Bhimeshwor Municipality

Suicide is a leading cause of death worldwide, with especially high rates in low-resource areas like South Asia. In Nepal, efforts to include mental health services in primary care offer a key chance to improve how suicide risk is identified and managed. Despite ongoing training for primary care providers through the mhGAP program, challenges remain in consistently detecting, referring, and following up with people at risk for suicide. This study aims to evaluate the feasibility and acceptance of a new package of strategies designed to enhance suicide prevention within Nepal's decentralized primary healthcare system, involving close collaboration with individuals who have lived experience of suicide. The study tests an implementation package called the Suicide Prevention Package (PSuPP), which includes training for systematic suicide risk assessment using standardized screening questions and decision-support tools, culturally adapted safety planning for risk management, and a collaborative care protocol involving community health workers to support follow-up and ongoing care. This behavioral intervention is integrated into government primary care facilities in rural Nepal. The study uses experience-based co-design and the RE-AIM framework to guide its approach. Participants will be monitored over six months to assess how well the intervention is taken up, fidelity to the protocol, adherence to randomization, retention rates, and completion of follow-up measures. Assessments include structured interviews, checklists, and the Beck Scale for Suicide Ideation at baseline, 3 months, and 6 months. The trial aims to provide preliminary evidence to inform a future larger effectiveness study, supporting Nepal's national suicide prevention strategy and global mental health goals.