Difficulties in suicide prevention facing primary healthcare workers based on the characteristics of people with suicide risk and healthcare systems.

AIMS
To clarify difficulties in suicide prevention that primary healthcare workers face based on the characteristics of people with suicide risk and healthcare systems.


DESIGN
Qualitative descriptive design.


METHODS
Semi-structured interviews were held with 15 primary healthcare workers employed by a Japanese municipality from August to October 2019. Data were subjected to qualitative descriptive analysis, performed in accordance with the COREQ guidelines.


RESULTS
Analysis identified 11 subthemes and three themes. Theme 1, 'Failure to connect with support', included the subthemes of 'Obstacles to communication' and 'Refusal of support'. Theme 2, 'Support that cannot offer a solution', included the subthemes 'Dying by suicide even while receiving psychiatric treatment' and 'Resolved to dying'. Theme 3, 'Isolation', included the subthemes 'Loneliness despite being connected with others' and 'Lack of community development'.


CONCLUSION
In relation to difficulties based on the characteristics of people with suicide risk, it is important to be aware of their unspoken views and to increase mental health literacy in society. Overcoming difficulties in relation to the primary healthcare system requires training and continuing education for professionals specializing in mental health and suicide prevention. To avoid isolating healthcare workers and ensure that those in need of treatment access support, systems should be established that enable collaboration with mental health specialists across organizations.


IMPACT
Primary healthcare workers, who are often the first point of contact for people with suicide risk, play a key role in suicide prevention. The identified challenges they face include difficulties in connecting people with suicide risk with support, a sense of helplessness because some people die even while receiving treatment and difficulties in building communities that prevent isolation. These findings can contribute to measures for alleviating the difficulties primary healthcare workers face, reforming primary healthcare systems for suicide prevention and saving lives.


PATIENT OR PUBLIC CONTRIBUTION
In this study, primary healthcare workers working in the study area participated as interviewees. They also confirmed the truthfulness of the study results, thereby ensuring the rigour of the data analysis.