Peer specialists and mental health nurses who work with patients who are suicidal: A comparative interview study.

Background: In the field suicide prevention, knowledge about the involvement and approaches of peer specialists is scarce, prompting an examination of their potential unique contributions compared to what mental health nurses offer. Objectives: We compared perspectives of peer specialists, mental health nurses, and patients with suicidal thoughts) on: 1) 'causes' of suicidality, 2) essential skills, insights, and interactions in working with patients who feel suicidal; and 3) beneficial approaches for reducing suicidality. Design: Qualitative interviews with three types of informants were analysed thematically using the Constant Comparative Method. The samples, all from the Netherlands, consisted of 19 peer specialists with a history of suicidality, 18 mental health care nurses, and seven patients with suicidality who had been in contact with both peer specialists and mental health nurses. Results: All three groups viewed suicidality as a prolonged process driven by problematic situations and thoughts, primarily to escape life rather than die. All groups found the following important: suicide literacy (i.e., knowing what it means to be suicidal and what is optimal suicide care), empathy, and understanding. Patients, however, felt peer specialists showed greater unconditional empathy than nurses, likely because nurses focused on risk assessment and safety. Patients also found peer specialists more convincing in promoting recovery from suicidality than nurses, with their lived experiences serving as powerful examples. Conclusion: Both mental health care nurses and peer specialists articulated suicide literacy and understood the relevance of empathy and genuine listening in caring for patients who feel suicidal. Nevertheless, in practice, nurses are less often experienced as empathic by patients and do not always abide by shared decision making (due to prioritising risk- and safety assessment). Through their own previous suicidal crises, peer specialists are unique in their ability to break down hierarchical barriers with authentic empathetic support.