Mental health care providers talk about suicide prevention among people with substance use disorders in South Africa

Goldstone, Daniel Graham (2017-12)

Thesis (MA)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: Introduction. Substance use is a well-established and potentially modifiable risk factor for suicidal behaviour. As a result, the World Health Organization has suggested that suicide prevention efforts should target people with substance use disorders (PWSUDs). Most suicide prevention strategies are largely framed within the biomedical paradigm and suggest somewhat generic approaches to suicide prevention. As such, they lack specificity for high-risk populations (such as PWSUDs) and for the different contexts in which they are implemented. Few studies have focused on the experiences of mental health care providers (MHCPs) who provide care for suicidal PWSUDs; the clinical, health care, and contextual factors they perceive to hinder suicide prevention; and their specific ideas for preventing suicide in PWSUDs. In my study, I sought to investigate MHCPs' experiences of preventing suicide in PWSUDs in South Africa (SA); their perceptions of the factors impacting on suicide prevention in this context; and their context- and population-specific suggestions for preventing suicide in PWSUDs. Methods. I conducted in-depth, semi-structured interviews with 18 mental health care providers (psychiatrists, psychologists, counsellors, and social workers) working in Cape Town, SA, who had experience providing care for suicidal PWSUDs. I used thematic analysis to analyse the data inductively with Atlas.ti software. Findings. I identified three superordinate themes: (1) experiences of preventing suicide; (2) perceptions of barriers to suicide prevention; and (3) ideas for suicide prevention. Participants described feeling hopeless, helpless, impotent, and guilty, and said they needed to debrief from their work. They perceived their experiences to be related to difficulties they encountered treating substance use disorders and assessing and managing suicide risk, and their perceptions that treating substance use might increase suicide risk. Structural issues in service provision (such as inadequate resources, insufficient training, and fragmented service Stellenbosch University https://scholar.sun.ac.za iii provision) and broad contextual issues (such as poverty and inequality, the breakdown of family, and stigma) were perceived as barriers to suicide prevention. Participants thought that PWSUDs were not receiving the psychiatric, psychological, and social care that they needed. Participants suggested a number of evidence-based strategies to prevent suicide, but also made novel, context- and population-specific suggestions for suicide prevention, including: improving training of health care providers to manage suicide risk; optimising the use of existing health care resources; establishing a tiered model of mental health care provision; providing integrated health care; and focusing on early prevention. Conclusion. These findings suggest that the ways MHCPs think about suicide and make sense of their experiences impact on their perceived abilities to prevent suicide. Additionally, these findings indicate that structural, social, and economic issues pose barriers to suicide prevention. Participants highlighted specific strategies that take account of sociocultural contexts that may be effective in preventing suicide among PWSUDs in SA. These findings challenge individual, biomedical risk-factor models of suicide prevention and highlight the need to consider a broad range of social, cultural, economic, political, and health care factors when planning suicide prevention interventions. Tailoring suicide prevention interventions to the specific needs of high-risk groups and to specific contexts may be important to prevent suicide.

