Overview
Suicide remains a major contributor to global mortality, with particularly high and persistent rates in low-resourced settings such as South Asia. In Nepal, ongoing integration of mental health services into primary care provides a critical opportunity to strengthen suicide risk assessment and management. Despite the scale-up of mhGAP training for primary care providers (PCPs), gaps remain in the systematic detection, referral, and follow-up of individuals at risk for suicide. There is an urgent need to enhance mhGAP implementation with strategies that address provider workload, stigma, and inequities within the health workforce.
Using experience-based co-design principles and RE-AIM this study will assess the feasibility and acceptability of integrating an implementation strategy package to optimize mhGAP suicide prevention delivery in Nepal's decentralized primary healthcare system. This clinical trial leverages deep collaboration with a community advisory board of individuals with lived experience of suicide throughout the trials' design, delivery and analysis.
This R34 will generate critical preliminary evidence on the feasibility, acceptability, and implementation of an integrated suicide prevention package within government primary care facilities in Nepal. The findings will inform the design and parameters of a future fully powered effectiveness trial, while aligning with Nepal's national suicide prevention strategy and advancing WHO and NIMH global mental health priorities.
Eligibility
Inclusion Criteria:
Primary Care Providers
- Health workers with a prescribing license employed in government health facilities in Bagmati Province.
- Are between 21-65 years, per government health system criteria.
- Participants will be required to have competency in Nepali, be actively engaged in care provision within their health facility
- Patients
- Patient lives in the study site
- Is under the care of a PCP at a facility site.
- Patient meets any level of suicide risk based on mhGAP 2.0 criteria.
- Patients who have been treated for mental illness before or presently (expected in both groups).
- Speaks Nepali.
- Levels of Suicide Risk (as defined by mhGAP 2.0)
Exclusion Criteria:
Primary Care Providers
- Healthcare workers without proper government credentials will be excluded.
- Health workers who plan to migrate or who do not intend to stay in the study area for at least a year.
- Patients
- Patient requiring immediate hospitalization
- Unable to consent as determined by the diminished capacity tool.