A GPs Conundrum: A qualitative study exploring GP-suicidal patient interactions and treatment prior to suicide

BackgroundLittle is known about General Practitioners’ (GP) perspectives, their management and interactions with suicidal patients prior to the patient’s suicide. ObjectivesThe aim of this study was to explore GP perceptions of the relationships and treatment of patients who have died by suicide and GP relationships with mental health service providers. Methods and DesignSemi-structured face-to-face interviews were conducted with 39 GPs involved in the care of patients who died by suicide between 1st January 2003 and 30th June 2007. The interviews were conducted between 1st June 2007 and 31st October 2009 in General Practices in the North-west of England. Information was gathered for patient contact with their GP in the 12 months prior to death, including clinical characteristics of the patient, the patient’s final consultation with a GP, and the immediate antecedents of the suicide. GPs were also asked about their views and perceptions on: their relationship with the patient, risk assessments, the patient’s treatment prior to suicide and GP relationships with local mental health service providers. Results Thematic analysis was conducted and the following five themes emerged from the interviews: (i) crying for help v crying wolf; (ii) piggy in the middle v left holding the baby; (iii) shifting responsibility v professional vulnerability; (iv) lost in the referral maze v the ever expanding gap; (v) patient autonomy v GP responsibility. Conclusion & ImplicationsGPs interpretations and perceptions of patients who communicated about previous self harm or suicidal ideation varied; thus affecting the management and treatment offered to patients. GPs highlighted the importance of developing and maintaining better professional relationships with mental health services (MHS) as the growing distance between GPs and MHS affected the rate at which treatment interventions were offered to patients at risk of suicide. Treating patients that are recognised as at high risk of suicide can be complex as the tension between patient autonomy and preserving life complicates the GP-suicidal patient relationship. The GPs conundrum is how to manage suicidal patients who are determined to take their own lives