Integrating a suicide prevention package of strategies into decentralized primary health care systems: an implementation pilot study in rural nepal

Active Project Grant Awarded Last action

Award ID
R34MH135122
Recipient
Awarding agency
Obligated
$1,148,275

Award facts

Assistance listing
93.242 Mental Health Research Grants
Completion date 89% complete
Place of performance
New Haven, CT 06510, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Suicide is a leading contributor to global mortality and rates have remained steady, or increased, in low- resourced settings. South asia has the highest suicide rate in the world and despite different cultural risk profiles for suicide, little research has explored strategies for health systems to address its growing suicide burden. Given rising suicide rates and growing dissemination of mental health training programs for primary care health workers to treat common mental disorders (the who mental health GAP action programme, mhgap), there is critical and urgent need to incorporate implementation strategies for suicide detection, management and follow up within these programs. Community health workers remain an untapped resource to provide suicide prevention support in settings where IT is needed most, particularly within overburdened health facilities. Using CO-design principals and RE-aim with primary health workers and a community advisory board, this project will assess barriers to implementing mhgap suicide modules, then adapt and pilot test a package of strategies to optimize implementation within a decentralized primary care system in nepal. We anticipate the primary care suicide prevention package (P-SUPP) will include more systematized screening with decision tool aids, the systematic integration of CHW task-shifted safety planning and contact follow-up, supportive supervision, and enhanced digital monitoring systems. The proposed research will in aim 1 conduct a formative evaluation of current mhgap suicide practices among clinicians and then CO-develop and refine implementation protocols (including workflows, health worker training, and support standards) for integrating suicide detection and follow-up management (P-SUPP) to meet the needs of primary health providers. Aim 2 will complete a pilot feasibility hybrid type 2 randomized controlled trial (RCT) of P-SUPP versus standard mhgap. We will use mixed-methods to assess trial feasibility and acceptability of implementing and sustaining P-SUPP. We will explore patient-level preliminary effectiveness outcomes including suicidality, depression, and uptake of follow-up care. We will also explore preliminary pilot RCT implementation outcomes including reach, adoption, implementation, and maintenance of P-SUPP at 6 months for a future fully powered trial. This R34 lays the groundwork for a future R01 to scale a package for suicide prevention strategies that can be integrated into government primary care facilities, particularly targeting individuals living in low-resourced settings. As the model is designed to be easily adapted and integrated, we anticipate the findings will be valuable for all researchers looking to improve population health and mental health services in disadvantaged settings.

Transactions

Action Obligated Date
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Subawards

Subrecipient Amount Awarded
Nyaya Health A Nonprofit Corp Along with Yale University personnel, we will perform the following tasks: 1) Formative evaluation, intervention design, preparation for the trial and… $80,852

Quick answers

Who received award R34MH135122?

R34MH135122 was awarded to Yale Univ by National Institute of Mental Health (National Institutes of Health) on May 15, 2024.

How much is award R34MH135122 worth?

$1,148,275 has been obligated on R34MH135122.

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