activity scheduling; cognitive restructuring; problem-solving; and relaxation training .
In response to the growing popularity of electronic means of communication, in particular among youth, CBT interventions are now routinely delivered via the Internet. Internet-based CBT has been shown to be an effective and cost-effective form of treatment for depression and anxiety among adults [18–24], and has the potential to be more accessible and less stigmatising than traditional, face-to-face models of therapy [25, 26]. It has also been shown to have the potential both to prevent and reduce symptoms of depression and anxiety in adolescents [27, 28].
Adherence has been highlighted as a particular issue with online interventions . There is evidence to suggest that programs that are password protected, practitioner prescribed and supported, tend to have higher rates of adherence, lower rates of attrition and better treatment outcomes than open access sites [23, 30].
Given that practitioner involvement appears to improve outcomes, and that school wellbeing staff are considered helpful by students when it comes to mental health-related difficulties , the development of an Internet-based CBT program that can be delivered by school wellbeing staff is a logical next step. Indeed schools are an obvious and accepted environment for implementing suicide prevention initiatives [11, 32–34].
Yet, despite the potential benefits of Internet-based CBT, there is virtually no research into the impact of Internet-based CBT on SRB. To date only one study specifically set out to test the effects of an Internet-based program among suicidal adults, and reported a reduction in SI , and two studies testing online interventions for depression also demonstrated a reduction in suicide-related outcomes [36, 37]. No studies have targeted suicidal youth.
In response to this, we have developed and piloted an Internet-based program for school students at risk of suicide called Reframe-IT. Reframe-IT has been specifically designed for young people, and unlike other Internet-based programs, is designed to be delivered and supported, by school wellbeing staff.
The program has been piloted with 21 young people from nine schools. Findings show a reduction in suicidal ideation, depressive symptoms and hopelessness , and an increase in problem solving and coping skills (Hetrick et al, forthcoming) over the course of the program. The data also show that the modules do not induce either distress or suicidal ideation, and overall participants report finding the program enjoyable and say that they would recommend it to a friend . The pilot study was small and uncontrolled, therefore the program requires testing in a randomised controlled trial to confirm its effectiveness.