title: Suicide Prevention in mental health patients: the role of primary care
Creators: name: Saini, P
Publisher: name: University of Liverpool Repository
Year: 2017

description: ABSTRACT Background: Primary care may be a key setting for suicide prevention as many patients visit their General Practitioner (GP) in the weeks leading up to their death. Comparatively little is known about GPs’ perspectives on risk assessment, treatment adherence, management of and interactions with suicidal patients prior to the patient’s suicide and the services available in primary care for suicide prevention. Aim: This study aimed to explore primary care data on a clinical sample of individuals who died by suicide and were in recent contact with mental health services in order to: investigate the frequency and nature of general practice consultations; examine risk assessment, treatment adherence and management in primary and secondary care; gain GPs’ views on patient non-adherence to treatment and service availability for the management of suicidal patients. Method: A mixed-methods study design including data from the National Confidential Inquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary care medical notes on 291 patients and 198 semi-structured face–to-face interviews with GPs' across the North West of England. We collected data on GPs' views on the treatment and management of patients in the year prior to suicide, suicide prevention generally and local mental health service provision. Quantitative data were analysed using SPSS. Interviews were transcribed verbatim and analysed using a thematic approach. Results: Overall, 91% of individuals consulted their GP on at least one occasion in the year before 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 the rating 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 were lack of insight, reported side effects and multiple psychiatric diagnoses. We obtained qualitative 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 were not under the care of specialist services. GPs recruited for the study may have had different views from GPs who have never experienced a patient suicide. Our findings may not be representative of the rest of the UK although many of the issues identified are likely to apply across services. Conclusion: Suicide prevention in primary care is challenging. Possible strategies for future suicide prevention in general practice include: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual’s situational context; removing barriers to accessing therapies and treatments; and, better liaison and collaboration between services to improve patient outcomes.