Caring for a friend or family member who has experienced psychosis and suicidal behaviour : A qualitative investigation

Marshall, Paul and Lobban, Fiona and Jones, Steven and Semino, Elena (2023) Caring for a friend or family member who has experienced psychosis and suicidal behaviour : A qualitative investigation. PhD thesis, Lancaster University.

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Abstract

Background: Carers of people with psychosis often provide vital emotional and practical support to friends, family members and other social contacts. Yet while people with psychosis are at increased risk of experiencing suicidal behaviour, including thinking about and attempting suicide, little is known of carers’ perspectives of providing support when this happens. This thesis therefore aimed to address the question: ‘What are carers’ experiences of supporting friends or family members with psychosis and suicidal behaviour?’ Methods: Three research methods were used to produce four articles. First, qualitative thematic synthesis was used to synthesise nineteen articles investigating carers’ experiences of supporting a friend or family member with suicidal behaviour. Second, reflexive thematic analysis was used to analyse online peer-to-peer conversations related to caring for someone with psychosis or bipolar disorder and suicidal behaviour. Third, reflexive thematic analysis was used to analyse twenty in-depth semi-structured interviews with friends and family members of people with psychosis and suicidal behaviour. Two articles based on this interview data are reported, focusing on the personal psychosocial impact of caregiving in this context, and on carers’ understandings of the relationship between psychotic experiences and suicidal behaviour, respectively. Results: Across studies, carers’ experiences were characterised by profound and ongoing fear of suicide. This left many stuck in a vicious cycle of hypervigilance to suicide risk, exasperation, and fatigue. Feeling unable to understand why suicidal behaviour occurred left carers in a distressing state of uncertainty about how to respond, an experience that was particularly apparent in the early and more acute periods of psychosis. Developing an understanding of how psychotic experiences contributed to suicidal behaviour allowed some carers to identify strategies for mitigating or avoiding situations that could cause an escalation in distress, thus reducing the likelihood of their friend or family member experiencing further suicidal behaviour. Carers sought help with this task, and, where unable to keep their friend or family member safe at home, looked to health services for assistance with managing this responsibility. Effective health services were framed as responsive, safety-focused, and interpersonally sensitive. Yet negative experiences of inaccessible services, unwilling or unable to collaborate with carers, were widely evident and highly disempowering. Conclusion: Necessary professional support for carers in this highly demanding circumstance is often limited and/or deprioritised within healthcare settings. To address this, policy, practice, and research priorities should emphasise: carer-inclusive, brief contact interventions to manage suicidal behaviour in crisis situations; strategies to communicate with and involve carers in transitions in and out of healthcare services following suicidal experiences; and ongoing carer-focused interventions, such as online support, to manage personal wellbeing and promote caregiving self-efficacy in this context.