Article Text

Original research
Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people’s perspectives
  1. India Bellairs-Walsh1,2,
  2. Yael Perry3,
  3. Karolina Krysinska1,2,
  4. Sadhbh J. Byrne1,2,
  5. Alexandra Boland1,2,
  6. Maria Michail4,
  7. Michelle Lamblin1,2,
  8. Kerry L. Gibson5,
  9. Ashleigh Lin3,
  10. Tina Yutong Li1,6,
  11. Sarah Hetrick1,7,
  12. Jo Robinson1,2
  1. 1Orygen, Parkville, Victoria, Australia
  2. 2Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
  3. 3Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
  4. 4School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
  5. 5School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
  6. 6Gold Coast University Hospital, Southport, Queensland, Australia
  7. 7Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  1. Correspondence to Ms India Bellairs-Walsh; india.bellairs-walsh{at}


Objectives General practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people’s opinions and experiences related to GPs’ practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people’s perspectives. This study aimed to explore young people’s views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs.

Design, setting and participants Two qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16–24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis.

Results Five major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist—disliking the terms ‘risk’ and ‘risk assessment’, and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs’ attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations.

Conclusions Our study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.

  • suicide & self-harm
  • primary care
  • qualitative research
  • mental health
  • quality in health care
  • child & adolescent psychiatry

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Supplementary materials


  • Contributors Contributions are described as per the CRediT taxonomy ( IBW conducted formal analysis, project administration, validation, visualisation and writing (original draft preparation). YP conducted investigation and project administration. KK conducted validation. SJB conducted investigation. AB conducted formal analysis. MM conducted conceptualisation and methodology. ML conducted project administration. KLG conducted validation. AL conducted project administration. TYL conducted conceptualisation and was a youth advisor on the project. SH conducted conceptualisation and methodology. JR conducted conceptualisation, funding acquisition, investigation, methodology, project administration and supervision. All authors conducted writing (reviewing and editing).

  • Funding This work was supported by the WA Primary Health Alliance (WAPHA) as part of the National Suicide Prevention Trial, through the Australian Government PHN Program. JR and AL are funded by National Health and Medical Research Council Career Development Fellowships (JR: 1142348; AL: 1148793). YP is funded by The Giorgetta Charity Fund.

  • Disclaimer None of the funding bodies had any role in the design of the study, in the collection, analyses, or interpretation of the data, in the writing of the manuscript, or in the decision to publish the results.

  • Competing interests IBW, KK, SJB, AB, ML, TYL and JR report grants from the WA Primary Health Alliance (WAPHA) to enable the conduct of this study. SH reports that she is the joint coordinating editor of the Cochrane Common Mental Disorders Group and manages the Children and Young People Satellite. She has funding from the Royal Society, the Faculty of Medical and Health Sciences at the University of Auckland, and Cochrane to pursue this work, including systematic reviews in the area of children and young people’s mental health. She is funded by the Auckland Medical Research Foundation to develop and test an app that delivers goal setting for young people with mental health and related difficulties, such as self-harm. She is a CureKids Research Fellow, working on developing digital tools to support parents to support children with mental health and related difficulties. YP, MM, KLG and AL report nothing to disclose.

  • Patient consent for publication Not required.

  • Ethics approval The study was granted ethical approval by The University of Melbourne Human Research Ethics Committee (HREC ID: 1748913). Written informed consent was obtained from all participants, who were able to withdraw their consent at any time.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Anonymised focus group transcripts are available at Orygen, Suicide Prevention. These may be accessed on reasonable request by contacting author IBW at

  • Author information The authors who conducted data collection, analysis, and interpretation are all researchers with psychology-related backgrounds and qualifications (such as Bachelors, Honours, Masters, and PhD degrees). They have a diverse range of professional experience working with young people around the topic of suicide and self-harm, and in consumer-orientated service use. The authors subscribe to youth-empowerment perspectives and are committed to providing young people with a voice that captures the quality and diversity of their personal experiences, to ensure their needs are identified and supported by services they use.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.