Evidence-Based Reviews

Losing a patient to suicide: Navigating the aftermath

Current Psychiatry. 2019 November;18(11):17-18,20,22-24

References

1. Tedeschi RG, Calhoun LG. Beyond the concept of recovery: Growth and the experience of loss. Death Stud. 2008;32(1):27-39.
2. Fuentes MA, Cruz D. Posttraumatic growth: positive psychological changes after trauma. Mental Health News. 2009;11(1):31,37.
3. Gitlin M. Aftermath of a tragedy: reaction of psychiatrists to patient suicides. Psychiatr Ann. 2007;37(10):684-687.
4. Huhra R, Hunka N, Rogers J, et al. Finding meaning: theoretical perspectives on patient suicide. Paper presented at: 2004 Annual Conference of the American Association of Suicidology; April 2004; Miami, FL.
5. Jones FA Jr. Therapists as survivors of patient suicide. In: Dunne EJ, McIntosh JL, Dunne-Maxim K, eds. Suicide and its aftermath: understanding and counseling the survivors. New York, NY: W.W. Norton; 1987;126-141.
6. Gutin N, McGann VM, Jordan JR. The impact of suicide on professional caregivers. In: Jordan J, McIntosh J, eds. Grief after suicide: understanding the consequences and caring for the survivors. New York, NY: Routledge; 2011:93-111.
7. Hendin H, Lipschitz A, Maltsberger JT, et al. Therapists’ reactions to patients’ suicides. Am J Psychiatry. 2000;157(12):2022-2027.
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9. Grad OT. Therapists as survivors of suicide loss. In: Wasserman D, Wasserman C, eds. Oxford textbook of suicidology and suicide prevention. Oxford, UK: Oxford University Press; 2009:609-615.
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13. Quinnett P. QPR: for suicide prevention. QPR Institute, Inc. www.cliniciansurvivor.org (under Postvention tab). Published September 21, 2009. Accessed August 26, 2019.
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19. Figueroa S, Dalack GW. Exploring the impact of suicide on clinicians: a multidisciplinary retreat model. J Psychiatr Pract. 2013;19(1):72-77.
20. Lerner U, Brooks, K, McNeil DE, et al. Coping with a patient’s suicide: a curriculum for psychiatry residency training programs. Acad Psychiatry. 2012;36(1):29-33.
21. Prabhakar D, Balon R, Anzia J, et al. Helping psychiatry residents cope with patient suicide. Acad Psychiatry. 2014;38(5):593-597.
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23. McGann VL, Gutin N, Jordan JR. Guidelines for postvention care with survivor families after the suicide of a client. In: Jordan JR, McIntosh JL, eds. Grief after suicide: understanding the consequences and caring for the survivors. New York, NY: Routledge; 2011:133-155.
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Helping affected clinicians

Suggestions for optimally supporting affected clinicians include:

clear communication about the nature of upcoming administrative procedures (including chart and institutional reviews)
consultation from supervisors and/or colleagues that is supportive and reassuring, rather than blaming
opportunities for the clinician to talk openly about the experience of the loss, either individually or in group settings, without fear of judgment or censure
recognition that the loss is likely to impact clinical work, support in monitoring this impact, and the provision of medical leaves and/or modified caseloads (ie, fewer high-risk patients) as necessary.

Box 1

Help for those who have lost a patient to suicide: The Clinician Survivor Task Force

Frank Jones and Judy Meade founded the Clinical Survivor Task Force (CSTF) of the American Association of Suicidology (AAS) in 1987. As Jones noted, “clinicians who have lost patients to suicide need a place to acknowledge and carry forward their personal loss…to benefit both personally and professionally from the opportunity to talk with other therapists who have survived the loss of a patient through suicide.”7 Nina Gutin, PhD, and Vanessa McGann, PhD, have co-chaired the CSTF since 2003. It supports clinicians who have lost patients and/or loved ones, with the recognition that both types of losses carry implications within clinical and professional domains. The CSTF provides a listserve, opportunities to participate in video support groups, and a web site (www.cliniciansurvivor.org) that provides information about the clinician-survivor experience, the opportunity to read and post narratives about one’s experience with suicide loss, an updated bibliography maintained by John McIntosh, PhD, a list of clinical contacts, and links to several excellent postvention protocols. In addition, Drs. Gutin and McGann conduct clinician-survivor support activities at the annual AAS conference, and in their respective geographic areas.

Both researchers and clinician-survivors in my practice and support groups have noted that speaking with other clinicians who have experienced suicide loss can be particularly reassuring and validating. If none are available on staff, the listserve and online support groups of the American Association of Suicidology’s Clinician Survivor Task Force may be helpful (Box 1⁷). In addition, the film “Collateral Damages: The Impact of Patient Suicide on the Physician” features physicians describing their experience of losing a patient to suicide (Box 2).

Box 2

Collateral Damages: An educational resource

“Collateral Damages: The Impact of Patient Suicide on the Physician” is a film that features several physicians speaking about their experience of losing a patient to suicide, as well as a group discussion. Psychiatrists in this educational film include Drs. Glen Gabbard, Sidney Zisook, and Jim Lomax. This resource can be used to facilitate an educational session for physicians, psychologists, residents, or other trainees. Please contact education@afsp.org to request a DVD of this film and a copy of a related article, Prabhakar D, Anzia JM, Balon R, et al. “Collateral damages”: preparing residents for coping with patient suicide. Acad Psychiatry. 2013;37(6):429-430.

Schultz¹⁴ offered suggestions for staff in supervisory positions, noting that they may bear at least some clinical and legal responsibility for the treatments that they supervise. She encouraged supervisors to take an active stance in advocating for trainees, to encourage colleagues to express their support, and to discourage rumors and other stigmatizing reactions. Schultz also urges supervisors to¹⁴:

allow extra time for the clinician to engage in the normative exploration of the “whys” that are unique to suicide survivors
use education about suicide to help the clinician gain a more realistic perspective on their relative culpability
become aware of and provide education about normative grief reactions following a suicide.

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Losing a patient to suicide: Navigating the aftermath

References

Helping affected clinicians

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