Exploring organisational influences on the implementation of gatekeeper training: a qualitative study of the Applied Suicide Intervention Skills Training (ASIST) programme in Wales

Abstract

Suicide is a public health priority. International guidance on prevention, epidemiology and treatment-based research indicates the potential of gatekeeper training in this area. Whilst there is some evidence to suggest that interventions enhance the knowledge and skill set of gatekeepers, evidence regarding changes to intervention-related behaviour remains unclear. This disruption to the causal pathway between competency and action suggests the need to address contextual mediators of the implementation of gatekeeper training and to consider the individual as a situated agent, who is both enabled and constrained by the discourses and working practices of the organisation in which they work. To explore organisational influences on intervention behaviour, this paper draws upon a qualitative study of the applied suicide intervention skills training (ASIST) gatekeeper intervention in Wales. Thirty-three individual interviews and six focus groups (n = 25 individuals) with those employed by a range of statutory and non-statutory organisations and networks were included. Three key organisational influences were identified as impacting on gatekeeper’s intervention behaviour. These include: the democratisation of intervention; organisational attempts to enhance opportunities to intervene; and the creation of a positive context for intervention. This study concludes that both policy and practice need to move beyond a reductionist approach to gatekeeper training and attend to the organisational influences and contextual factors affecting intervention-related behaviour.

Keywords:

• prevention
• health
• workplaces
• suicide
• suicide intervention
• suicide prevention
• gatekeeper training
• organisational influences