Keywords: General practice, Suicide prevention, Continuity of care, Primary care, Mixed methods.

Background:

Care for people with suicidal ideation in Flanders and Brussels is complex and fragmented. General practitioners (GPs) often serve as the first and central point of care, yet face substantial challenges in ensuring continuity, a core suicide prevention strategy. Insight into how GPs fulfil this role, and where they encounter barriers remains limited.

Research questions:

This study explores how GPs in Flanders and Brussels contribute to continuity of care for people with suicidal ideation, which actions they undertake at the micro- and meso-level, and which barriers and support needs they experience.

Method:

A mixed-methods study combined data from a large-scale online survey among healthcare professionals (N = 723), including GPs (n = 74), with qualitative in-depth interviews with people with suicidal ideation and relatives, providing complementary insights into the organisation and experienced continuity of care.

Results:

GPs describe their role as a low-threshold point of contact and a key figure in follow-up and referral, but report substantial barriers in collaboration with specialised mental health care. Long waiting times, complex referral procedures and limited information exchange impede continuity, particularly at high-risk transition points. Capacity shortages place significant responsibility on GPs, while time, specific expertise and structural support are often lacking. Patients and relatives expect GPs to act as navigators, yet describe this role as difficult to realise due to unclear care pathways and limited overview of the care system.

Conclusions:

GPs occupy a crucial yet vulnerable position in care for people with suicidal ideation. Strengthening continuity requires clear role definitions, improved information exchange, and structural support through training, protected time and formalised care agreements, underscoring the need for a stronger primary care role within integrated suicide prevention.

Points for discussion:

How can we keep the role of “navigator” realistic for GPs in a system where they have no overview of the social map or waiting times for specialists?

To what extent is the digitisation of tools (such as the Backup app) a solution if GPs themselves indicate that they do not have the necessary knowledge to introduce them? Shouldn't these tools be integrated into the Electronic Medical Record (EMR) as standard in order to lower the threshold, rather than expecting GPs to manage external applications?