Suicide is one of the most frequent causes of death in young age groups and represents a serious health problem affecting patients, families and societies worldwide [1
]. It is a complex problem that is often associated with mental illness [2
]. Suicidal ideation and behaviour are risk factors for suicide and are important triggers for mental health treatment [2
]. The professional’s priorities and attitudes towards suicidal patients are important in motivating patients to engage in treatment and manage suicidal indications. Many suicidal patients are vulnerable and may feel rejected easily. Suicidal behaviour indicates a significant health problem that requires professionals to convey appropriate attitudes towards their patients to achieve effective treatment. Attitudes affect emotions, cognition and behaviour. However, the topic has attracted relatively limited systematic research interest and documented interventions have been limited, which may partly reflect attitudes towards suicide [4
] and its low status in health care [5
The capacity to treat patients with suicidal behaviour has increased in mental health outpatient units such as Child and Adolescent Psychiatry (CAP) for patients aged 0–18
years and District Psychiatric Centres (DPC) for patients aged 18–67
]. Studies from different cultures indicate that attitudes can influence referring to aftercare following a suicide attempt [7
]. We do not know if the quality of care offered to patients with suicidal behaviour is the same as the care offered to patients with other severe health problems, or if the age of the patient influences professionals’ attitudes [8
] and their ability to treat. The fact that suicide is more common among adults [9
] while self-harm and suicidal behaviour is more common among adolescents [10
] might be the reason why suicidal behaviour is more serious in adults.
Studies from other health-care fields show that professionals report more irritation, anger, frustration and helplessness towards patients who self-harm than towards other patients [8
]. Patients who self-harm describe feeling humiliated by the experience of receiving physical treatment delivered without empathy, which differentiated them from patients with other conditions. Staffs often lack knowledge about suicidal behaviour and ideation, and communication between patients and staff is perceived as poor. Patient feedback indicates a need for improvements in psychological assessment and aftercare [11
Most studies on professionals’ attitudes are conducted in somatic [8
] or psychiatric care in-patient units [8
]. Attitudes towards suicidal patients differ within and between departments and professional groups. The most empathic attitudes are found among trained psychiatric professionals, professionals with experience, and those who have received supervision or have educational qualifications or special status [10
]. The majority of studies have included nurses and physicians, with a relative minority of studies including psychologists and social workers. We have less knowledge of professionals’ attitudes towards suicidal behaviour in outpatient clinics. In these settings, they tend to work alone and with less control over their patients’ behaviour. At the same time as they have more independent responsibility compared with their in-patient unit counterparts, only physicians and psychologists have more formal independent responsibilities while other professional groups work by delegation [15
]. The stresses of working with suicidal behaviour and the emotional burden of losing a patient [16
] might also influence professionals’ attitudes.
For professionals generally, coping with accidents, illness and death in children and adolescents is more demanding than coping with the same scenarios involving adults. Professionals almost certainly experience a similar burden of coping with suicide in younger patients that may influence their attitudes [18
]. Therefore, it is interesting to study whether attitudes towards suicide may differ between professionals in CAP and DPC. With an understanding that professionals in mental health outpatient units in Norway are at the forefront of suicide prevention efforts [6
], we investigate the following questions.
1. What is the range of attitudes towards suicidal patients among mental health professionals in Child and Adolescent Psychiatry (CAP) and the District Psychiatric Centre (DPC) outpatient units in Oslo, Norway?
2. Do attitudes differ according to profession, gender, age or religion?
3. Do experience, competence and understanding of suicidal behaviour vary by work site or profession?