Dareecha: Contextually-Adapted and Evidence-Informed Zero Suicide Implementation Approach for Risk Reduction among Adolescents in Schools of Ghizer District, Gilgit-Baltistan, Pakistan

Abstract Globally, suicide is remarkably growing at unprecedented rates among young people. District Ghizer, Gilgit-Baltistan in Pakistan, witnesses a surge in mental health issues and suicide among its youth. Limited research in remote areas coupled with profound stigma, underreporting of suicide cases, and the absence of validated data recording mechanisms significantly impact our grasp of the burden and the factors associated with it. Additionally, the inadequate mental health workforce in the region and the lack of evidence-based preventive measures implemented leave a vulnerable demographic at a heightened risk of suicide attempts. Insufficient platforms for youth mental health screening and provision of individualized care, especially for students attending educational institutions, hinder our understanding of the extent of the problem, and how best we may address the suicidal tendencies and youth mental health needs. The paper describes the implementation of the Zero Suicide Model in educational institutions in rural Pakistanwith minimal access to mental healthcare for testing its feasibility and acceptability. The model incorporates key elements of suicide risk factor stratification and modification, including suicide risk identification, comprehensive suicide risk assessment, safety planning intervention, counselling on reducing access to lethal means, parental/familial involvement and school leadership engagement, suicide-specific clinical interventions, follow-up care, and monitoring. The foundational premise of the model focuses on associating an at-risk individual with a trained care provider to prevent suicide incidence. Leveraging parental trust in schools, the school-based zero suicide model seeks to engage parents/caregivers in suicide prevention initiatives, optimizing the influential role of school teachersand leadership in normalizing and enforcing suicide prevention policies and guidelines. It further involves the evaluation of processes and individual outcomes to devise institutional policies and integration of a holistic suicide care system within schools. The multifaceted approach will derive evidence to signify the potential of sustaining clinical and preventive measures within the model and provide insights into the components that need to be further strengthened to best fit the needs of beneficiaries.