How acceptable is a Culturally adapted Manual Assisted Problem solving (C-MAP) intervention for Self-Harm? A qualitative study.
Suicide is a serious global public health problem, ranked amongst the leading causes of death in the world. Each year more than 800,000 people worldwide kill themselves; 75% suicides occur in Low and Middle Income Countries (LAMIC). 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. Self-harm (SH) is a risk factor for suicide. Offering appropriate treatment to individuals presenting after SH is considered a key component of suicide prevention strategies. In Pakistan, there are more than 100,000 episodes of self-harm annually. Both suicide and attempted suicide are classified as illegal acts, and are socially and religiously condemned.A multi-centre Randomised Controlled Trial (RCT) is being conducted in Pakistan, aimed at testing the effectiveness of C-MAP Intervention for patients following an episode of SH. The intervention comprised 6 sessions delivered by wellbeing practitioners. We explored patient participants’ views about SH and the CMAP intervention.
Semi-structured interviews were conducted with participants who had completed the intervention, exploring views about SH and its causes; barriers and facilitators to help-seeking; experiences and acceptability of the intervention, and its impact on them since participating in the trial. Interviews were transcribed and translated verbatim. Thematic analysis was conducted by research team members, using the principles of constant comparison.
Initial analysis suggests that participants viewed SH as an impulsive act, associated with feelings of anger and worthlessness, often precipitated by interpersonal conflicts, perceived lack of support, family problems and financial difficulties. Participants reported that the C-MAP sessions had helped in developing an understanding of their feelings and responses, improving coping strategies and problem-solving skills. They suggested that they could now identify the potential to respond impulsively to crises, and adapt their behaviour, thus avoiding the need to resort to SH. Participants suggested that they were more able to share problems, particularly within their family, and attributed this to the C-MAP intervention.
The C-MAP intervention is acceptable to people who have self-harmed, and may help people presenting after SH to develop problem-solving skills, and may have a role in the prevention of suicide. Ongoing analysis of data is exploring barriers and enablers to intervention access and implementation in the healthcare system in Pakistan.