Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency...

Area of Science:

• Global Health
• Public Health
• Mental Health Systems

Background:

• Suicide is a major global health concern, disproportionately affecting developing countries.
• Limited evidence-based strategies exist for suicide detection and prevention in low-resource settings.
• Emergency departments are critical points for identifying individuals at risk.

Purpose of the Study:

• To evaluate the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department.
• To assess staff perceptions and knowledge regarding suicide screening.
• To identify barriers and facilitators for program implementation.

Main Methods:

• Pilot implementation trial involving preliminary training phases and phased supportive coaching.
• Co-design focus groups with staff and leadership to develop the implementation package.
• Embedded ethnography to observe implementation processes and identify barriers.
• Assessment of staff acceptability, appropriateness, confidence, system priority, and myth knowledge.

Main Results:

• Training significantly improved staff appropriateness, confidence, system priority, and suicide myth knowledge.
• Co-designed strategies and phased coaching facilitated screening uptake.
• Ethnographic observations identified barriers including stigma, family engagement reluctance, and referral distrust.

Conclusions:

• The pilot program demonstrated that training enhances staff capacity for suicide risk screening.
• Co-designed strategies and coaching are effective in overcoming implementation barriers.
• The findings highlight the potential for sustainable suicide prevention programs in similar low-resource contexts.