AFRIKAANS OPSOMMING: Inleiding. Middelgebruik is 'n gevestigde en potensieel veranderlike risikofaktor vir selfmoordgedrag. As gevolg daarvan, het die Wêreldgesondheidsorganisasie voorgestel dat selfmoordvoorkomingspogings gerig moet word op mense met middelgebruiksteurnisse (MMMSe). Selfmoordvoorkomingstrategieë word grootliks binne die biomediese paradigma beplan en stel ietwat generiese benaderings tot selfmoordvoorkoming voor. As sodanig ontbreek hierdie strategieë spesifisiteit vir hoë-risikobevolkings (soos MMMSe) en vir die verskillende kontekste waarin hulle geïmplementeer word. Daar is min studies wat fokus op die ervarings van geestesgesondheidsorg-verskaffers wat versorging aan MMMSe met selfmoordneigings verskaf; hul waarnemings rondom die kliniese, gesondheidsorg, en kontekstuele faktore wat selfmoordvoorkomingspogings verhinder; en hul spesifieke idees vir die voorkoming van selfmoord in MMMSe. In my studie het ek gepoog om GGVs se ervarings van selfmoordvoorkoming in MMMSe in Suid-Afrika (SA) te ondersoek; hul persepsies van die faktore wat selfmoordvoorkoming in hierdie konteks beïnvloed; en hul konteks- en bevolkingspesifieke voorstelle vir die voorkoming van selfmoord in MMMSe. Metodes. Ek het in-diepte, semi-gestruktureerde onderhoude gevoer met 18 geestesgesondheidsorg-verskaffers (psigiaters, sielkundiges, beraders, en maatskaplike werkers) wat werk in Kaapstad, SA, en ervaring in die versorging van MMMSe met selfmoordneigings gehad het. Ek het tematiese analise gebruik om die data induktief te analiseer met Atlas.ti sagteware. Bevindings: Ek het drie oorheersende temas geïdentifiseer: (1) ervarings rondom die voorkoming van selfmoord; (2) persepsies van hindernisse tot selfmoordvoorkoming; en (3) idees vir selfmoordvoorkoming. Deelnemers het beskryf dat hul hopeloos, hulpeloos, magteloos en skuldig gevoel het, en gesê dat hulle 'n behoefte aan ontlading van hul werk het. Hul persepsie was dat hul ervarings verband hou met probleme wat hulle ondervind met die Stellenbosch University https://scholar.sun.ac.za v behandeling van middelgebruiksteurnisse en die assessering en bestuur van selfmoordrisiko, en hul persepsies dat die behandeling van middelgebruik selfmoordrisko kan verhoog. Strukturele kwessies in diensverskaffing (soos onvoldoende hulpbronne, onvoldoende opleiding, en gefragmenteerde diensverskaffing) en kontekstuele kwessies (soos armoede en ongelykheid, die ineenstorting van families, en stigma) was beskou as struikelblokke vir selfmoordvoorkoming. Deelnemers het gedink dat MMMSe nie die geestesgesondheidsorg ontvang wat hulle nodig het nie. Deelnemers het 'n aantal bewysgebaseerde strategieë voorgestel om selfmoord te voorkom, maar het ook konteks- en bevolkingspesifieke voorstelle vir selfmoordvoorkoming gemaak. Hierdie voorstelle sluit in: verbetering van opleiding van gesondheidsorgverskaffers om selfmoordrisiko te bestuur; optimalisering van die gebruik van bestaande gesondheidsorgbronne; oprigting van 'n multi-vlak model van geestesgesondheidsorg-voorsiening; verskaffing van geïntegreerde gesondheidsorg; en 'n fokus op vroeë voorkoming. Gevoltrekking. Hierdie bevindings dui daarop dat die maniere waarop geestesgesondheidsorg-verskaffers oor selfmoord dink en sin maak van hul ervarings, 'n impak op hul waargenome vermoëns het om selfmoord te voorkom. Daarbenewens dui hierdie bevindings aan dat strukturele, sosiale, en ekonomiese probleme hindernisse tot selfmoordvoorkoming veroorsaak. Deelnemers het spesifieke strategieë uitgelig wat rekening hou met sosio-kulturele kontekste wat effektief kan wees om selfmoord onder MMMSe in SA te voorkom. Hierdie bevindings daag individuele, biomediese risikofaktormodelle van selfmoordvoorkoming uit en beklemtoon die behoefte om 'n wye verskeidenheid sosiale, kulturele, ekonomiese, politieke, en gesondheidsorgfaktore te oorweeg wanneer selfmoordvoorkomings-intervensies beplan word. Om selfmoordvoorkomings-intervensies aan te pas by die spesifieke behoeftes van hoërisikogroepe en spesifieke kontekste, kan belangrik wees om selfmoord te voorkom.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102828
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