South Asia Harm Reduction Movement (SAHAR-M)
Suicide and self-harm are the major public concern that needs immediate attention. Suicide is
the 15 th leading cause of death worldwide, with 78% of suicides taking place in Lower and
Middle Income Countries. Self-harm is considered to be the single most important predictor
of death by suicide. The first global suicide prevention report by the WHO for 112 out of 172
countries highlighted that the quality of data on suicide was poorer in LMIC. In Pakistan
13,377 (crude all age rate of 7.5/100,000) suicide cases were reported in the year 2012. The
WHO reports the annual prevalence of self-harm that requires medical treatment in Pakistan,
ranges from 0.15% to 0.30%. Unfortunately no national suicide statistics has been collected
and the reasons for this are that under Pakistani law both suicide and self-harm are illegal acts
that are punishable, so in cases of self-harm and suicide people avoid going to public
hospitals for the fear of harassment by the medico legal officers, the police and they prefer to
get treatment from private hospitals because such presentations are not reported to the medico
legal officers in most cases.
WHO is aiming to reduce suicide rates by 10% by 2030 and suicide rate reduction is also an
indicator of Sustainable Development Goals (SDGs), however due to a lack of surveillance
systems for self-harm attempts in most LMICs, the development of strategies and
interventions cannot be established. However in some LMICs steps have been taken towards
the registration of suicide and self-harm attempts presenting to hospitals, such as India
(Rajendra et al., 2015) and Jamaica (Ward et al., 2010). Data from these registers has
demonstrated the value of having such systems in place and has proven to be very
informative in LMICs where attempted suicide, self-harm rates and patient profiles are
different from high-income countries.
SAHAR-M, means ‘The morning twilight before a new dawn’ in the Urdu Language. The M
is for Movement, the group considered the programme of research has increasing become
more of a research movement and thus the name South Asia HArm Reduction (SAHAR)-
Movement (M) was derived. Building on the last two years of work, the movement is aimed
at working towards ‘Zero suicide’- a systematic framework for creating an integrated
approach to prevent suicide and quality improvement in the healthcare system with the
aspirational goal of "zero suicides.”
The mission of SAHAR-M is to facilitate and execute through rigorous research methodology
and governance a range of national self-harm and suicide prevention activities with a strong
focus on building capacity and capability, in readiness and timely responsiveness to support
the people and communities in preventing self-harm behaviour and suicide. This programme
of work will support the local and national health economies in Pakistan. This will involve
knowledge mobilisation using an integrated trans-disciplinary approach to self-harm and
suicide prevention. The main objective of this movement is to facilitate networking and
partnership strengthening and to carry high quality research and to reduce the stigma around
self-harm and suicide in particular and mental illnesses in general, in collaboration with
individuals who have a lived experience.
Following outcomes are expected from this research programme:
1: This project will fill critical gaps in knowledge, facilitating improvements in the
organization and delivery of health and social care, and in public health measures.
2. This will improve public and political understanding of mental health generally and self-
harm and suicide particularly. These are important elements in an overall suicide prevention
strategy and mental health policy and also guide the adaptation of evidence-based
interventions for Pakistan.
3. Broaden understanding of the research landscape of early career researchers and local
academic community will build a strong research infrastructure of community and increase
capacity for further research planning such as scoping reviews, feasibility studies, trial
platforms and systematic reviews. Training local fieldworkers has the potential to create a
sustainable, flexible and efficient research delivery team for future research projects.
4. Pakistan have, been under-represented in health research efforts and building research
capacity internationally will help produce a global pool of researchers who are able to make
use of current knowledge and techniques to develop strategies, tools and methods to tackle
mental health issue that are best suited to their local setting and needs.
5. The obtained date from two primary methods about suicide attempts (1) self-reports of
suicide attempts in surveys of representative samples of the population, and (2) hospitals,
community, and prisons, healthcare self-harm episode routine data will contribute to key
areas in addressing knowledge gaps and improving service provision for individuals
presenting to hospitals following attempted suicide and self-harm and information on specific
service capacity and treatment requirements.