Abstract
BackgroundSubstance use is a well-established, and potentially modifiable, risk factor for suicide. Suicide prevention interventions are typically framed within the biomedical paradigm and focus on addressing individual risk factors, improving access to psychiatric care, and improving the skills of medical personnel to recognise at-risk individuals. Few studies have focused on contextual factors that hinder suicide prevention in people with substance use disorders, particularly in low-resource settings. The aim of this qualitative study was to explore mental health care providers’ perceptions of barriers to suicide prevention in people with substance use disorders in South Africa.MethodsSemi-structured interviews were conducted with 18 mental health care providers who worked with suicidal people with substance use disorders in Cape Town, South Africa. Data were analysed using thematic analysis and Atlas.ti software was used to code the data inductively.ResultsTwo superordinate themes were identified: structural issues in service provision and broad contextual issues that pose barriers to suicide prevention. Participants thought that inadequate resources and insufficient training hindered them from preventing suicide. Fragmented service provision was perceived to lead to patients not receiving the psychiatric, psychological, and social care that they needed. Contextual problems such as poverty and inequality, the breakdown of family, and stigma made participants think that preventing suicide in people with substance use disorders was almost impossible.ConclusionsThese findings suggest that structural, social, and economic issues serve as barriers to suicide prevention. This challenges individual risk-factor models of suicide prevention and highlights the need to consider a broad range of contextual and socio-cultural factors when planning suicide prevention interventions. Findings suggest that the responsibility for suicide prevention may need to be distributed between multiple stakeholders, necessitating intersectoral collaboration, more integrated health services, cautious use of task shifting, and addressing contextual factors in order to effectively prevent suicide in people with substance use disorders.
Highlights
Substance use is a well-established, and potentially modifiable, risk factor for suicide
Structural issues such as (a) a lack of resources, (b) insufficiencies in training, and (c) fragmentations in the organisation of care led participants to think that many suicidal person with a substance use disorder (PWSUD) do not receive the psychiatric, psychological, and social care that they need
These factors acted as barriers to suicide prevention and led participants to feel hopeless and powerless in their work preventing suicide in PWSUDs
Summary
Substance use is a well-established, and potentially modifiable, risk factor for suicide. Few studies have focused on contextual factors that hinder suicide prevention in people with substance use disorders, in low-resource settings The aim of this qualitative study was to explore mental health care providers’ perceptions of barriers to suicide prevention in people with substance use disorders in South Africa. Suicidal ideation and behaviour (SIB) is a major public health concern in South Africa (SA) [1], and it is Goldstone and Bantjes Int J Ment Health Syst (2017) 11:46 be a population targeted for specific suicide prevention interventions This makes it important to better understand the context in which SIB occurs in PWSUDs and the contextual factors that might hinder suicide prevention in this population of health care users. There is evidence that individuals who are intoxicated at the time of presenting for treatment following an incident of suicidal behaviour are less likely to be admitted to hospital or to be seen by a psychiatrist because of problems with the stigma associated with SUDs [14, 15]
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