Suicide Prevention in Mental Health Patients: The Role of Primary Care

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Abstract

Background: Primary care may be a key setting for suicide prevention as many patients visittheir General Practitioner (GP) in the weeks leading up to their death. Comparatively little isknown about GPs’ perspectives on risk assessment, treatment adherence, management of andinteractions with suicidal patients prior to the patient’s suicide and the services available inprimary care for suicide prevention.Aim: This study aimed to explore primary care data on a clinical sample of individuals whodied by suicide and were in recent contact with mental health services in order to: investigatethe frequency and nature of general practice consultations; examine risk assessment,treatment adherence and management in primary and secondary care; gain GPs’ views onpatient non-adherence to treatment and service availability for the management of suicidalpatients.Method: A mixed-methods study design including data from the National ConfidentialInquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary caremedical notes on 291 patients and 198 semi-structured face–to-face interviews with GPsacross the North West of England. We collected data on GPs views on the treatment andmanagement of patients in the year prior to suicide, suicide prevention generally and localmental health service provision. Quantitative data were analysed using SPSS. Interviewswere transcribed verbatim and analysed using a thematic approach.Results: Overall, 91% of individuals consulted their GP on at least one occasion in the yearbefore suicide. GPs reported concerns about their patient’s safety in 27% cases, but only 16%of them thought that the suicide could have been prevented. The overall agreement in therating of risk between primary and specialist care was poor (overall kappa = 0.127; p = 0.10).Non-adherence was reported for 43% of patients. The main reasons for non-adherence werelack of insight, reported side effects and multiple psychiatric diagnoses. We obtainedqualitative data from GPs on their interpretations of suicide attempts or self-harm,professional isolation and GP responsibilities when managing suicidal patients.Limitations: Our findings may not be generalisable to people who died by suicide and werenot under the care of specialist services. GPs recruited for the study may have had differentviews from GPs who have never experienced a patient suicide. Our findings may not berepresentative of the rest of the UK although many of the issues identified are likely to applyacross services.Conclusion: Suicide prevention in primary care is challenging. Possible strategies for futuresuicide prevention in general practice include: increasing GP awareness of suicide-relatedissues and improving training and risk assessment skills; increasing awareness in primarycare about why patients may not want treatments offered by focusing on each individual’ssituational context; removing barriers to accessing therapies and treatments; and, betterliaison and collaboration between services to improve patient outcomes.

Keyword(s)

General Practitioner; Mental Health; Primary care; Self-harm; Suicide prevention

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