The paper is a literature review in the chosen field of study of interest that is mental health nursing. However, to make the discussion more focused on the pathway of interest, domain 4a.i. (Patient experience of primary care – GP services) of the NHS Outcomes Framework Indicator 2019 has been selected. Accordingly, the main focus is on assessing the barriers to preventing suicide in both primary and secondary care. Therefore, the paper will proceed through the following sections: background, research question formulation, methodology, discussion, and a conclusion. Notably, a central element of quality in the NHS is recognised as patient experience. Consequently, there is a need to understand the best ways to ensure enhanced patient experience and improved outcomes for mental health patients served by general practitioners in both primary and secondary care. In this manner, improving nursing practice and patient care in the context of suicide prevention in mental health requires appraising evidence. There are increasing suicide trends among mental health patients served by GP and examining evidence regarding such engagements in care settings helps in identifying barriers to preventing suicide that further aids in improved care to reduce cases of suicide deaths among mental health patients.
A summary of what is already known about the topic
Under the topic of interest, barriers to suicide prevention, it is known that general practitioners hold different perceptions regarding suicide risk in mental health and such tell on their biases while evaluating patients (Gale et al. 2016, p.1). Again, it is also known that though self-harm is non-suicidal, it increases the risk of future suicide and that GPs differently explain the association between self-harm, suicide, and the aspect of suicide risk assessment (Chandler et al. 2015, p.42). Equally, GPs’ clinical expertise in handling suicidal young patients differs based on experience (Michail, Tait, and Churchill 2017, p.419), and their perspectives and views concerning the association between treatment non-adherence and suicide outcomes also differ (Saini, Chantler, and Kapur 2018, p.112). Similarly, it is known that suicide coming as a consequence of mental health problems is becoming a significant challenge and GPs report that suicides are non-preventable in their care settings and practice (Leavey et al. 2017, p.369). Arguably, General Practitioners in their areas of service are charged with the responsibility of providing quality care to improve mental health patients’ experiences in primary and secondary care. The approaches to handling mental health patients in primary care affect their experiences and poor outcomes lead to the increasing adverse occurrences such as suicide.
A brief highlight of original research studies
Five original research studies have been selected to guide the discussion of the paper. Accordingly, the first original research selected to guide the literature review organised is by Gale et al. 2016 where the researchers conducted a study to explore mental health professionals’ perceptions of suicide risks. The second original study is by Chandler et al. 2015 and the study team of the selected article engaged GPs to understand their accounts of patients who have self-harmed. The third study is by Michail, Tait, and Churchill 2017 and explores GPs’ clinical expertise in dealing with suicidal youths while the fourth article is by Saini, Chantler, and Kapur 2018 that examines the perceptions and views of GPs concerning treatment non-adherence and its associations with suicide. The fifth original research is by Leavey et al. 2017 and explores the perspectives of both GPs and families on the failure of suicide prevention in primary care.
Justification of findings of background studies
One of the priorities for the NHS in the United Kingdom is to promote mental health and also provide appropriate care for individuals with mental health challenges (England 2017, p.4). Therefore, preventing suicide occurrences is a necessity, but with the upward trend in suicide cases from individuals receiving care from their GPs, it is hypothesised that there are barriers to receiving appropriate mental health care within outpatient settings. Accordingly, the findings from background studies explore the perceptions of GP as well as that of families bereaved of suicide on managing mental health patients within primary care. Likewise, the studies evaluate the accounts of GPs regarding treatment non-adherence as well as encounters with patients with histories of self-harm and their links to suicide. The studies point to discrepancies concerning the means through which GPs in primary care work with and manage mental health patients as the problem of mental health patients committing suicide worsening. Therefore, this informs on the need to conduct the literature review to determine the barriers to suicide prevention in primary care and secondary care.
Formulation of a research question
A PICO question is formulated to guide the literature review and the question is: “What are the barriers to suicide prevention in primary and secondary care?” The P (patient population) is patients with mental problems in primary and secondary care with the intervention (I) as suicide prevention and no comparison (C); however, the outcome (O) is barriers. Conversely, the issue of suicide among mental health patients being served by primary care imply on the practice approach of the GPs that is supposed to avoid such mental health deteriorations. Patients’ experiences in primary care influence their decisions to commit suicide thereby agreeing with the requirements of the fourth domain that is of interest in the paper.
Accordingly, mental health care in primary care is a recent concept (England 2017, p.3) and there is a need to appropriately incorporate mental health care in general practice for improved mental health outcomes (Thomas et al. 2016, p.3). Notably, an improvement from the literature review will be detailed barriers to suicide prevention in GP practices in primary care to further help guide the means and environment of interaction with the patients for the best and desired outcomes of caring for mental health patients within primary and secondary care settings.
Literature search strategy
The search terms or keywords used to search for articles are inclusive of “mental health patients,” “mental health problems,” “general practitioners,” “primary and secondary care,” “suicide prevention,” “self-harms,” “suicide,” and “barriers.” On the other hand, articles were included if the study teams of the studies evaluated or examined GPs’ knowledge and expertise in managing mental health patients in primary or secondary care. Again, articles were included for review if they were published in reputable peer-reviewed journals within the last five years and also if they were studies conducted within the United Kingdom. GP s knowledge and expertise in caring for mental health patients in primary or secondary care inform tell on the quality of care and any discrepancy tells on barriers to appropriate management of mental health patients. Equally, most recent evidence is found in recent studies, and relying on research conducted in the United Kingdom aids in finding evidence applicable to the area of interest (mental health nursing) in the country. The sources searched for needed articles include British Journal of Mental Health Nursing, BMC Psychiatry, Journal of Mental Health, Cochrane database, and Google Scholar. Accordingly, hundreds of articles on topics related to mental health suicide and GP practices were listed upon querying the databases; however, appropriate filters were used to get the needed articles.
The process followed to identify research papers
The CASP guideline was used to appraise the studies for their relevance to the topic of interest in this literature review. The first step in appraising the research studies was to determine the validity of the results. Accordingly, the first step was achieved through six distinct methods that included, first, assessing the aim of the study and secondly, checking whether the methodology was appropriate for the study. The third method was assessing the appropriateness of the design in addressing the aims of the study with the fourth being examining the appropriateness of the recruitment strategy to the aims of the research conducted. The fifth method was to assess data collection methods and how such approaches addressed the research issue with the sixth method focusing on the consideration of the relationship between the researcher and participants in the paper. The second step was to evaluate the results and this was achieved through three methods that included assessing ethical consideration in the paper, rigor in data analysis, and a clear statement of the findings of the paper. The third step in appraising the studies was evaluating the relevance of the results in local settings and areas of interest in practice.
Data extraction from the articles
The approach to extracting data for the literature review proposed by Timmins and McCabe (2005) was used but their grid or summary table modified to meet data requirements for the literature review in this paper.
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