Browsing by Author "Goldstone, Daniel Graham"

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    Mental health care providers talk about suicide prevention among people with substance use disorders in South Africa
    (Stellenbosch : Stellenbosch University, 2017-12) Goldstone, Daniel Graham; Bantjes, Jason; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    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.