# A suicide safety protocol with vulnerable populations with chronic physical health conditions: A pragmatic protocol implementation among displaced Myanmar adults in Thailand

## TL;DR

This paper outlines a suicide safety protocol for displaced Myanmar adults in Thailand with chronic health conditions, showing how it can be adapted and used in humanitarian settings.

## Contribution

The study provides practical insights on adapting and implementing a suicide safety protocol in complex humanitarian settings with vulnerable populations.

## Key findings

- The CETA suicide safety protocol was successfully adapted and implemented for displaced Myanmar adults in Thailand.
- Case examples demonstrate how suicide risk is influenced by physical illness, psychosocial stressors, and structural vulnerability.
- Adaptations like language translation and cultural referrals improved protocol feasibility and acceptability.

## Abstract

Suicide is a serious global health problem with ~73% deaths by suicide occurring in low- or middle-income countries (LMICs), many of which are among people experiencing humanitarian emergencies. Few guidelines outline specific steps and strategies to tackle suicide risk and manage post-attempt consequences in these settings, leaving program implementers with limited information to translate guidance to practice. This article describes the implementation of the Common Elements Treatment Approach (CETA) suicide safety protocol as part of a randomized controlled trial in northern Thailand for displaced adults from Myanmar with chronic physical health conditions. The CETA safety protocol has been used in many trials and programs to screen for and manage suicide risk, including in a prior CETA effectiveness trial with Myanmar adults. In this article, we describe how this safety protocol was adapted for the study setting, and utilized to effectively screen, assess suicidal thoughts and behaviors, develop and manage action plans for study participants with active suicidal ideation. We present three illustrative case descriptions of individuals with whom we implemented the safety protocol to highlight how suicide risk intersects with physical illness, psychosocial stressors and structural vulnerability. Reflections on feasibility, acceptability and adaptations – such as language translation, culturally grounded referral pathways and training for nonspecialist providers – are shared to inform future implementation. Our findings support the implementation of suicide safety protocols within humanitarian programming and offer practical insights for global health practitioners and policymakers working in similarly complex settings.