CASP | Centre for Mental Health Law & Policy

CASP is a suicide prevention intervention that trains nurses and community health officers in delivering Contact and Safety Planning (“CASP”) to reduce suicide among adults who have a recent history of attempted suicide.

The project is being implemented and tested in the form of a pilot study in Chhattisgarh, in collaboration with the Department of Health and Family Welfare.

Why CASP?

Suicide is a leading cause of death in India, particularly in the central Indian state of Chhattisgarh which recorded a suicide rate of 26.4 in 2021, more than double the national average.

Although Chhattisgarh does have a State Suicide Prevention Policy and efforts are being made to address suicide, the lack of specialised care providers dedicated to suicide-related issues in rural areas poses a significant challenge in several districts. Consequently, training non-specialist health workers (nurses, community health workers) to deliver a brief suicide intervention may be a promising approach to tackle suicide.

According to the World Health Organization, individuals who have recently attempted suicide are at the highest risk of completing suicide in the future, rendering this group highly vulnerable and requiring targeted intervention.

Contact and Safety Planning (“CASP”) consists of:

Regular follow-ups with individuals who have recently attempted suicide, and
Safety planning, a collaborative exercise which helps individuals identify coping and response strategies to suicidal feelings and behaviour.

CASP has shown promising results when tested in a refugee population in Tamil Nadu, but requires further testing to understand its feasibility, acceptability and efficacy when delivered within the health system.

Thus, we will be evaluating CASP as a suicide prevention intervention when integrated in the district health system by non-specialist health workers to follow up with individuals who have recently attempted suicide.

How are we addressing the issue?

In Chhattisgarh’s district hospitals and primary health facilities, first responders to suicide attempts are usually nurses in casualty wards. In the villages, Community Health Officers (CHOs) work within communities to address non-communicable diseases.

In this study, adults who appear in district hospital and primary care facility casualty wards with attempted suicide will be identified and recruited by ward nurses. They will subsequently be followed up with by CHOs who will deliver the five-session CASP intervention in the community.

We are testing the implementation and potential efficacy of this program in the form of a 2:2 non-randomised controlled pilot study in two districts (compared to two control districts) in Chhattisgarh to understand its implementation and potential efficacy.

What is the potential impact?

This research will impact the lay community by increasing the awareness and capacities of Community Health Officers (CHOs) and nurses to respond effectively to suicide and deploy potential solutions and options for care. The CHOs and nurses we train will be empowered to address these harms in their own communities in the long term.

Findings from CASP will shed light on real-world factors that may facilitate or impede the implementation of a suicide prevention program within the existing public health system in India.

Knowledge generated from our work will aid researchers, health professionals, and policy actors, based regionally, nationally, and globally, in their efforts to reduce the treatment gap for suicide.