Multicenter RCT to evaluate the clinical and cost-effectiveness of a culturally adapted therapy (C-MAP) in patients with a history of self-harm

Lead Research Organisation: University of Manchester
Department Name: School of Health Sciences

Abstract

Suicide is a serious global public health issue ranked amongst the leading causes of death in many countries. The worldwide rates of suicide have increased by 60% in the last 45 years, and the 1.8% total global burden of disease attributed to suicide in 1998 is expected to increase to 2.4% by 2020.

The WHO Mental Health Action Plan 2013-2020 and all the member states have committed to work towards the global target of a 10% reduction in the suicide rate by 2020. WHO's Mental Health Gap Action Programme includes suicide as one of the priority conditions and the recent WHO report "Preventing suicide: a global imperative" calls for suicide prevention to be a high priority on the global public health agenda. More than 800 000 people across the world die due to suicide each year and for each suicide there are more than 20 people attempting suicide. Each suicide takes the life of the individual and has a tremendous effect on friends, family and the wider community. Up to 75% of all suicides occur in in low- and middle-income countries where resources and services are limited for treatment and support for people who need. There is a clear gap in the robust evaluation of culturally appropriate suicide prevention strategies in low and middle income countries. Individuals who have a history of self-harm are at much higher risk of dying by suicide than individuals who do not have such a history. The WHO recommends that offering them appropriate treatment should be a key component of all suicide prevention strategies.

There are in excess of 100,000 acts of self-harm carried out in Pakistan annually. The aim of the proposed trial is to evaluate the clinical and cost-effectiveness of a culturally adapted psychological therapy (C-MAP) in patients with a history of self-harm. We carried out a study in Karachi to determine the effectiveness of a 6-8 session CBT-based intervention (C-MAP) in people who had recently self-harmed. The assessments were carried out at baseline, 3 & 6 months. There was a significant reduction from baseline in suicidal ideation, severity of depression and hopelessness in the intervention group compared to the Treatment as Usual (TAU) group at each follow up assessment. The findings from this work have highlighted the applicability of such an intervention to health services in Pakistan for patients who present after a self-harm episode. The proposed research will be conducted in Karachi, Lahore, Rawalpindi, Quetta and Peshawar. Participants will be randomized either to the Intervention (C-MAP) or TAU. The existing culturally adapted intervention (C-MAP) includes an evaluation of the self-harm episode, crisis skills, problem solving and basic cognitive techniques to manage emotions, negative thinking and relapse prevention strategies. The intervention will be delivered in six sessions over 12 weeks. Assessments will be conducted at baseline and at 3 months (end of intervention) 6 months and 12 months after randomisation. The outcome measures will include questionnaires to measure the repetition of self-harm, severity of suicidal ideation; depression; hopelessness; quality of life and coping resources. In addition, qualitative interviews and focus groups will provide rich information regarding the experiences of participants and therapists, which will inform the development of more effective and sensitive services for self-harm management. TAU will be standard routine care delivered by local medical, psychiatric and primary care services according to their clinical judgement. A record will be kept of any treatment received by each participant.

This trial will provide detailed clinical and cost-effectiveness analyses for the management of self-harm which will inform future research and national clinical practice guidelines. We have established contacts with the ministry of health and once the trial is completed we will enter discussions to present the results to them and attempt to influence policy change.

Technical Summary

Design: A multicenter Randomised Control Trial to compare Treatment As Usual (TAU) plus the Culturally adapted Manual Assisted Psychological therapy (C-MAP) with TAU in patients with a recent history of self-harm.

There is a built in 12 months internal pilot phase with clear stop/go criteria to prove viability to proceed to a full trial across all the study sites.

Setting: Participants will be recruited from general practices, emergency departments and medical wards of participating hospitals.

Health Technologies being assessed: A culturally adapted brief psychological intervention, based on the principles of Cognitive Behavioural Therapy (CBT). The intervention has 6 sessions, approximately 50 minutes each, and its feasibility has previously been established.

