General practitioners’ perspectives on primary care consultations for suicidal patients

Abstract

Little is known about general practitioners' (GPs') perspectives, management of and interactions with suicidal patients prior to the patient's suicide. The aims of the study were to explore GPs' interpretations of patient communication and treatment in primary care leading up to suicide and to investigate the relationship between GPs and mental health services prior to a patient's suicide. Thirty-nine semi-structured interviews with GPs of people who had died by suicide were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using a thematic approach. The following themes emerged from GP interviews: (i) GP interpretations of suicide attempts or self-harm; (ii) professional isolation; and (iii) GP responsibilities versus patient autonomy. GPs recruited for the study may have different views from GPs who have never experienced a patient suicide or who have experienced the death of a patient by suicide who was not under the care of specialist services. Our findings may not be representative of the rest of the United Kingdom, although many of the issues identified are likely to apply across services. This study highlighted the following recommendations for future suicide prevention in general practice: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; removing barriers to accessing therapies and treatments needed in primary care; improving liaison and collaboration between services to provide better patient outcomes; and increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual's situational context.

“Every structure we're taught goes out the window”: General practitioners' experiences of providing help for patients with emotional concerns'

“…GPs in previous studies have discussed feeling unable to refer patients to secondary services due to unacceptably long waiting lists, rigid criteria and high thresholds (Dew, Fox, Rodham, Taylor, & Harris, ; Saini, Chantler, & Kapur, ; Saini et al, ). Limited treatment options led to GPs being more likely to prescribe antidepressants, as this is the treatment over which they have the most control and they often felt that there was little else they could offer (Hyde et al, ; Saini et al, ; Saini, Chantler, & Kapur, ). As highlighted by Saini and colleagues (), this is seen as unacceptable to both GPs and patients, as the lack of choice infringes on the patients’ right to make decisions about their medical care.…”

“…Limited treatment options led to GPs being more likely to prescribe antidepressants, as this is the treatment over which they have the most control and they often felt that there was little else they could offer (Hyde et al, ; Saini et al, ; Saini, Chantler, & Kapur, ). As highlighted by Saini and colleagues (), this is seen as unacceptable to both GPs and patients, as the lack of choice infringes on the patients’ right to make decisions about their medical care. As a result, the choice that is often made by GPs and patients is between medication and no treatment at all.…”

Psychiatric Emergencies

“…Over 90% of individuals who complete suicide will present to their primary care provider within weeks to months of their death. 2–5 A primary care provider with a practice of approximately 2,000 patients will, on average, lose a patient to suicide every 3 years. 6 Growing requirements for depression screening in primary care render screening, assessing, and managing suicidal ideation and behaviors a more common element of practice.…”

“…Providers also struggled with limited access to mental health services for their patients. 5 This challenge is also described when working with adolescent populations where risk factors are often interpreted as attention-seeking or part of normal development. In younger populations, open communication can be difficult and involving a support system can be more challenging.…”

GPs’ views and perspectives on patient non-adherence to treatment in primary care prior to suicide

“…Comparatively little is known about GPs' perspectives on treatment adherence and the management of suicidal patients prior to their death (Saini et al, 2015). Non adherence to treatment is recognized by the World Health Organization [WHO], which defines therapeutic adherence as "the extent to which a person's behavior corresponds with agreed recommendations from a health care…”