Qualitative investigation of relatives’ and service users’ experience of mental health care for suicidal behaviour in bipolar disorder.

Objective: People with bipolar disorder are known to be at high risk of engaging in suicidal behaviours, and those who die by suicide have often been in recent contact with mental health services. The objective of this study was to explore suicidal behaviour in bipolar disorder and how these are monitored and managed by mental health services.

Aims: Identify themes within relatives’ and service users’ accounts of mental health care, related to management and prevention of suicidal behaviour in bipolar disorder.

Design: Thematic analysis of 22 semi-structured interviews.

Participants: Participants were aged 18 years or over, fluent in written and spoken English, and either had bipolar disorder with a history of suicidal behaviour, or were relatives of people who had bipolar disorder and died by suicide.

Setting: England, UK.

Primary outcome: Themes identified from participants’ accounts of mental health care for suicidal behaviours in bipolar disorder.

Results: Two main themes were identified. ‘Access to care’ was characterised by a series or cycle of potential barriers to care (e.g. gate-keepers, lack of an accurate diagnosis), which had the potential to increase risk of suicidal behaviour if failure to access care continued over time. ‘Problems with communication’ captured the importance of maintaining open routes of communication between all parties involved in care to ensure successful monitoring and management of suicidal behaviours in bipolar disorder.

Conclusions: Mental health services need to be accessible and respond rapidly to people with suicidal behaviour in bipolar disorder. Open communication and inclusion of relatives in care, where appropriate, could help closer monitoring of changes in symptoms that indicate increased risk.