Equipping GPs to identify and support people in distress is one of the highest-impact, evidence-based interventions available for suicide prevention.[1]

In Australia, we know that many people experiencing suicidal thoughts visit their GP and general practice in the weeks before death.

While available data does not tell us whether those people are disclosing suicidal ideation or their psychological distress to their GP, there are opportunities to build the skills and confidence of general practice teams to better identify and support people at risk.

While those with a diagnosis of mental illness are a prompt for GPs to assess suicidal ideation, we know that approximately half those who die by suicide do not have such a diagnosis.

The RACGP’s position on preventing suicide highlights the unique opportunities for early intervention presented by the ongoing relationship between a patient and their general practice team, who may be able to recognise emerging symptoms rather than relying on self-reporting.

Here at Larter we know from our conversations with GPs about suicide prevention that:

• Many GPs are not always confident probing about psychological distress in the confines of 15 minute appointments  
• Many GPs are not comfortable managing suicidal risk in a primary care setting because they haven’t been provided with appropriate training
• GPs can feel unsupported working with people at risk of suicide when there is a lack of adequate psychiatric consultation / liaison available and access barriers to private psychological support (for example, clinician databases, waiting lists, specialties)
• GPs can feel concerned about lack of follow through for men who are provided with referrals to mental health treatment/support
• Many GPs would like additional skills training and support when working with people presenting with AOD issues / dual diagnosis; complex trauma; complex family dynamics; family violence; and relationship breakdown
• We have found variable confidence in delivering LGBTI-inclusive practice and culturally safe care for Aboriginal and Torres Strait Islander communities
• GPs want more information and training to support and manage children who present with suicidal ideation
• GPs themselves need support in self-care and the management of vicarious trauma.

There are several types of capacity building objectives that have the potential for significant impact in general practice settings:

• Identifying risk earlier and systems for managing at-risk patients: Supporting GPs to be alert to emerging symptoms of suicidality, raise the subject, manage the conversation within a busy appointment schedule, and facilitate early intervention. For example, Larter hears from GPs that they are increasingly supporting people in distress due to relationship breakdown or misuse of alcohol or other substances. Some GPs are specifically looking for support in working alongside people who are widowed or with a family history of suicide attempts. Building GP confidence to initiate conversations, or to use practice systems such as recall/reminder systems or ‘red flags’ in patient notes are examples of capacity building.
• Building general practice understanding of the barriers some people face in talking about psychological symptoms and accessing care following referral: Some of the patient cohorts that we know face barriers to receiving care include men, people living in rural and remote communities, Aboriginal and Torres Strait Islander peoples, people who identify as LGBTI, children and adolescents, and culturally and linguistically diverse people. For example, GPs frequently tell us about difficulties engaging men in discussion about their mental health, and on ensuring that men follow through on referrals for mental health treatment.
• Providing education to GPs on effective risk assessment and collaborative safety planning: When we spoke with GPs in rural Victoria, we found that very few had undertaken any form of suicide prevention training. However, many are interested in accessing the latest evidence-based approaches, including:
• team approaches to treatment planning
• effective management of individuals (and families/carers) after a suicide attempt
• upskilling GPs in depression recognition and treatment
• psychological skills training.

There are a number of other supports that can be provided to general practice in addition to professional development and skills training. For example,  

• Tools and resources including risk assessment tools, safety plans, eHealth for mental health
• Quality improvement activities (potentially utilising PIP-QI funding) focused on data cleansing, routine mental health screening or risk factor documentation for example
• Facilitating improved information sharing from mental health service providers and specialist providers
• Improving coordination and integration of care with local area mental health services.

With multiple competing demands on GP time, undertaking professional development can be quite challenging for time-poor GPs who also have to take time away from earnings in order to attend. Increasingly these days, GPs are looking for brief and focused learning opportunities which can be accessed on-demand around busy working schedules, or which provide opportunity for peer-based discussion and learning.

Primary Health Networks now have an opportunity to reflect on learnings from place-based suicide prevention trial sites when considering how to build general practice capacity for suicide prevention. 

Larter creates education to meet general practice needs and has recently begun delivering Level 1 Mental Health Skills Training and Level 2 Focussed Psychological Strategies training to GPs.  We have begun planning new modules in mental health for clinicians given the significant need in this area. Our training is delivered through a combination of online technology, peer group learning and locally available resources (such as local subject matter experts), so GPs can develop new skills without the need to leave their practice and local community. Where possible, training provides the opportunity for GPs to strengthen connections with local secondary health providers (e.g. psychiatrists, psychologist, outpatient) to help integrate pathways for referral and shared care.

Contact us if you would like to know more about suicide prevention in general practice or to discuss your education needs.

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[1] https://www.blackdoginstitute.org.au/education-services/lifespan-integrated-suicide-prevention/