Evidence-Based Reviews

Losing a patient to suicide: What we know

Current Psychiatry. 2019 October;18(10):14-16,19-22,30-32

Suicide loss can impact clinicians’ professional identities, relationships with colleagues, and clinical work.

First of 2 parts.

References

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23. Jordan JR, Baugher B. After suicide loss: coping with your grief, 2nd ed. Newcastle, WA: Caring People Press; 2016.
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25. Cvinar JG. Do suicide survivors suffer social stigma: a review of the literature. Perspect Psychiatr Care. 2005;41(1):14-21.
26. Feigelman W, Gorman BS, Jordan JR. Stigmatization and suicide bereavement. Death Stud. 2009;33(7):591-608.
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33. Al-Mateen CS, Jones K, Linker J, et al. Clinician response to a child who completes suicide. Child Adolesc Psychiatric Clin N Am. 2018;27(4):621-635.
34. Henry M, Séguin M, Drouin M-S. Mental health professionals’ response to the suicide of their patients [in French]. Revue Québécoise de Psychologie. 2004;25:241-257.
35. Carter RE. Some effects of client suicide on the therapist. Psychother Theory Res Practice. 1971;8(4):287-289.
36. Dewar I, Eagles J, Klein S, et al. Psychiatric trainees’ experiences of, and reactions to, patient suicide. Psychiatr Bull. 2000;24(1):20-23.
37. Gitlin M. Aftermath of a tragedy: reaction of psychiatrists to patient suicides. Psychiatr Ann. 2007;37(10):684-687.
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40. Maltsberger JT. The implications of patient suicide for the surviving psychotherapist. In: Jacobs D, ed. Suicide and clinical practice. Washington, DC: American Psychiatric Press; 1992:169-182.
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50. Kolodny S, Binder RL, Bronstein AA, et al. The working through of patients’ suicides by four therapists. Suicide Life Threat Behav. 1979;9(1):33-46.
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Studies have found that 1 in 2 psychiatrists,^1-4 and 1 in 5 psychologists, clinical social workers, and other mental health professionals,⁵ will lose a patient to suicide in the course of their career. This statistic suggests that losing a patient to suicide constitutes a clear occupational hazard.^6,7 Despite this, most mental health professionals continue to view suicide loss as an aberration. Consequently, there is often a lack of preparedness for such an event when it does occur.

This 2-part article summarizes what is currently known about the unique personal and professional issues experienced by clinician-survivors (clinicians who have lost patients and/or loved ones to suicide). In Part 1, I cover:

the impact of losing a patient to suicide
confidentiality-related constraints on the ability to discuss and process the loss
legal and ethical issues
colleagues’ reactions and stigma
the effects of a suicide loss on one’s clinical work.

Part 2 will discuss the opportunities for personal growth that can result from experiencing a suicide loss, guidelines for optimal postventions, and steps clinicians can take to help support colleagues who have lost a patient to suicide.

A neglected topic

For psychiatrists and other mental health professionals, the loss of a patient to suicide is certainly not uncommon.^1-5 Despite this, coping with a patient’s suicide is a “neglected topic”⁸ in residency and general mental health training.

There are many published articles on clinicians experiencing suicide loss (for a comprehensive bibliography, see McIntosh⁹), and several authors^10-19 have developed suggestions, guidelines, and detailed postvention protocols to help clinicians navigate the often-complicated sequelae to such a loss. However, these resources have generally not been integrated into clinical training, and tend to be poorly disseminated. In a national survey of chief residents, Melton and Coverdale²⁰ found that only 25% of residency training programs covered topics related to postvention, and 72% of chief residents felt this topic needed more attention. Thus, despite the existence of guidelines for optimal postvention and support, clinicians are often left to cope with the consequences of this difficult loss on their own, and under less-than-optimal conditions.

A patient’s suicide typically affects clinicians on multiple levels, both personally and professionally. In this article, I highlight the range of normative responses, as well as the factors that may facilitate or inhibit subsequent healing and growth, with the hope that this knowledge may be utilized to help current and future generations of clinician-survivors obtain optimal support, and that institutions who treat potentially suicidal individuals will develop optimal postvention responses following a suicide loss. Many aspects of what this article discusses also apply to clinicians who have experienced a suicide loss in their personal or family life, as this also tends to “spill over” into one’s professional roles and identity.

Grief and other emotional effects

In many ways, clinicians’ responses after a patient’s suicide are similar to those of other survivors after the loss of a loved one to suicide.²¹ Chemtob et al² found that approximately one-half of psychiatrists who lost a patient to suicide had scores on the Impact of an Event Scale that were comparable to those of a clinical population seeking treatment after the death of a parent.

Continue to: Jordan and McIntosh have detailed...

Losing a patient to suicide: What we know

References

A neglected topic

Grief and other emotional effects

Pages

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