Sample Size: This trial will use repetition of self-harm as its primary outcome measure because it is a strong predictor of completed suicide. Brown et al (2005) saw a reduction from 41.6% to 24.1% in the rate of repetition of self-harm over an 18 month period. The sample size calculation assumes an event rate of 27.7% in the control arm and 16.1% in the talking therapy (C-MAP) arm of the study, an ICC of 0.05 and a 75% follow-up rate. Under the these assumptions a sample of 624 randomised patients will be required for a cluster adjusted test of proportions to have 80% power to detect this difference assuming a 5% significance level.

Measurement: The statistical analysis of the primary outcome measure repetition of self-harm episode and binary secondary outcome measures will be based on a cluster adjusted test of proportions. Economic analysis will estimate costs of primary, secondary/tertiary health care use, Disability Adjusted Life Years (DALYs) and quality adjusted life years (QALYs). Qualitative methods will explore patient and professional experiences. We will use an established approach in order to understand what factors block and facilitate successful delivery of the programme.

Planned Impact

Impact on service users: The overall objective of the trial is to bring about a reduction of self-harm, overall morbidity, a reduction in rates of suicide and a better quality of life. In low income countries there is a huge treatment gap and up to 9 out of 10 people with mental health difficulties do not receive appropriate treatment. Outcomes from our earlier studies provide a strong foundation to build on and aid the translation of research into action. There can be other wide ranging positive outcomes, including increased awareness, improvements in relationships and greater employment. It is suggested that therapies which enhance self-efficacy such as Cognitive Behavioural Therapy (CBT) may reduce relapse and recurrence rates of many mental disorders including depression and anxiety.
Community awareness: The participants understanding of mental health issues will improve. We have experience of promoting our research within the Pakistani community including presentations or seminars with community leaders, local Pakistani media (newspapers & radio), and promotional material in GP surgeries. The importance of addressing mental health difficulties promoted through general public awareness will guide people to seek early clinical help for their mental health problems.
Service users as co-researchers: We organise an annual course on the fundamentals of qualitative research methods at the Pakistan Institute of Learning and Living, service users are invited to attend this course. Service users on the advisory board were trained in research methods and will contribute to the qualitative analysis in the proposed trial. Our team has significant expertise in this area and we have trained over 20 users and carers in research methods. We know service users provide very helpful additional insights into the themes emerging from the data and contribute greatly to the interpretation of findings. We will continue to offer this training to service users and carers.
Impact on services: There is limited data available currently to guide treatment choices for clinicians in Pakistan. The outcome of this trial will have implications for the health services, in terms of helping to improve the organisation of care and interventions offered for patients who self-harm and thus improve the quality of health services with potential reduction in overall costs. One of the outputs of this study will be a portfolio of user-defined, evidence-based, manual assisted intervention; a resource pack and training programme on 'how to do it' for use across local health services. This trial will provide detailed clinical and cost-effectiveness analyses which will inform future research and national clinical practice guidelines. Together these data will be useful to inform planning of effective and culturally appropriate interventions in Pakistan.
Research and clinical capacity: There is limited research capacity in Pakistan if funded we will be able to train research assistants in robust research methods. There will be workshops on fundamentals of quantitative & qualitative research methods which will be open for aspiring academics from outside the research team. We have developed the curriculum and trained more than 200 clinicians in Tier-1 psychosocial interventions for severe mental illness. We have initiated discussions with the nursing schools and departments of psychology that if the results show that C-MAP is effective it should be included in the curriculum.
Impact on policy: Research from the Global Mental Health Group have recommended that scaling up services for people with mental disorders is the most important priority for global mental health. We have contacts with the ministry of health and once the trial is completed we will enter discussions to present the results to them to take this work towards implementation. We now have Professor Mukesh Kapila as part of the research team his tremendous experience will be of great value in this regard.
 
Title Art posters - Global mental Health competition 
Description To mark World Mental Health day the team promoted an art poster competition. The competition in Pakistan requested for expression and understanding on the topic of self harm and suicide prevention in South Asia through a painting, drawing or designed posters. 3 prizes were offered to the competition winners that aimed to develop capacity and continuous professional development 
Type Of Art Artwork 
Year Produced 2018 
Impact The posters were displayed at a conference event held at the Whitworth Art gallery in Manchester. The competition resulted in much needed awareness raising in Pakistan around the topic of suicide and self-harm prevention. 
 
