Mental health care providers talk about suicide prevention among people with substance use disorders in South Africa

[摘要] ENGLISH SUMMARY: Introduction. Substance use is a well-established and potentially modifiable riskfactor for suicidal behaviour. As a result, the World Health Organization has suggested thatsuicide prevention efforts should target people with substance use disorders (PWSUDs).Most suicide prevention strategies are largely framed within the biomedical paradigm andsuggest somewhat generic approaches to suicide prevention. As such, they lack specificityfor high-risk populations (such as PWSUDs) and for the different contexts in which they areimplemented. Few studies have focused on the experiences of mental health care providers(MHCPs) who provide care for suicidal PWSUDs; the clinical, health care, and contextualfactors they perceive to hinder suicide prevention; and their specific ideas for preventingsuicide in PWSUDs. In my study, I sought to investigate MHCPs' experiences of preventingsuicide in PWSUDs in South Africa (SA); their perceptions of the factors impacting onsuicide prevention in this context; and their context- and population-specific suggestions forpreventing suicide in PWSUDs.Methods. I conducted in-depth, semi-structured interviews with 18 mental healthcare providers (psychiatrists, psychologists, counsellors, and social workers) working in CapeTown, SA, who had experience providing care for suicidal PWSUDs. I used thematicanalysis to analyse the data inductively with Atlas.ti software.Findings. I identified three superordinate themes: (1) experiences of preventingsuicide; (2) perceptions of barriers to suicide prevention; and (3) ideas for suicide prevention.Participants described feeling hopeless, helpless, impotent, and guilty, and said they neededto debrief from their work. They perceived their experiences to be related to difficulties theyencountered treating substance use disorders and assessing and managing suicide risk, andtheir perceptions that treating substance use might increase suicide risk. Structural issues inservice provision (such as inadequate resources, insufficient training, and fragmented serviceStellenbosch University https://scholar.sun.ac.zaiiiprovision) and broad contextual issues (such as poverty and inequality, the breakdown offamily, and stigma) were perceived as barriers to suicide prevention. Participants thought thatPWSUDs were not receiving the psychiatric, psychological, and social care that they needed.Participants suggested a number of evidence-based strategies to prevent suicide, but alsomade novel, context- and population-specific suggestions for suicide prevention, including:improving training of health care providers to manage suicide risk; optimising the use ofexisting health care resources; establishing a tiered model of mental health care provision;providing integrated health care; and focusing on early prevention.Conclusion. These findings suggest that the ways MHCPs think about suicide andmake sense of their experiences impact on their perceived abilities to prevent suicide.Additionally, these findings indicate that structural, social, and economic issues pose barriersto suicide prevention. Participants highlighted specific strategies that take account of socioculturalcontexts that may be effective in preventing suicide among PWSUDs in SA. Thesefindings challenge individual, biomedical risk-factor models of suicide prevention andhighlight the need to consider a broad range of social, cultural, economic, political, andhealth care factors when planning suicide prevention interventions. Tailoring suicideprevention interventions to the specific needs of high-risk groups and to specific contextsmay be important to prevent suicide.

[发布机构] Stellenbosch University