Barriers and Facilitators to Caring for People Presenting With Suicidal Distress in Rural Emergency Departments: A Qualitative Study.

This qualitative study explored rural emergency department (ED) staff experiences of caring for people presenting with suicidal thoughts and behaviours and examined perceived barriers and facilitators to providing best care. Semi-structured individual interviews and focus groups were conducted with 18 ED staff across two rural hospitals in Victoria, Australia. Participants included nurses (n = 15), mental health clinicians (n = 2) and a social worker (n = 1). Data were analysed using reflexive thematic analysis following Braun and Clarke's approach, and reporting was guided by the COREQ checklist. Four overarching themes were identified: the central role of people and relationships in shaping care; inadequate resourcing of rural EDs and community services to respond to suicidal presentations; current ED processes that hinder timely and responsive mental health care; and insufficient education and training regarding suicidal presentations. Staff described strong commitment and compassion in their care, alongside distress arising from long wait times, unsuitable ED environments, limited specialist support and gaps in follow-up care. Structural and systemic constraints were perceived to compromise both consumer safety and staff wellbeing. The findings highlight the challenges rural ED staff face in delivering timely, person-centred care to people in suicidal distress and demonstrate the need to strengthen environments, workforce capacity, care pathways and training to improve the quality and safety of care in rural ED settings.