Two projects , in China and Canada to prevent repetition of suicide attempts .

1. Implementation research on community interventions to prevent repeated suicide attempts among individuals in low-resource settings in Ningxia, China and Nunavut, Canada Twoprojects, in China and Canada to preventrepetition of suicide attempts. PI China: Michael Phillips Director, Suicide Research and Prevention Center, Shanghai Mental Health  Center,  Shanghai Jiao Tong UniversitySchoolof MedicineExecutive Director, WHO Collaborating Center for Research and Training in Suicide Prevention,  Beijing HuilongguanHospital Professor of ClinicalPsychiatry and ClinicalEpidemiology,Columbia University Along withmanycollaborators PI Canada: Brian L. Mishara Director, Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Professor, Psychology Department, Université du Québec à Montréal Along with Allison Crawford, Jack Hicks and a large number of Agencies and CommunityPartners

2. Aims and Objectives • The China and the Canada Project both: • Focus on a demonstrated high risk group for death by suicide and a repeatedattempt: personsseen in hospital of a suicide attempt • Implement a proven intervention to reduce suicide recidivism: the SUPRE-MISS protocoldeveloped by WHO, involvingregularcommunity non-professionalfollow-up afterdischargefromhospital • Interventions are developed in collaboration withcommunities, and are adapted to local cultures and ressources • Implementation science approach to evaluation, combinedwithassessment of outcomemeasures

3. Canadian Project: Prevention of repeated suicide attempts in Nunavut, Canada by communityfollow-up adapted to Inuit culture Principal Investigators for Canadian Project Brian L. Mishara, Ph. D., Directeur, Centre de recherche et d’intervention sur le suicide et l’euthanasie (CRISE), Professeur, Département de psychologie; Allison Crawford, M.D. Assistant Professor, Department of Psychiatry, University of Toronto, Directrice du Northern Psychiatric Outreach Program and Telepsychiatry, Centre for Addiction and Mental Health, Directrice, Psychiatry outreach services to Nunavut; Jack Hicks, Ph. D. Cand., Ilisimatusarfik (The University of Greenland), Adjunct Professor, Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan Kimberly Masson, Embrace Life Council, Nunavut

7. Inuit village near Frobisher Bay, from Hall (1865)

10. Suicide by Inuit in Nunavut, and Canada (all) 1970-2015

11. Suicide by Inuit in Nunavut, by sex and age group

12. -- ‘Suicide’, Napatchie Pootoogook, Cape Dorset, 1997-8.

14. Our approach • Collaboration betweenresearchers, communityorganizations, members of communities, in decisionmaking at all stages of the development, planning, implementation, evaluation, interpretation of results and dissemination of results.

16. Challenges • Coordonnating a project in isolated villages accessible only by air, eachwithdifferent ressources; after patients return from the (only) hospital in Iqaluit, usually over 1000 km away. • Ensuring adaptation of interventions to local culture and ressources, and uptake by target population • High costs of everything in Nunavut, including personnel for project.

17. China Project: Prevention of repeated suicide attempts in Nunavut, Canada by communityfollow-up adapted to Inuit culture Principal Investigators for China Project Michael Phillips Director, Suicide Research and Prevention Center, Shanghai Mental Health  Center,  Shanghai Jiao Tong UniversitySchool of MedicineExecutive Director, WHO Collaborating Center for Research and Training in Suicide Prevention,  Beijing HuilongguanHospital Professor of ClinicalPsychiatry and ClinicalEpidemiology, Columbia University

18. Community intervention to prevent repeated suicide attempts in Ningxia Province, China The project in China will implement and evaluate an adapted version of the WHO SUPREMISS project (previously proven effective in China) to all 44 level-2 and level-3 general hospitals in Ningxia PREPARATION：Develop an accidental injury registry system and associated attempted suicide registry in the ED of at all 44 county-level and higher general hospitals in Ningxia Province PHASE 1：In-depth interviews and focus groups with relevant stakeholders in 4 of Ningxia’s 22 counties to assess (and subsequently revise) the feasibility of the WHO SUPRE-MISS intervention previous used for suicide attempters in Shandong Province: including a 45 interview and educational intervention about suicide in the ED, a home visit within 2 weeks of discharge to identify and train a local ‘guardian’, and quarterly home visits to provide social support and re-assessments over the next 2 years. PHASE 2：A pilot test of the revised intervention in 6 hospitals in the 4 target counties for 1 year PHASE 3：Revise the intervention based on the pilot, implement it in the EDs of 18 hospitals in 12 counties, and then compare the suicide rates and suicide attempt repeat rates over the subsequent 2 years in the 12 intervention counties with that in the 10 non-intervention counties PHASE 4：Conduct in-depth interviews and focus groups with stakeholders to determine their attitudes about the feasibility and effectiveness of the intervention; combine the quantitative and qualitative to prepare a report and use the report to promulgate the intervention throughout Ningxia, in other provinces in China, and to low-resourced settings in other LMICs interested in suicide prevention. EXPECTED OUTCOME: A manual for developing and promulgating an effective suicide prevention strategy for low-resourced settings in LMICs

22. Implementation research on community interventions to prevent repeated suicide attempts among individuals in low-resource settings in Ningxia, China and Nunavut, Canada Twoprojects, in China and Canada to preventrepetition of suicide attempts. PI China: Michael Phillips Director, Suicide Research and Prevention Center, Shanghai Mental Health  Center,  Shanghai Jiao Tong UniversitySchoolof MedicineExecutive Director, WHO Collaborating Center for Research and Training in Suicide Prevention,  Beijing HuilongguanHospital Professor of ClinicalPsychiatry and ClinicalEpidemiology,Columbia University Along withmanycollaborators PI Canada: Brian L. Mishara Director, Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Professor, Psychology Department, Université du Québec à Montréal Along with Allison Crawford, Jack Hicks and a large number of Agencies and CommunityPartners