Mental health care providers' suggestions for suicide prevention among people with substance use disorders in South Africa: a qualitative study

Abstract

BackgroundPeople with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa.MethodsQualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis.ResultsParticipants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide.ConclusionsTraining mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.Electronic supplementary materialThe online version of this article (10.1186/s13011-018-0185-y) contains supplementary material, which is available to authorized users.

Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa

“…This study provides the first empirical evidence to support long-standing concerns about the relevance and appropriateness of South Africa’s SUD services for people with comorbid MSUD [ 50 , 51 ]. South Africa’s publicly funded SUD treatment system rarely provides integrated SUD and mental health treatment, largely due to a lack of intersectoral collaboration between the separate SUD and mental health treatment systems that has resulted in SUD providers often lacking the training and skills to address comorbid mental disorders among people with SUDs [ 51 , 52 ]. While SUD providers do refer patients with comorbid conditions to external mental health services, patients struggle to access chronically under-resourced public sector services due to long waiting periods, provider stigma towards people with SUDs, and other patient barriers [ 51 , 53 ].…”

Estrategias de intervención en la prevención de comportamiento suicida en pacientes con trastorno por consumo de sustancias en tiempos de COVID-19

“…Las evidencias actuales ponen claramente de manifiesto la elevada prevalencia del comportamiento suicida en los pacientes con consumo de sustancias. Las estrategias de prevención representan un desafío que se incrementa en este perfil de pacientes, siendo una población de riesgo en la que todavía no está clara la estrategia que emplear para poder reducir la tasa de muertes por suicidio (Goldstone, Bantjes y Dannatt, 2018).…”

“…Sociales y medioambientales (Goldstone et al, 2018). Sería de gran utilidad disponer de información que nos pueda indicar qué medidas de intervención son las óptimas para aplicar en esta población; o reafirmar que las estrategias utilizadas en la población general presentan la misma eficacia en este perfil de pacientes de riesgo.…”

“…Principalmente en la formación de los profesionales sanitarios en los tres niveles de intervención, siendo estos: el tratamiento del consumo, de la comorbilidad psiquiátrica y la prevención del comportamiento suicida. A través de este tratamiento se puede brindar una intervención más específica y distinta a la genérica (Goldstone et al, 2018).…”

Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda

“…However, no such data exists for individuals in sub-Sahara Africa (SSA), such as Uganda. However, most individuals with suicidal behaviors in SSA do not receive appropriate assessment and management for their suicide risk [ 6 , 7 ]. This may be attributed to health providers’ knowledge gaps and negative attitudes towards suicide [ 7 , 8 ].…”