Over 700 000 people a year die by suicide worldwide (64). One of the four key interventions in WHO’s LIVE LIFE: An implementation guide for suicide prevention in countries (65) is the early identification of anyone affected by suicidal behaviours, and their assessment, management and follow-up. Suicidal behaviours include suicidal thoughts (or ideation), plans of suicide, suicide attempts and suicide. Individuals should be assessed for risk of self-harm/suicide prior to initiating or during TB treatment if any of the following applies: extreme hopelessness and despair, current thoughts, plan or act of self-harm/suicide or history of suicidal behaviours (e.g. thoughts, plans, acts); if a person has a comorbid mental, neurological or substance use condition (such as depression, substance use disorder, anxiety or psychosis), chronic pain or extreme emotional distress; or where cycloserine is part of the treatment regimen.
It is important to manage self-harm/suicide, including follow-up, according to the WHO mhGAP Intervention Guide 2.0, Self-Harm/Suicide protocol) (32).