Evaluating the follow-up care system after suicide attempt in Iran: barriers and insights from a mixed-method study

Despite ongoing efforts to provide hospital-based and post-discharge care for individuals who attempt suicide in Iran, the national suicide rates continue to rise. This study applied the Medical Research Council framework to systematically examine how the suicide follow-up care system is implemented in Shahriar city, Iran, identifying barriers and systemic challenges that affect service delivery. An explanatory sequential mixed-methods design was employed. Quantitative data were extracted from 992 cases of suicide attempts recorded between April and September 2023. The qualitative phase involved semi-structured interviews and focus group discussions with 45 stakeholders, including mental health workers, hospital staff, mental health experts, and service users. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed through the Framework Method using MAXQDA software. Findings indicated that of the 992 individuals referred to follow-up services, only a small proportion (n = 15) engaged with designated health centers, and only three attended all sessions, indicating significant limitations in program reach. Qualitative analysis revealed nine thematic domains consistent with the MRC framework: infrastructure, information gaps, and human resource challenges within implementation mechanisms; participant experiences, and acceptability, related to impact mechanisms; and socioeconomic factors, stigma, organizational barriers, and access to means restriction as contextual components. This study provides a unique contribution by using a comprehensive framework to evaluate Iran’s national suicide follow-up system and its role in broader prevention efforts. The results indicate that the implementation of the Follow-up Care System faces substantial structural, organizational, and cultural barriers, including limited human resources, infrastructure gaps, delays in follow-up, and weak coordination between hospitals and health centers. Despite these challenges, some interventions provided emotional support and improved coping mechanisms. Findings emphasize the importance of program fidelity, staff training, and attention to social and cultural factors. Strengthening hospital-based follow-ups and improving data systems can enhance accessibility, participation, and overall effectiveness. This study offers valuable evidence for policymakers to address operational barriers and improve program implementation.