Description A total of 901 participants were recruited from this hard to reach community where suicide is a forbidden act.

The intervention group showed significant improvement in suicidal and depression scores at completion of intervention and this improvement was sustained even at the 12th month follow up. Their was significant improvement in their quality of life scores and coping resource inventory and client satisfaction questionnaire

One of the key achievements was retention rates over 12 months of 94% of this sample of 901
Exploitation Route Policy changes in management of suicide and self-harming behaviours
Further funding for work within this field
Sectors Communities and Social Services/Policy,Government, Democracy and Justice

 
Description Suicide and attempted suicide (deliberate self harm DSH) are a serious global public health problem with particularly high rates in SE Asia. DSH creates social and economic burden for communities and services and long-term effects on wellbeing. DSH poses a major challenge to policymakers. Improved availability and quality of data about suicide and DSH are essential for effective prevention strategies (WHO 2014). Pakistan is a low and middle income country. Our population rates are high. We are the 6th most populous country in the world. The literacy rate in the country is about 35-40%. A third of the population lives below the poverty line and it is a patriarchal, conservative Islamic country. This is an understudied and under researched subject in Pakistan. There is no official data on rates of Suicide. Most of the information available is through media, newspaper and from colleagues . Under the Pakistan Penal code both suicide and attempted suicide are considered criminal offences punishable by either a jail term for up to 1 year , a fine or both. With the above in consideration the trial was able to recruit 901 participants across Pakistan which is a huge achievement and maintain a 94% retention rate. The first meeting to develop Pakistan national suicide prevention strategy was held by our team in Sept 2019 in London. A research strategy meeting was held in Pakistan, the first of its kind. Considering such a complex phenomena, related to a number of Sustainable Development Goals (SDG), has led the organisation of mental health question time which was televised on 10th March and a parliamentary mental health summit also in March 2020 which is being jointly chaired by a member of parliament. This will be a significant contributing factor in starting a change in government policies and procedures in the management of suicide and self harm. It is a step to starting to develop a roadmap for research and implement plans which contribute to the achievement of 17 SDGs.
First Year Of Impact 2019
Sector Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice
Impact Types Cultural,Societal,Policy & public services

 
Description Meeting with Dr Muhammad Asif ( Chief Health) Ministry of planning, Development and reform, Government of Pakistan, Islamabad
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description GCRF
Amount £4,900,000 (GBP)
Organisation University College London 
Department Grand Challenges Global Health
Sector Academic/University
Country United Kingdom
Start 06/2018 
End 06/2022
 
Description MRC DFID NIHR
Amount £1,000,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 05/2018 
End 05/2022
 
Description MOU between PILL and University of Punjab 
Organisation University of the Punjab
Country Pakistan 
Sector Academic/University 
PI Contribution To explore joint work in research particularly in the area of self-harm. MOU signed by PILL supported by Manchester Global mental and Culture psychiatry research group for strengthening capacity and capability of both partners
Collaborator Contribution To explore joint work in research particularly in the area of self-harm. MOU signed by PILL supported by Manchester Global mental and Culture psychiatry research group for strengthening capacity and capability of both partners
Impact Collaboration with the Institute of Psychology
Start Year 2019
 
Description All Parliamentary Mental Health Summit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Summit Inaugural was by President of Pakistan showing commitment to support mental health research and innovation in Pakistan.Each session was jointly chaired by a parlimentarian and mental health expert. This group will develop aa mental health strategy and an implementation plan align with the sustainable developmental goals

PILL in collaboration with the Prof Husain from University of Manchester, MNA Mr Riaz Fatyana SDGs Taskforce and other parliamentarians organized the first Pakistan mental health summit 2020

Outcomes include Learning from our research work in Pakistan and input from other internationally renowned stakeholders on the day and further 18 months will provide a unique opportunity to work out a road map for Pakistan Mental Health Strategy and the
SDG's 2020-2030.
Year(s) Of Engagement Activity 2020
 
