Design of a brief psychological intervention for youth who self-harm: a formative study in India

Background There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs). Objective The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms. Methods A systematic, sequential approach was used to integrate available scientific evidence, expert service providers' knowledge and experience, and service users' lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops. Findings We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients. Conclusion and clinical implications ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers.