CASP is a health system intervention that will pilot test a contact and safety planning intervention to reduce suicide attempts among adults with a recent history of attempted suicide. The intervention will be tested in two districts in Chhattisgarh.
Suicide is a leading cause of death in India, particularly in the central Indian state of Chhattisgarh which records the third highest suicide rate in the country.
Suicide prevention efforts in Chhattisgarh are hampered by the lack of specialist care providers, and so capacity building of non-specialist health workers becomes a promising avenue for reducing the care gap.
Intervening with individuals who have attempted suicide is a targeted prevention strategy for a high-risk population, as attempted suicide is the strongest predictor of future suicide.
In district hospitals in Chhattisgarh, first responders to suicide attempts are usually nurses in casualty wards. In the villages, Community Health Officers work within communities to address non-communicable diseases. In this study, adults who appear in district hospital 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.
Given that brief contact interventions have shown to be effective in reducing suicidal behaviour, training health workers in delivering a brief Contact And Safety Planning Intervention (CASP) to reduce suicidal behaviour may be an effective, scalable and sustainable method for low-resource states in India such as Chhattisgarh.
How are we addressing the issue?
We will carry out a pilot trial to evaluate the feasibility, acceptability, preliminary effectiveness and implementation challenges of delivering CASP in two districts in Chhattisgarh.
We will train nurses and Community Health Officers to deliver CASP to individuals with a history of attempted suicide at district, sub-district and private hospitals in the districts of Balod and Rajnadgaon.
Enhanced Usual Care (EUC) will consist of identification of at-risk patients and counselling as per the existing District Mental Health Programme. It will also entail the distribution of informational flyers in health facilities and community centres in the control districts of Mungeli and Balodabazar.
Data will be collected through mixed methods at baseline, endline, and 6 & 12 months after the completion of the intervention to measure feasibility, acceptability, preliminary effectiveness and implementation challenges of the intervention.
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.
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.
Where have we reached?
We have begun formative research from October 2022.
Soumitra Pathare, Centre for Mental Health Law & Policy, ILS, Pune
Lakshmi Vijayakumar, SNEHA Suicide Prevention Centre, Chennai