7 - (IOP 22) The Straw That Breaks the Camel’s Back: Public Healthcare Professionals’ Perspectives on Behavioural Strategies for Suicide Prevention in South Africa

Background:
Suicide and non-fatal suicidal behaviour (NFSB) are major public health concerns in South Africa. There is an urgent need for suicide prevention interventions, yet there is limited region-specific data to inform the development of behavioural interventions that address the unique nature of suicidal behaviour in South Africa.

Method:
Informed by the World Health Organizations’ LIVE LIFE framework, we conducted a qualitative situational analysis to explore the nature of suicide and NFSB and public healthcare professionals’ perspectives on suicide prevention strategies in in Cape Town, South Africa. Using purposive and snowball sampling, we recruited healthcare professionals (n = 23) across eight healthcare facilities providing suicide care in emergency departments, tertiary hospitals, and primary healthcare facilities. Participants completed semi-structured interviews in English, Afrikaans, or isiXhosa. A subset of interviews was reviewed to develop a thematic codebook. Content thematic analysis was applied to the dataset to identify emergent themes.

Results:
Most participants conceptualised suicide and NFSB as a confluence of stress – suicidal behaviour is driven by a multitude of psychosocial and structural stressors (i.e., unemployment, interpersonal conflict). This combined stress is “the straw that breaks the camel's back – life is just too much and there's no way out”. Key behavioural strategies for suicide prevention emerged. Safety planning with an emphasis “training in healthy coping skills” and “emotional regulation” emerged as prominent intervention strategies. Interestingly, participants argued that mental health concerns were less prominent for these patients, and in the context of social and structural stressors, “mental health is always going to take a back seat”. Although all participants agreed that suicide prevention should be situated in healthcare settings, linkage between emergency departments and primary healthcare facilities is necessary to facilitate outpatient suicide prevention. Participants highlighted the need for a manualised cognitive behavioural intervention with remote training materials to ensure consistency and feasibility of implementation.

Discussion:
Healthcare settings are uniquely positioned to reach populations at risk of recurrent suicidal behaviour to deliver indicated suicide prevention interventions. Our results suggest there are unique precipitating factors to suicide and NFSB in South Africa, and prevention strategies should be tailored to equip individuals with cognitive and behavioural skills to respond to these situational factors. In the context of South Africa’s limited mental health professionals, a manualised intervention focused on safety planning, fortified by training in adaptive coping skills, appears to be a viable approach to suicide prevention.