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. 2020 Oct 28;10(10):e038855.
doi: 10.1136/bmjopen-2020-038855.

Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people's perspectives

India Bellairs-Walsh  1   2 , Yael Perry  3 , Karolina Krysinska  4   2 , Sadhbh J Byrne  4   2 , Alexandra Boland  4   2 , Maria Michail  5 , Michelle Lamblin  4   2 , Kerry L Gibson  6 , Ashleigh Lin  3 , Tina Yutong Li  4   7 , Sarah Hetrick  4   8 , Jo Robinson  4   2
Affiliations

Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people's perspectives

India Bellairs-Walsh et al. BMJ Open. .

Abstract

Objectives: General practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people's opinions and experiences related to GPs' practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people's perspectives. This study aimed to explore young people's views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs.

Design, setting and participants: Two qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16-24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis.

Results: Five major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist-disliking the terms 'risk' and 'risk assessment', and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs' attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations.

Conclusions: Our study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.

Keywords: child & adolescent psychiatry; mental health; primary care; qualitative research; quality in health care; suicide & self-harm.

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Conflict of interest statement

Competing interests: IBW, KK, SJB, AB, ML, TYL and JR report grants from the WA Primary Health Alliance (WAPHA) to enable the conduct of this study. SH reports that she is the joint coordinating editor of the Cochrane Common Mental Disorders Group and manages the Children and Young People Satellite. She has funding from the Royal Society, the Faculty of Medical and Health Sciences at the University of Auckland, and Cochrane to pursue this work, including systematic reviews in the area of children and young people’s mental health. She is funded by the Auckland Medical Research Foundation to develop and test an app that delivers goal setting for young people with mental health and related difficulties, such as self-harm. She is a CureKids Research Fellow, working on developing digital tools to support parents to support children with mental health and related difficulties. YP, MM, KLG and AL report nothing to disclose.

References

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