PRECIPICE - PREventing Suicide In PrImary CarE

Problem

Suicide represents a serious public health issue and is the largest killer of men under the age of 50 in the UK. A third of patients visit their General Practitioner (GP) in the months leading up to their suicide attempt and up to 75% of individuals who die by suicide have not been in contact with mental health services in the previous year. This highlights the key role of Primary Care in the system wide approach to suicide prevention. Previous work has highlighted the barriers and challenges GP’s face when managing suicidal behaviour. Less is known about the approaches GP’s find effective in managing suicidality and their training needs to deliver effective suicide prevention responses. This work, commissioned by the Yorkshire and the Humber Mental Health & Suicide Prevention Community of Improvement (Y&H MH&SP CoI), aims to explore GP perspectives on suicide prevention in the Yorkshire and Humber Region.

Approach

GP and GP trainees were recruited from across the Yorkshire and Humber Region using a snowball sampling method. Participants underwent semi-structured qualitative interviews using a topic guide. This topic guide was informed by a systematic scoping review and the four research aims provided by the commissioners of this work. 1. What are the barriers and challenges relating to suicide prevention? 2.What approaches work well? 3. What additional training is needed for GP’s? 4. How are cases of suspected suicide reviewed in their place of work? The interview transcripts were analysed using Framework Analysis; a seven-step qualitative thematic analysis which aims to produce summarising themes that best describe the data set. Emerging themes from the participant interviews underwent regular internal review by the research team, with any new areas for discussion being added to the topic guide as per the iterative process of qualitative research.

Findings

Five interviews have taken place so far and are currently ongoing. Early analyses suggest there is a lack of support from secondary care services when managing acutely unwell patients. Patients presenting from ethnic minority groups present a challenge when performing a suicide risk assessment due to language barriers and mental health presenting differently in different cultures. GPs would like a stronger presence of mental health professionals in primary care to help assess and manage acutely unwell patients.

Consequences

The interviews in this study are ongoing. We aim to produce a rich data set describing the perspectives of GP’s regarding suicide prevention in the Yorkshire and Humber Region. The results of our work will help to inform policy relating to suicide prevention plans in the region and inform future work to gain the perspectives of other stakeholders in suicide prevention such as charities, public health leads and service users.