Abstract
BackgroundPeople with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa.MethodsQualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis.ResultsParticipants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide.ConclusionsTraining mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.
Highlights
People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour
Sample characteristics Participants had a collective 173 years of experience working with suicidal PWSUDs and the median number of years worked with suicidal PWSUDs was six years
At the time of data collection, three participants were working in psychiatry departments within academic hospitals providing services to psychiatric inpatients and outpatients, three were working in private practice providing psychiatric and psychotherapeutic substance use treatment services, nine were working in outpatient state-funded substance use treatment facilities providing counselling and social work services to clients with a primary diagnosis of a SUD, two were working in Non-governmental organisation (NGO) providing counselling services to PWSUDs, and one was a clinician with experience of providing treatment to PWSUDS who was currently completing a doctoral degree in the field of substance use
Summary
People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. People with substance use disorders (PWSUDs) are a clearly delineated group who are at elevated risk of engaging in fatal and non-fatal suicidal behaviour [6, 7], it is not always clear what strategies should be employed to curb suicidal behaviour in this group, in countries like South Africa (SA), where mental health resources are scarce, health care is often inaccessible, and services for PWSUDs are fragmented and unintegrated [8]. It is within this context that we set out to explore MHCPs' suggestions for preventing suicide in PWSUDs in SA
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