Grant: Team Grant: GACD Mental Health - Canada-China

BACKGROUND: Suicide is the most serious outcome of a variety of mental illnesses, including depression, bipolar disorder, schizophrenia, eating disorders and substance abuse. Reducing suicide mortality is an important objective of the World Health Organization’s 2013-2020 Global Mental Health Action Plan and the United Nation’s 2015-2030 Sustainable Development Goals. A prior suicide attempt is the most important risk factor for death by suicide, but regular brief community follow-up after an attempt can prevent repeated suicidal behavior. AIMS: This 5-year implementation science project will develop methods for adapting the WH0 SUPRE-MISS intervention for suicide attempters in parallel projects in Ningxia, China, and among Inuit in Nunavut, Canada. These methods for adapting SUPRE-MISS will then be promulgated in Inuit and other indigenous populations, other parts of China, other low- and middle-income countries, and other low-resourced settings in high-income countries. METHODS: PHASE 1. Conduct focus groups with local stakeholders to identify local factors that need to be considered when developing a location-specific version of SUPRE-MISS that provides a brief educational intervention about suicide prevention to individuals who have recently made a suicide attempt and periodic social support and access to emergency services to these highrisk individuals. PHASE 2. Pilot-test the adapted intervention in a small number of settings for one year. PHASE 3. Revise and then scale-up the intervention to more settings for 30 months and continuously collect outcome measures, process measures, and resource utilization measures (for cost-effectiveness assessment). PHASE 4. Conduct post-intervention focus groups with stakeholders to identify the strengths and weaknesses of the intervention. Integrate these qualitative results with the quantitative results (e.g., rates of repeated suicidal behavior) to prepare a report on the process of implementing the SUPRE-MISS intervention in low-resource settings. Work with administrators and policy makers in China, Nunavut, and other locations to develop policies that will widely promulgate the use of this approach to suicide prevention. FEASIBILITY: A strong multidisciplinary team with extensive experience in suicide prevention in the target communities has been assembled and the active support of local administrators and policy makers who can provide practical support for the project and develop policies to promote its results has been obtained. EXPECTED OUTCOMES: This project will develop methods that can be widely disseminated to help achieve the United Nation’s ambitious goal of reducing suicide mortality by 1/3 by 2030. Combining findings from parallel projects in a low-middle-income country with those from a low-resource setting in a high-income country will provide a unique case example of how implementation science can be used to address complex mental health problems in different low-resource settings.