Difficulties in suicide prevention facing primary healthcare workers based on the characteristics of people with suicide risk and healthcare systems

Abstract

Aims To clarify difficulties in suicide prevention that primary healthcare workers face based on the characteristics of people with suicide risk and healthcare systems. Design Qualitative descriptive design. Methods Semi‐structured interviews were held with 15 primary healthcare workers employed by a Japanese municipality from August to October 2019. Data were subjected to qualitative descriptive analysis, performed in accordance with the COREQ guidelines. Results Analysis identified 11 subthemes and three themes. Theme 1, ‘Failure to connect with support’, included the subthemes of ‘Obstacles to communication’ and ‘Refusal of support’. Theme 2, ‘Support that cannot offer a solution’, included the subthemes ‘Dying by suicide even while receiving psychiatric treatment’ and ‘Resolved to dying’. Theme 3, ‘Isolation’, included the subthemes ‘Loneliness despite being connected with others’ and ‘Lack of community development’. Conclusion In relation to difficulties based on the characteristics of people with suicide risk, it is important to be aware of their unspoken views and to increase mental health literacy in society. Overcoming difficulties in relation to the primary healthcare system requires training and continuing education for professionals specializing in mental health and suicide prevention. To avoid isolating healthcare workers and ensure that those in need of treatment access support, systems should be established that enable collaboration with mental health specialists across organizations. Impact Primary healthcare workers, who are often the first point of contact for people with suicide risk, play a key role in suicide prevention. The identified challenges they face include difficulties in connecting people with suicide risk with support, a sense of helplessness because some people die even while receiving treatment and difficulties in building communities that prevent isolation. These findings can contribute to measures for alleviating the difficulties primary healthcare workers face, reforming primary healthcare systems for suicide prevention and saving lives. Patient or public contribution In this study, primary healthcare workers working in the study area participated as interviewees. They also confirmed the truthfulness of the study results, thereby ensuring the rigour of the data analysis.

Insights from primary care workers supporting people at risk of suicide in local communities in Japan: A qualitative descriptive study

“…Willingness and perseverance on the part of healthcare workers to open the doors to the heart and home are indispensable, allowing those with feelings of helplessness, hopelessness and distrust to come forward. A major difficulty in supporting people at risk of suicide is that a proportion of them do not want to receive support (Tanaka & Ikeuchi, 2022). Although there is no one approach to this issue, the three aforementioned strategies under the theme of ‘meaningful connections’ could offer valuable insights for primary healthcare workers.…”

“…Also, while the efficacy of restrictions on access to firearms, ligature points and pharmacological agents in institutional settings has been reported (Platt & Niederkrotenthaler, 2020), limiting access to hazardous materials in community settings is difficult. Furthermore, the lack of help‐seeking behaviour among people at risk of suicide and the challenges facing healthcare systems mean that primary healthcare workers experience difficulties such as ‘failure to connect with support’, ‘support that cannot offer a solution’ and a ‘lack of community development’ (Tanaka & Ikeuchi, 2022).…”

“…Even trained primary care providers can lack confidence in dealing with people at risk of suicide, and barriers to referral exist from primary care providers to psychiatrists (Harmer et al., 2022). Also, because those at risk tend not to disclose suicidal ideation on their own, primary healthcare workers face formidable challenges in providing support, including difficulties in identifying those at risk or identifying those who decline support while trying to deal with problems in their lives that treatment cannot resolve or who do not change their minds after having resolved to die (Tanaka & Ikeuchi, 2022). There is also inadequate evidence for the effectiveness of suicide screening because suicide has the potential to occur even in the absence of identifiable risk factors (Spottswood et al., 2022).…”

Suicide prevention curriculum development for health and social care students: Protocol for a scoping review

“…Training of healthcare staff has been highlighted as an important element of suicide intervention and prevention (11). However, healthcare staff often do not receive appropriate training or lack knowledge and awareness of suicide and self-harm that allows for an appropriate response to suicide risk, primarily due to a lack of resources for healthcare professionals to gain access to appropriate information and training (12)(13)(14). This is reflected in the fact that both professional practitioners and students rate their own interpersonal suicide prevention skills as poor (15).…”

Suicide prevention curriculum development for health and social care students: Protocol for a scoping review

“…Training of healthcare staff has been highlighted as an important element of suicide intervention and prevention [12]. However, healthcare staff often do not receive appropriate training or lack knowledge and awareness of suicide and self-harm that allows for an appropriate response to suicide risk, primarily due to a lack of resources for healthcare professionals to gain access to appropriate information and training [13][14][15]. This is reflected in the fact that both professional practitioners and students rate their own interpersonal suicide prevention skills as poor [16].…”