Description Awareness session and walk on suicide prevention day with University of Baluchistan 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Awareness session on suicide prevention was delivered to Baluchistan university students
Year(s) Of Engagement Activity 2019
 
Description Awareness session at Iqra university Peshawar on world mental health day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Awareness session for university students conducted in Peshawar University on world mental health day
Year(s) Of Engagement Activity 2019
 
Description Awareness session on Self harm and Suicide at refugee camp Quetta 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Refugee camps in Quetta - Spreading awareness regarding self-harm and suicide prevention to people living in refugee camp. Well received by almost 100 residents.
Year(s) Of Engagement Activity 2019
 
Description Awareness session on self and suicide in Nawabshah at Shah faisal memorial public high school on 25th of Sep 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Attended by students of class 8th to 10th and their teachers as well. Informational material also given.
Year(s) Of Engagement Activity 2019
 
Description Consolidated newsletter on common mental health problems and Self harm / Suicide 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Consolidated version of newsletter on common mental disorders associated with self-harm and suicide developed both in Urdu and English for general public.
Newsletter's aim was to spread awareness regarding mental disorders among general public for reducing stigma and increasing awareness on mental health issues.
Year(s) Of Engagement Activity 2019
 
Description Culture and International Mental Health conference - stall, poster presentation and talk 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Annual Culture and International Mental Health conference held in Nov 2017. The event was attended by academics, medics and students across England and Internationally. ROSHNID and ROSHNI2 were presented by PIs at the conference, a stall was held and poster presentations done. Many questions were taken from audience members and good interest generated through networking. The theme of the conference was Suicide and Self-harm. Stalls were held and poster presentations of the CMAP project. Talks were given on rates and incidence of self-harm, prevalence in Pakistan and psychosocial interventions for the prevention of repeat self harm
Year(s) Of Engagement Activity 2017
 
Description First Round Table Conference to develop suicide prevention strategy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Organized in Collaboration with University of Manchester and SDGs Taskforce( Mr. Riaz Fatyana, member of National assembly of Pakistan at the Royal College of Psychiatris
This was organized to develop Pakistan suicide prevention strategy and road map for future research.
In Pakistan self harm is a criminal offense, the main output of this meeting was presentation of a bill in the Parliament by Mr Riaz fatyana to decriminalize self-harm and suicide in Pakistan which is a tremendous milestone.
Year(s) Of Engagement Activity 2019
 
Description Importance of involving psychologists in Self harm and Suicide prevention work in Pakistan 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Presented Role and Scope of using psychologists in self-harm and suicide prevention work.
Year(s) Of Engagement Activity 2019
 
Description Meeting at Chief Commissioner Office, Islamabad capital territory (ICT) Administration, Islamabad 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Meeting held with Women Program Officer Ms. Seema at the Chief Commissioner Office in Islamabad to discuss the importance of suicide and self harm prevention, female empowerment and other key policy issues in Pakistan
Year(s) Of Engagement Activity 2018
 
Description Mental Health Question Time 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Awareness session -PILL in collaboration with the Prof Husain from University of Manchester and MNA Mr Riaz Fatyana SDGs Taskforce organized "Mental Health Question Time" on the 10th March at Pakistan National Council of Arts
People from all walks of life attended and had the opportunity to interact with others and mental health experts from Pakistan and across the Globe to discuss issues around mental health

"Question time" session was conducted in order to increase awareness regarding different mental health issues. Stake holders, general public and service users fully participated in discussions. Feedback was very positive. Informational material around common mental disorders also distributed.
Year(s) Of Engagement Activity 2020
 
Description Pakistan Psychiatric Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact A talk was given on the research project detailing the background, aims and objectives and progress to date. Discussion were held around the importance of discussing such a taboo topic within the Pakistani community and the challenges and barriers in accessing accurate information on suicide rates. The talk included the importance of raising awareness as a community and was a chance to network with professionals and stakeholders who are interested in being updated on the study
Year(s) Of Engagement Activity 2016
 
