| Theme | Sub-theme | Quote |
|---|---|---|
| Challenges to managing suicidal behaviour | Challenges of the patient population | ‘It’s more difficult to, I suppose, gauge the risk . . . [for] teenagers it’s such a difficult time, and there’s a lot of emotional upheaval.’21 |
| Time constraints | ‘We are not trained enough ... we cannot go deeper ... For instance, someone may say they wanted to kill themselves because their husband left them, and you cannot understand why because you have no time to go deeper and lack knowledge on what to ask.’28 | |
| Fragmented relationships with mental health services | Lack of support from secondary care | ‘Waiting times and a lack of beds is a problem. Sometimes patients who are referred for assessment cannot be admitted as there are no beds. Sometimes patients have to wait too long.’26 |
| Poor communication | ‘GPs do not have quick access to support services within mental health services, especially at early stages where they have no immediate access. This may be due to the CMHT not allowing immediate access as they have very rigid criteria. Therefore need faster assessments for vulnerable patients, especially if the GP has assessed them and thinks they are in need of some treatment.’26 | |
| Personal attitudes of GPs regarding suicidal behaviour | Uncertainty and complexity in suicide risk assessment |
‘It’s very difficult to find who’s really suicidal because, as I
said, we do, most of the time, they will not come here and say I’m suicidal.’7 |
| GPs’ perceptions of the relationship between self-harm and suicide | ‘In my experience it seems like the majority of self-harmers didn’t seem to have that high a risk of completing a suicide. In my experience most of them are fairly low risk [...] A lot of them were cry for helps.’ 22 | |
| The use of screening tools | ‘So in terms of assessment, I don’t use a risk assessment tool or anything, and I kind of weigh what they’re actually saying, in terms of what they’re planning and what’s their history, so I guess I do take that into consideration, and their social situation as well.’22 | |
| Identified needs to improve suicide prevention in primary care | Wider community-based support | ’As a health centre we need to re-activate the teen club with the idea of encouraging activities for young people, sports, music, meetings between the clubs, so that will help them to do other things, like having their minds occupied also at school, giving them small workshops or inviting them to come for the different workshops and activities.’25 |
| Working with primary care mental health support staff |
‘I think you should make people aware that MHSS play an important role in this; they may even be more important than GPs. They often have more time, expertise, and experience than GPs in dealing with these issues. [This helps] especially when you are kind of insecure as a GP.’23
‘I think it’s about time that people turn around and say maybe we should have CPN[s] within the surgeries, and they should have always been in the surgeries. The reason why GPs want CPNs in the surgery is because they want support not only for patients but also for themselves. At the end of the day, I am not a psychiatrist, I’m just a GP and I see things and try to do the best I can.’ 29 |
CMHT = community mental health team. CPNs = community psychiatric nurses. MHSS = mental health support staff