SAMASTH
Systems Approach for MAnagement of self-harm by integrating Surveillance with mental health Training in general Hospitals in South India (SAMASTH)
Duration of project
(2024 to 2029)
Though suicide is a major public health concern in India, self-harm patients who mostly present to state run general hospitals are frequently discharged without a mental health assessment. There is a lack of implementation guidance and no framework to deliver mental health training programmes. Staff face multiple challenges with limited capacity for mental health assessment and treatment. We will examine if implementation of an integrated programme of self-harm registers, staff mental health training and digitally-assisted mental assessments strengthen health systems in general hospitals by increasing capacity for assessment and care-planning by non-specialists and improved care for self-harm patients? We will test the feasibility of implementation of this programme across three state general hospitals and to measure changes in rate of mental health assessment among self- harm patients, rate of engagement with mental health services and rate of repetition of self-harm and mental health literacy and competencies of health care professionals in management of self- harm patients. We will employ realist evaluation methods informed by Theory-of-Change processes.
Relevant policies will be reviewed and informed by this study, policy briefs and implementation guidance will be generated. This project has a framework to build, strengthen and sustain the research and training capacity in self-harm research.
In this study, we aim to implement and evaluate an integrated programme at three large state general hospitals in South India, comprising an e-selfharm register (e-SHR), with an associated mental health training programme for clinical staff. The proposed programme aims to strengthen health care systems in these settings by (a) Using the eSHR for surveillance and to identity self-harm patients. (b) Increasing capacity for mental health assessments among non- specialists using GMHAT (c) Improving clinical staff mental health literacy and (d) Embedding our structured training programme into the continuing professional development systems of the state hospitals.
Process evaluation to examine the feasibility of implementing this integrated programme and to determine if this is associated with:
- To increase the rates of mental health assessment among self-harm patients and engagement with mental health services by at least 30% at each site (Primary outcome of interest for power estimates)
- To decrease in proxy measures of repetition of self-harm such as re-presentation.
- To improve mental health literacy and competencies of health care professionals in management of self-harm patients.
- Satisfaction with services provided amongst self-harm patients and their families.
| Name | Institution |
| Dr. Murali Krishna T N | Institute of Public Health Bengaluru |
| Prof. Abhijit Nadkarni | London School of Hygiene & Tropical Medicine |
| Dr. Bontha Babu | ICMR-NIIRNCD |
| Dr. Raveesh B N | Mysore Medical College & Research Institute, Mysore |
| Dr. Rajesh Raman | JSS Hospital, Mysore |
| Vishwajeet Kumar | The Johns Hopkins University |
| Shiva Raj Adhikari | Tribhuvan University, Nepal |
| Prof. Greg Armstrong | Melbourne School of Population and Global Health |
| Mr. Vaibhav Agavane | Institute of Public Health Bengaluru |
| Dr. Prashanth Nuggehalli Srinivas | Institute of Public Health Bengaluru |
| Dr Anish V Cherian | National Institute of Mental Health and Neuro Sciences (NIMHANS) |
| Dr Rahul Ramchandra Shidhaye | Pravara Institute of Medical Sciences |
| Dr. Naveen Kumar | National Institute of Mental Health and Neuro Sciences (NIMHANS) |
| Prof. Mina Chandra | Ram Manohar Lohia Medical College, Delhi |
| Prof. Steve Jones | Centre for International Mental Health, University of Chester |
| Prof. Sumanth Mallikarjuna Majgi | Mysore Medical College and Research Institute MMCRI |
| Dr. Rajgopal Rajendra | Mysore Medical College and Research Institute MMCRI |
| Prof Vimal Sharma | University in Manchester, England |
| Mr. Sudeep P K | JSS Hospital, Mysore |
| Arnold Abel G | Institute of Public Health Bengaluru |
- Hospital services level: Evidence-based electronic SHR and surveillance, capacity building for mental health assessments, the training programme for the hospital staff, streamlined care pathways for those who self-harm and a cohort of mental health trainers.
- Staff level: Improvement in mental health literacy, increase in competencies to diagnose and manage mental health problems, effectively engage with self-harm survivors.
- Patient level: Improved access to mental health assessments and treatment, structured follow-up, sensitive and responsive care, and satisfaction with services.
- Regional and National level: Implementation of existing national policies, action plan for implementation of the SHR and the training programme, policy brief for the State Mental Health Task Force and the District Mental Health Programme through which we will inform the National Suicide Prevention Policies. As well as standard scientific dissemination and peer-reviewed outputs, we will arrange local dissemination events for care providers and community leaders.
Three clinical sites:
MMCRI
BMCRI
CIMS
