SAHAR M

Background

The M in SAHAR-M is for Movement, the patient and public involvement and engagement (PPIE) group considered the programme of research has become more of a movement, thus the name South Asia HArm Reduction (SAHAR)-Movement (M) was decided. Building on the last two years of work, the movement is aimed at working towards ‘Zero suicide’- a systematic framework for creating an integrated approach to prevent suicide and quality improvement in the healthcare system.

Mission

The mission of SAHAR-M is to facilitate and execute through rigorous research methodology and governance, a range of national self-harm and suicide prevention activities with a strong focus on building capacity and capability. This will ensure health systems readiness and timely responsiveness to support the people and communities in preventing self-harm behaviour and suicide. This will involve knowledge mobilisation using an integrated trans-disciplinary approach to self-harm and suicide prevention.

Capacity and Capability Building

 

Aim: To develop world leading researchers in global mental health and self-harm and suicide prevention.

 

Context: Lack of trained researchers and peer networks, as well as limited availability of time and incentives for mental health research, are potential barriers for research capability building in Pakistan.

Mental Health and Wellbeing National Household Survey

Training
Household survey training NUMS, Rawalpindi, Pakistan

This Work Package involves a nationwide household survey on the prevalence of Mental Health and Wellbeing in Pakistan. The core objective of this work package is to develop an understanding of the psychosocial determinants of mental illness and the key context for understanding mental illnesses among adults (aged 18 and over) living in private households in Pakistan.

A comprehensive interview with 11,000 adult participants from selected households across Pakistan is planned, creating opportunities for capacity and capability building for local health workers. It is a cross-sectional household survey, which contains a comprehensive interview using structured questionnaires. The questionnaires for the interview are similar to the UK Adult Psychiatric Morbidity Survey (APMS; 2014), to also help us cross-examine the diaspora Pakistani community’s mental health in the UK.

Mental health and wellbeing are significant foundations of healthcare, therefore detecting and reducing the risk of these issues is essential for the healthy psychosocial functioning of individuals and communities. In Pakistan, most of the people face significant economic and social pressures. These kinds of difficulties may be associated with poor psychological well-being, including anxiety, depression, hopelessness, and suicidal ideation. Mental health conditions are common and can be highly disabling. The increasing impact of mental health conditions has important considerations for the social and economic well-being of individuals, families, and societies. Despite the large number of individuals experiencing mental health difficulties, mental health research has not received much attention particularly in low- and middle-income countries (LMICs), such as Pakistan.

There is a little information about the psychological and social determinants of mental health from the community. Collating data from the community settings with the Mental Health and Wellbeing National Household Survey is essential in gaining a better understanding of psychosocial factors, helping to develop appropriate preventive strategies, and improve access to health care.

Hospitals and community self-harm episode Routine Data

This work package aims to study the existing system of suicide and self-harm episode records in prisons, police stations, medico-legal officers (MLOs), presentations to hospitals and community health care facilities across Pakistan. We will conduct a mapping and linkage exercise of routinely collected data on self-harm and suicide over a period of 12 months to determine a pragmatic minimal dataset for self-harm and suicide.

The use of routine health care data is quite common in high-income countries to describe patient characteristics, risk factors identification and understanding variations in outcomes and practice across different settings. Data on suicide and self-harm will help in the understanding of factors influencing suicidal behaviour in Pakistan and can better inform public health policies on intervention and treatment as well as national suicide prevention strategies.

Objectives

Evaluation of the hospital, community and prison healthcare self-harm episode routine data across Pakistan.

Qualitative interviews with different stakeholders including:

a) Clinician/GP‟s views on the role of psychological treatment and its impact on self-harm and suicide prevention;
b) Interviews with policymakers to identify barriers/facilitators involved in policy development and implementation;
c) Interviews with medico-legal officers (MLOs) to explore self-harm and suicide case management, difficulties and barriers in reporting both and;
d) Religious leaders/scholars views about self-harm and suicide and their role in prevention.

Qualitative Research

The purpose of this work package is to improve mental health infrastructure, especially for self-harm and suicide in Pakistan by exploring stakeholders’ perspectives about needs, gaps, social realities related to self-harm, and suicide in Pakistan.

Qualitative research can play an important role in developing appropriate health services and policies. This type of research provides valuable insights into the ways health; illness; patients’ and carers’ experiences are conceptualized as well as explore different aspects of care delivery. Moreover, qualitative research has the potential to inform the process of research itself. For example, these approaches can help to understand, why some of the patients decline to participate in research, or how the patients experience participation in the research.

Building on the extensive joint work of PILL and the University of Manchester on self-harm and suicide prevention (CMAP, Y-CMAP) and facilitated by our Theory of Change process, this work package will help to identify the core elements and/or help in policy development, adaptive treatment, prevention strategies and user-friendly toolkit for the wider community.

In-depth qualitative interviews will be conducted with individuals with a history of self-harm and their carers using a 1:1 semi-structured interview, to explore their lived experiences. We will also carry out these in-depth interviews with other health professionals, medico-legal officers, police, and policymakers to identify the barriers/ challenges in working with people who self-harm and with people who bereaved by suicide.

Evidence Synthesis

The primary focus of work package 5 is on Evidence Synthesis. Its aim is to provide the best available evidence on self-harm and suicide in Pakistan, and if the evidence is unavailable, then it is mandatory to highlight the areas where further original research is required. Our team is working on a wide range of systematic reviews listed below:

Prevalence of self-harm and suicide in individuals with severe mental illnesses in South Asia

The Asian region is at peak of suicide all over the world, the literature reported the 68 to 97% of suicide are due to psychiatric illness but only 35 to 40% received the diagnosis. This systematic review will explore the prevalence of self-harm and suicide among people with severe mental illnesses in South Asia.

The relationship between internet use, SH, and Suicidal behaviour in youth in South Asia

This review aims to understand the relationship between internet use, self-harm and suicidal behaviours in youth in South Asia. To identify any relevant information on the association between internet use and any type of self-harm, suicidal ideation and suicide.

Systematic Review: Protocol on the topic of similarities and differences in mental health policy in LMICs

There is a great need to understand the experience and research evidence from other low and lower-middle-income countries to help inform future mental health policies and initiatives in Pakistan where patients with more severe mental and neurological disorders are treated. To achieve this, we plan to examine national mental health policies, and all articles that study or review those policies in significant depth.

Prevalence of mental health issues among immediate family members bereaved by suicide: a systematic review

This review aims to identify the risk of depressive symptoms and suicidal ideation in immediate family members bereaved by suicide as compared to bereavement by other cause of death and to assess the association between bereavement by suicide and depressive symptoms/suicidal ideation vary between LMIC and High-Income Countries.

Risk factors and Prevalence of suicidal behaviour and suicidal ideation during the perinatal period in LMICs

This review aims to identify the risk factors for suicidal behaviour and suicidal ideation among women during the perinatal period in LIMIC and to assess the prevalence of suicidal behaviour and suicidal ideation among women during the perinatal period in LIMIC.

Prevalence and risk factors of self-harm in substance misuse in South Asia: A systematic review:

Globally, self-harm and suicide is a serious public health problem with long-term harmful effects on individuals, families and communities. The incidences of self-harm and suicide have been increasing worldwide, however, substance use disorder carries a comparatively increased risk for self-harm and suicide as compared to the general population. This review aims to better understand the prevalence and risk factors of self-harm in people with substance misuse to address this global public health problem. The review will include qualitative study designs with participants aged 16-and above, having a problem with substance misuse and self-harm.

Prevalence of Pandemic-Related Distress and the Suicidal Ideation: A Systematic Review and Meta-Analysis

In this review, researchers will establish the prevalence of COVID-19 pandemic related distress in association with self-harm. Meta-analysis will be performed for the studies, which will be deemed homogenous by the research to identify their combined effect.

Prevalence and risk factors of self-harm, suicidal ideation & suicide among prisoners in Low-and-lower-middle-income countries (LLMICs): A Systematic Review and Meta-Analysis

This review aims to determine the prevalence and risk factors of self-harm, suicidal ideation & suicide among prisoners in Low-and-Lower middle-income countries

Family dynamics and deliberate self-harm (with/without suicide intention) in adolescents: a systematic review

In family dynamic review, we aim to synthesize the research exploring the impact of family dynamics such as family conflict or tension (between parents, between parents and children, between siblings); family cohesion; family supportiveness; parenting style or behaviour (e.g. authoritarian, authoritative, permissive, neglectful) on self-harm in adolescents aged 10-19 years.

Feasibility Studies

Feasibility studies work package aims to evaluate the feasibility and acceptability of evidence-based psychological interventions to prevent self-harm and suicide.

(SAHAR-M) the project aims to prevent self-harm and suicide and quality improvement in the healthcare system with the aspirational goal of zero suicides. Given that, the SAHAR-M research team has planned small research studies to gather evidence on the feasibility and acceptability of evidence-based psychological interventions such as problem-solving intervention to prevent suicidal ideation, self-harm, and suicide.

We want to be as inclusive as we can in terms of working with people with a variety of mental health problems across different settings such as; maternal mental health, people with autism, burn survivors, prison settings, people with substance use disorder, older adults, and people with severe mental illness. We plan to test eHealth/Telephone based intervention to prevent the repetition of self-harm. Our plan includes training for local community health workers and field workers to create a sustainable, flexible, and efficient research delivery team and to strengthen the community-based health management system for diagnosing mental health disorders by combining technologies and traditional solutions. If proven effective, this will be implemented at a wider level in Pakistan. The table below lists the various studies ongoing:

Outcomes