Our aim is characterize mental health therapists’ self‐efficacy pertaining to working with patients at risk for intimate partner violence (IPV) and suicide at a community mental health center (CMHC), where these issues intersect. Consistent with community‐based participatory research, a multidisciplinary team partnered with an urban CMHC in New York to conduct 3 focus groups comprising 23 therapists. We iteratively coded and mapped prevalent themes according to self‐efficacy theory. Therapists described multiple sources of self‐efficacy: successful achievement of tasks such as demonstrating a mastery of local resources and knowledge of therapeutic strategies for IPV‐involved clients; vicarious experiences including homicide–suicide portrayals in the media; verbally persuading patients regarding treatment engagement; and physiologic reactions, including distress and burnout. Therapists feel equipped to address patients’ needs, but they want more information on IPV and suicide. Perhaps most surprising was the frustration and isolation participants discussed regarding working with physicians and agencies outside their office walls. Interdisciplinary dialogue and case conferencing may enhance patient care and safety.
Introduction: Intimate partner violence (IPV) and suicide are pressing public health issues, yet their intersection in mental health care settings is understudied. We conducted a qualitative study to characterize mental health therapists' personal and system barriers in preparation for an upcoming training curriculum seeking to help patients address these interconnected issues. Method: We partnered with an urban community mental health center in New York to facilitate focus groups grounded in communitybased participatory research principles. Twenty-three therapists formed 3 focus groups. Participant responses were audio-recorded, transcribed, and coded using Bronfenbrenner's socioecological model. We performed a primary qualitative framework analysis, coding for therapist barriers in addressing the intersection of IPV-suicide at individual, relational, community, and societal levels. Results: Therapists perceived numerous barriers in all 4 domains. Individually, some struggled with feelings of helplessness and a lack of appropriate training. At the relational level, therapists expressed apprehension about harming the therapeutic relationship by discussing IPV and suicide at length. From a community perspective, therapists voiced concerns for clients' limited local access to support systems and financial resources. Societal barriers included policy-related limitations such as length of appointment times. Discussion: Community mental health center therapists face considerable barriers working with patients affected by IPV and suicide. The socioecological model is a fitting framework for understanding multisystem barriers at individual, relational, community, and societal levels. A better understanding of these challenges is critical for advancing therapist education, enhancing patient outcomes, and improving health systems. Public Significance StatementIntimate partner violence and suicide are prevalent conditions globally with considerable effects on physical and mental health. Greater recognition and study of the intersectional nature of these conditions may improve patient outcomes, as well as have significant impacts upon therapist training initiatives and public health policy.
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