Written By: Julius Mwimo, MsGH Candidate 27′
In a recent Think Global event hosted by the Duke Global Health Institute (DGHI), a panel convened by the Center for Global Mental Health explored community-engaged approaches to suicide prevention across diverse settings, from U.S. hospitals to the Pacific Islands, Kenya, and Tanzania. The panel was moderated by Dr. Brandon Knettel, Associate Professor of Nursing and Global Health at Duke and Associate Director of the Center for Global Mental Health.
The first panelist, Dr. Marissa Marcini, Associate Professor of School Psychology at UNC Chapel Hill, presented her team’s virtual reality intervention, PRESSER (Practice Experiences for Social and School Reintegration), designed for youth hospitalized following suicide-related crises. The VR tool allows adolescents to learn and practice coping skills in immersive, lifelike scenarios while still in the hospital, aiming to improve recovery and school reintegration. Marcini emphasized the importance of partnering with teens with lived experience, particularly racial or ethnic minority and LGBTQ+ youth, while balancing the need to empower their voices without overburdening them.
Next, Dr. Emma Mew, psychiatric epidemiologist and postdoctoral associate at DGHI, shared her work in American Samoa, where an estimated one in three high school students had attempted suicide in the past year, prompting a declared youth suicide crisis. Guided by decolonizing methodologies and the principle of “nothing about us without us,” her team worked with youth and community stakeholders to co-create the Fono Fale (house model), a culturally grounded family skills intervention framework aligned with Samoan values. She highlighted that the greatest challenge was building and protecting trust in a context where suicide is deeply stigmatized and parenting practices must be approached with cultural sensitivity. Her team is now adapting the Strengthening Families Program and has submitted an R01 to evaluate its impact.
Dr. Ali Giusto, clinical psychologist and Assistant Professor at Florida International University, described applying the Safety Planning Intervention within community-embedded trials in Eldoret, Kenya, in partnership with Moi Teaching and Referral Hospital and AMPATH. A key adaptation involved Step 6 of the protocol, which typically directs individuals to call 911, a resource that did not exist in the Kenyan context. Her team instead worked with participants to identify trusted community leaders and problem-solve barriers to reaching out during crises. She stressed the importance of training every team member in suicide assessment and fostering a culture of help-seeking across the research team.
Dr. Kim Madundo, psychiatrist and Head of the Department of Psychiatry and Mental Health at Kilimanjaro Christian Medical Center (KCMC) in Tanzania, presented the Ideas for Hope intervention, a telehealth-based counseling program to reduce depression, prevent suicide, and improve HIV care engagement among adults living with HIV. In a country with approximately one psychiatrist per million people and where suicidal behavior is criminalized, his team developed a house model framework with pillars including living healthy with HIV, living free of stigma, emotional health, and fulfilling basic needs. Key adaptations included visual distress thermometers (since numerical scales did not translate well in Swahili) and a task-shifting model empowering junior nurses to deliver the intervention with high fidelity. Madundo stressed that it is possible to build impactful, accessible mental health care even from critically limited resources.
During the discussion, panelists explored the value of transdiagnostic approaches that address underlying distress, such as poverty, food insecurity, and family conflict, rather than isolated diagnoses. They discussed the complexities of suicide criminalization, with Dr Madundo noting that healthcare workers in Tanzania maintained patient confidentiality despite the legal framework, and that published research found near-unanimous agreement that criminalization was antiquated and a barrier to care. All panelists encouraged researchers hesitant to engage with suicide prevention to “partner up” with experienced colleagues, noting that asking about suicidal thoughts does not cause harm but can uncover distress that individuals have not felt safe to share.
Across the panel, the message was clear: effective suicide prevention requires deep community engagement, cultural humility, and creative adaptation to local realities. At the Center for Global Mental Health, we remain committed to advancing community-driven, culturally responsive approaches to suicide prevention worldwide.