Integrating a Suicide Prevention Package of Strategies Into Decentralized Primary Health Care Systems in Rural Nepal: An Implementation Pilot Study

What this Trial Is About

Suicide is a major cause of death globally, with high rates in low-resource areas like South Asia. In Nepal, integrating mental health services into primary care offers a chance to better assess and manage suicide risk. Although training programs exist for primary care providers (PCPs), gaps remain in detecting, referring, and following up with at-risk individuals. This trial aims to study how adding certain strategies can improve suicide prevention delivery in Nepal’s primary healthcare system, involving community members with lived experience in the process. The study compares two groups of PCPs: one receiving standard or refresher training based on the WHO mhGAP Intervention Guide covering depression, psychosis, epilepsy, alcohol use disorder, and suicide; and another group receiving the same training plus an additional implementation package. This package includes optimized assessment with screening questions and a decision-support tool, culturally adapted safety planning, and a collaborative care protocol with Community Health Workers to support follow-up and ongoing care. Training lasts five days, led by a qualified Nepali psychiatrist, with psychiatric supervision every three months. Participants will be monitored over six months to evaluate the feasibility and acceptability of these approaches. Researchers will assess intervention uptake, retention, adherence, and fidelity, along with suicide ideation scores and other mental health measures at baseline, three months, and six months. Additional evaluations include surveys on suicide prevention knowledge, self-efficacy, clinical competency, and patient health. The study’s findings will inform future larger trials and support Nepal’s national suicide prevention efforts.

Implementing Suicide Prevention Into Primary Care in Nepal