Core mhGAP-IG follow-up principle for self-harm
The
mhGAP-IG treats any history of intentional self-harm as a strong marker of ongoing suicide risk, even when the wound was minor and the person now appears calmer. A brief improvement in mood or a healed injury does not cancel the need for structured, long-term monitoring. The guide therefore recommends
frequent contact early—daily or at least weekly—for the first 2 months, followed by less frequent contact as the person stabilizes, with total follow-up continuing for 2 years. At every visit, the nurse must directly ask about suicidal thoughts, plans, and access to means, because risk can fluctuate even when the person denies distress at a single encounter.
Why the correct answer is option 1
Option 1 matches the mhGAP-IG schedule:
weekly contact for 2 months, then less often, for
2 years. The other options shorten either the intensive phase or the total duration. For example, option 2 stops follow-up at
6 months, which is too short for a person with a self-harm history. Option 3 begins with monthly contact, which misses the high-risk window immediately after a self-harm episode. Option 4 ends with “as needed” after only
2 months, which is unsafe because the person may not return when risk rises.
| Option | Early phase | Total duration | Problem |
|---|
| 1 | Weekly for 2 months | 2 years | Matches mhGAP-IG |
| 2 | Weekly for 1 month | 6 months | Total follow-up too short |
| 3 | Monthly for 3 months | Every 3 months until well | Early contact too infrequent |
| 4 | Every 2 weeks for 2 months | As needed | No structured long-term monitoring |
Clinical reasoning in the RHU setting
In a Rural Health Unit, the nurse may be the only consistent provider this man sees. The
mhGAP-IG is designed for exactly this non-specialized setting: it gives a clear, time-bound follow-up plan so that a busy primary care worker does not rely on subjective impressions of improvement. The man’s family support is protective, but it does not replace structured clinical follow-up. Family members may not recognize early warning signs of relapse or may hesitate to report a new self-harm plan. The nurse should involve the family in monitoring while keeping the clinical schedule fixed.
Key point! A healed self-harm wound and a calmer presentation do not reduce the mhGAP-IG follow-up requirement. The schedule is based on the history of self-harm, not on the current severity of the injury.
Watch out! Do not confuse the follow-up schedule for depression without self-harm with the schedule for self-harm risk. Self-harm triggers the longer, more intensive monitoring plan described in option 1.
What to assess at each contact
The mhGAP-IG directs the nurse to evaluate suicidal ideation, specific plans, and access to lethal means at every follow-up visit. The man’s previous method—cutting his forearm—means the nurse should ask directly about sharp objects in the home and work with the family to reduce access. The
2-year duration is not arbitrary: it covers the period when recurrence risk remains elevated after an index self-harm episode. Even when the person reports feeling well, the nurse maintains the schedule because
self-harm risk can return without obvious warning, and early detection depends on regular, structured contact rather than waiting for the person to seek help.