Caring for People at Risk of Suicide in the Andalusian Health Service: A Qualitative Study of the Institutionalisation Process

Abstract

Suicide continues to be the main external cause of death in Spain. Andalusia is the re-gion with the highest number of suicides in the country. It is important to address its prevention. Here we describe how people who have attempted suicide access and are treated by the Andalusian Health Service. A qualitative study was conducted exploring public health care and its assessment. Data were collected through in-depth interviews with health professionals, patients, family members and relatives. This search was complemented with ethnographic information, all of which was explored following a combined strategy of analysis in line with the grounded theory assumptions. The re-sults reveal setbacks in access to the health system, and stigmatised representations among professionals. At the same time, limitations due to lack of training and uncer-tainties in risk management were identified. Finally, strong difficulties were found among family members and patients, as they face stigmatisation and taboos that lead to profound vulnerability, especially in areas with fewer resources. All of this hinders early detection and reduces the capacity for prevention.

El suicidio continúa siendo la principal causa externa de muerte en España. Andalucía es la región con mayor número de suicidios del país. Es importante abordar su prevención. Aquí se describe cómo las personas que han sufrido tentativas de suicidio acceden al Servicio Andaluz de Salud y son atendidas en este. Se realizó un estudio cualitativo explorando la asistencia sanitaria pública y su valoración. Se recabaron datos mediante entrevistas en profundidad, tanto a profesionales de la sanidad como a personas afectadas y familiares de estas. Esta búsqueda se complementó con información etnográfica. Todo ello se analizó siguiendo una estrategia combinada de exploración atendiendo a los presupuestos de la teoría fundamentada. Los resultados revelan contrariedades en el acceso al sistema sanitario y representaciones estigmatizadas entre profesionales. Al mismo tiempo, se identificaron limitaciones por la falta de capacitación y las incertidumbres en la gestión del riesgo. Finalmente, se comprobaron fuertes dificultades en familiares y supervivientes, pues hacen frente a la estigmatización y a los tabúes con profunda vulnerabilidad, especialmente en las zonas con menos recursos. Todo ello lastra la detección temprana y resta capacidad de prevención.

Suicide continues to be the main external cause of death in Spain. Andalusia is the region with the highest number of suicides in the country. It is important to address its prevention. Here we describe how people who have attempted suicide access and are treated by the An-dalusian Health Service. A qualitative study was conducted exploring public health care and its assessment. Data were collected through in-depth interviews with health professionals, patients, family members and relatives. This search was complemented with ethnographic information, all of which was explored following a combined strategy of analysis in line with the grounded theory assumptions. The results reveal setbacks in access to the health system, and stigmatised representations among professionals. At the same time, limita-tions due to lack of training and uncertainties in risk management were identified. Finally, strong difficulties were found among family members and patients, as they face stigmati-sation and taboos that lead to profound vulnerability, especially in areas with fewer resour-ces. All of this hinders early detection and reduces the capacity for prevention.