Gatekeeping and poor staff attitudes are significant barriers to accessing care for patients with bipolar disorder showing suicidal behaviours, according to research led by the University of Manchester.
Researchers interviewed 22 service users with bipolar disorder and their relatives on their experiences of mental healthcare for suicidal behaviour.
The interviews revealed two main themes: access to care and problems with communication.
Participants reported a range of difficulties when trying to access care when the risk for suicidal behaviour was high. This applied across different service-contact situations. Access to care was characterised by a series or cycle of potential barriers, including gatekeeping and a lack of an accurate diagnosis. Many accounts reported that one barrier often led to another.
Sympathy and trust were key features of positive evaluations of care. Clinicians who were willing to provide and receive information from service users and relatives were valued. Continuity of care to establish long-term therapeutic relationships was also vital for building trust, aiding identification of times of increased risk.
Presenting the study in the BMJ Open, the authors said participants’ accounts consistently showed some level of underestimation of illness severity and suicide risk by clinicians, even for individuals under mental healthcare services.
“Additional interview work with clinicians may help uncover problems in communication about suicidal behaviour in people with bipolar disorder, and help explore the perception of lower risk in people who are better able to communicate their distress and concerns,” they said.
