Suicide Prevention Under Austerity: The Local Shaping of Referral Practices in French Primary Care.

Abstract

This article examines how French general practitioners (GPs) navigate suicide-related referrals within a healthcare system strained by austerity. Drawing on repeated interviews with 29 GPs and a mind-mapping methodology, it shows that referral practices are shaped less by formal clinical pathways than by local resource configurations and the workarounds practitioners develop in response to them. The analysis highlights three interrelated dynamics. First, GPs rely on a sense of technical mastery-an embodied, experience-based judgement of what they can manage-which is continually stretched as they assume responsibilities once assigned to specialists. Second, they operate with expectations inherited from a previously better-resourced institutional network, generating tensions between normative ideals of care and limited referral possibilities. Third, in this context, local social capital becomes an essential resource: Personal relationships, informal networks and accumulated local knowledge decisively structure how practitioners deal with patients deemed suicidal. Situating these dynamics within the concept of suicidescape, this article advances a locally anchored sociology of suicide prevention.