Barriers, enablers and lessons learned
In suicide prevention, there is reasonable knowledge of what approaches are effective, but less consideration is given to factors that positively or negatively impact implementation.
Understanding what helps and hinders different approaches is crucial to ensuring implementation success.
A recent study by Kasal et al. (2023)1 explored barriers and enablers to implementing suicide prevention interventions. This study, along with many others, use the Consolidated Framework for Implementation Research (CFIR) to identify factors that impact implementation.
Barriers include:
- Approaches that do not reflect peoples' needs – A person-centred approach involving individuals with lived experience in all stages of the implementation process is required to implement suicide prevention approaches.
- High cost – If the approach costs a lot of money.
- Low adaptability – If an approach isn’t tailored to the required context.
- High complexity – If the approach is perceived to be highly difficult or complex to implement.
- Low relative advantage – if the approach is perceived as inferior to another existing intervention or approach.
Enablers include:
- Approaches that reflect peoples' needs – Implementation may be more successful if the approach meets the needs of the intended audience. The involvement of people with lived experience at all stages of implementation will support this.
- High relative advantage – If the approach is perceived to be better than existing approaches.
- Low cost – If the approach is relatively inexpensive.
- High adaptability – If the approach can be tailored to the required context.
Overcoming barriers and leveraging enablers
Understanding the barriers and enablers that impact suicide prevention approaches is an important aspect of implementation. Equally important, is reflecting on lessons learned in implementation and sharing what works to help overcome roadblocks.
The table below includes themes that commonly act as barriers to implementation. Each barrier is linked to examples of lessons learned and insights into what works best to address it, as highlighted in a recent study.2
| What’s the barrier? | What were the lessons learned? | What works best? |
| Stakeholder engagement | “A matching of needs and priorities with important stakeholders is necessary for successful buy-in.” “Presenting a realistic picture in lobbying with policymakers.” | • Working with local stakeholders |
| Stakeholder needs not matching the approach objective. | “Asking stakeholders what outcomes matter to them and what success looks like.” “Ensuring well-being of stakeholders involved.” | • Listening to stakeholders needs and ideas about what may or may not work. • Use the existing strengths of stakeholders. |
| Access to funding | “The return on investment for complex [suicide prevention] interventions is not large and immediate.” “Equity in access to resources is essential, especially when thinking of under resourced contexts.” | • Having support from policymakers helps ensure funding is sustainable. • Using existing systems and resources. • Engaging local people and local funding. |
| Limited capacity and time | “Building relationships and collaborations are important skills needed by individuals working on the ground.” “Allowing adequate time to develop the implementation action plan, building relationships, and evaluation is necessary.” | • Having dedicated people with the required skills or expertise. • Having resources to support and sustain the team helps continuity and makes sure knowledge is not lost. |
| Engaging people with a lived experience | “Important to ask people with lived experience what they need.” “A combination of peer support and clinician support is essential for recovery.” | • Engaging people with a lived experience in intervention design, delivery and evaluation. • Having personal relevance to suicide is an important factor for engagement and buy-in. |
| Delivering and adapting interventions | “Delivering the intervention in a real-life setting offers insights into what is feasible.” “Community consultations are key in intervention delivery.” | • Exchanging ideas and support in shared learning spaces. • Having conversations around readiness to implement • Having localised plans for delivery. • Skills-based training rather than knowledge-based training. |
| Evaluation | “Allocation of adequate resources for evaluation is necessary.” “Adopting a personable, sensitive approach while collecting data helps build trust.” | • Developing a constant feedback loop with community members. • Using process indicators to track and examine implementation. |
Table adapted from Table 2 of Krishnamoorthy S, Ross V, Mathieu S, Armstrong G, Kõlves K. Understanding international, practice-based, stakeholder perspectives on implementation of complex suicide prevention interventions: A qualitative exploration. Psychological Services. 2024.
Implementation strategies are the steps we can take to improve how an evidence-based approach is adopted, carried out, or sustained. The strategies and frameworks page dives deeper into how understanding barriers and enablers can be used to identify implementation strategies.
Sharing lessons learned
Reflecting on and sharing lessons learned from implementing suicide prevention approaches helps others to overcome similar barriers. Below, are some key insights or lessons learned, from implementing different suicide prevention projects—browse through them or submit your own reflections.
Notes
- 1
Kasal A, Táborská R, Juríková L, Grabenhofer-Eggerth A, Pichler M, Gruber B, et al. Facilitators and barriers to implementation of suicide prevention interventions: Scoping review. Cambridge Prisms: Global Mental Health. 2023;10. doi:10.1017/gmh.2023.9
- 2
Krishnamoorthy S, Ross V, Mathieu S, Armstrong G, Kõlves K. Understanding international, practice-based, stakeholder perspectives on implementation of complex suicide prevention interventions: A qualitative exploration. Psychological Services. 2024; doi: 10.1037/ser0000887