Description Panel Discussion - Self-harm and Suicide as a consequence of intolerance in youth - Ziauddin University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presentation delivered by study manager Tayyeba Kiran at Ziauddin University in Pakistan
Year(s) Of Engagement Activity 2017
 
Description Presentation and development of work - Intellectual disabilities and self-harm 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Building on the work of the CMAP project and the start of the SASHI project, Pakistan Institute of Living and Learning have started the development of work looking at self harm and intellectual disabilities. Dr Jill McGarry, Consultant Clinical Psychologist travelled from the UK to Pakistan to develop this work and deliver a workshop on this to the team
Year(s) Of Engagement Activity 2017
 
Description Presentation on " Self-harm and suicide prevention in Pakistan" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented work done in Pakistan on Self-harm and Suicide prevention.
Year(s) Of Engagement Activity 2019
 
Description Presentation on "self-harm and suicide prevention: Evidence from Pakistan" at Round table conference on 9th September 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented work done in Pakistan on Self harm and Suicide prevention and their findings.
Year(s) Of Engagement Activity 2019
 
Description Press release in local paper - raising awareness of study 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Article published Oct 2017 to raise awareness among the public on suicide and how to deal with vulnerable individuals, with quotes from Dr Nasim Chaudry, CEO of the Pakistan Institute of Living and Learning (PILL).
Year(s) Of Engagement Activity 2017
URL https://dailytimes.com.pk/129593/awareness-key-prevention-suicide-pill-ceo/
 
Description Prevention of Suicide and Self harm roadmap for research 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presented Self harm and suicide prevention work.
Year(s) Of Engagement Activity 2019
 
Description Promoting suicide prevention through creativity - Training 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Lead researchers at Pakistan Institute of Living and Learning who are leading this project in Pakistan have done training events on suicide and self harm prevention

This includes training on suicide and self harm prevention using creativity and this has been delivered to researchers, professionals and academics
Year(s) Of Engagement Activity 2018
 
Description Self-harm and Suicide prevention in Pakistan: Our response to a public health tragedy 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented work done in Pakistan on Self-Harm and Suicide prevention
Year(s) Of Engagement Activity 2019
 
Description Self-harm and suicide prevention session at Bahria University Karachi 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Awareness session well received by university students and teachers.
Year(s) Of Engagement Activity 2019
 
Description Self-harm and suicide prevention in adolescent in Manchester 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presented study outline of " Multicenter RCT to evaluate the clinical and cost effectiveness of Youth culturally adapted manual assisted intervention (YCMAP)"
Year(s) Of Engagement Activity Pre-2006
 
Description South Asia Self Harm Initiative (SASHI) Project - Launch event at Manchester Museum 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Global Challenge Research Fund: South Asia Self Harm research capability building Initiative (GCRF-SASHI)
SASHI formed in late 2015 as a collaboration led by the Centre for Mental Health and Society at Bangor University. It is a partnership between academics working in Mysore and Karachi and UK academics in Bangor, Manchester and Oxford Universities. The purpose of the GCRF-SASHI project is to help to find effective responses to deliberate self-harm and suicide in South Asia by building research infrastructure and expertise in India and Pakistan. This will allow each country to build a body of evidence to facilitate the development of culturally relevant and effective interventions, both social and medical.
This was done developing on the work done in CMAP. A launch event was held in November 2017 to mark the opening of the project. Presentations were given on rates of suicide and self-harm in low income countries and discussions held on best ways to work within this context
Year(s) Of Engagement Activity 2017
 
Description Suicide awareness session on 27th September 2019 at SM group of schools Nishtar Colony Lahore 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Raised awareness regarding prevention strategies for self-harm, warning signs and available support in Pakistan. Translated WSPD brochure also distributed.
Year(s) Of Engagement Activity 2019
 
Description Suicide prevention day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Supporters
Results and Impact Suicide prevention day-contributed to awareness sessions on self-harm and suicide prevention with non-managerial staff at all four sites of GSK in Karachi (west wharf, korangi, site area and Jamshoro) Self-harm and suicide awareness session delivered to almost 400 non health professional staff.
Year(s) Of Engagement Activity 2019
 
