Suicide is a major public health concern in South Africa, neccesitating region-specific interventions that address the unique nature of suicidal behaviour in South Africa.
Informed by the World Health Organizations' LIVE LIFE framework, we conducted a qualitative situational analysis to explore the nature of suicide and NFSB and healthcare professionals' perspectives on suicide prevention strategies in public healthcare in Cape Town, South Africa. We recruited healthcare professionals (n = 23) across eight healthcare facilities providing suicide care until theoretical saturation was reached. 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. Most participants conceptualised suicide and NFSB as a confluence of stress - suicidal behaviour is driven by a multitude of psychosocial stressors. This combined stress is "the straw that breaks the camel's back - life is just too much and there's no way out". Interestingly, participants argued that mental health concerns were less prominent for these patients, and in the context of 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. Safety planning with an emphasis on "training in healthy coping skills" and "emotional regulation" emerged as prominent intervention strategies. Participants highlighted the need for a manualised intervention with remote training materials to ensure consistency and feasibility of implementation.
Healthcare settings are uniquely positioned to deliver indicated suicide prevention interventions. 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.