Description Suicide prevention session at Government Girls higher secondary school, Murree Road Rawalpindi on 25th September 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Awareness session at school. Spreading awareness among school students regarding prevention strategies for self-harm and work done in Pakistan.
Year(s) Of Engagement Activity 2019
 
Description Suicide prevention session at Muslim higher secondary school for boys in Rawalpindi 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Spread awareness regarding prevention strategies for self-harm, warning signs and available support in Pakistan. Translated WSPD broachers also distributed
Year(s) Of Engagement Activity 2019
 
Description Suicide prevention session at government model high school Lahore, 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Awareness regarding prevention strategies for self-harm, warning signs and available support in Pakistan. Translated WSPD broachers also distributed
Year(s) Of Engagement Activity 2019
 
Description Suicide prevention session in Government Mohsin high school Quetta 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Spread self-harm/ suicide prevention awareness among students of high school.
Year(s) Of Engagement Activity 2019
 
Description Supervised a faculty member from Dow institute of Nursing for a HEC grant on developing suicide prevention curriculum 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Supervised a faculty member from Dow institute of Nursing for a HEC grant on developing suicide prevention curriculum
Year(s) Of Engagement Activity 2019
 
Description TV show - Study PI and trial manager tv interview on suicide and self harm in Pakistan 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact In Oct 2017, CEO of Pakistan Institute of Learning and Living Dr Nasim Chaudhry and study trial manager Tayyeba Kiran took part in a TV show in Pakistan on Samaa TV. They discussed the rates and reasons behind self-harm, risk factors of suicide and self-harm in Pakistan. The aim of the programme was to raise awareness of the growing problem of suicide and self-harm in Pakistan
Year(s) Of Engagement Activity 2017
 
Description Talk on Developing Research in Self Harm and Suicide Prevention 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Undergraduate students
Results and Impact A Talk on Developing Research in Self Harm and Suicide Prevention by Prof. Nusrat Husain at Department of Psychology, Foundation University Islamabad, Rawalpindi Campus
Year(s) Of Engagement Activity 2018
 
Description Talk on developing research in suicide and self harm prevention 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact A talk delivered by study CI Prof Nusrat Husain at the Department of Psychology, Foundation University, Islamabad, Rawalpindi Campus
Year(s) Of Engagement Activity 2019
 
Description Talk with Dr Zareed Uddin Khan - (senior advisor governance and leadership) and Dr Babar Tasneem Shaikh (HSS policy advisor). 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Prof Nusrat Husain CI met with Dr Zareed Uddin Khan - (senior advisor governance and leadership) and Dr Babar Tasneem Shaikh (HSS policy advisor). The meeting was held at JSI Research and training institute. The purpose was to increase conversation on the importance of suicide and self harm prevention, the wider global mental health work and the policies that need to be reviewed around suicide prevention
Year(s) Of Engagement Activity 2019
 
Description Understanding Self Harm: Perception of Clinicians from Pakistan 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presented qualitative work done in Pakistan on self-harm and suicide prevention (CMAP)
Year(s) Of Engagement Activity 2019
 
Description World Suicide Prevention Day (WSPD) 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Jointly translated WSPD information leaflet in Urdu with a translated version available on WSPD website
Year(s) Of Engagement Activity 2019
 
Description World Suicide Prevention Day - campaigns and raising awareness 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact World Suicide Prevention Day - The day was marked with an active campaign led by PILL who published newsletters and flyers raising awareness of suicide and self harm prevention in English and Urdu. These were used at events and distributed widely. Talks were given at Universities in Pakistan to raise awareness of this growing problem in low income countries
Year(s) Of Engagement Activity 2017
 
Description World Suicide Prevention Day conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact As part of world suicide prevention day promotions, an awareness event was organised by the lead organisation Pakistan Institute of learning and living in collaboration with Ziauddin University Pakistan. The event aimed to raise awareness of suicide and self-harm within this community and a talk was given on the project and updates on the work done to date
Year(s) Of Engagement Activity 2016