With
every death, no matter how expected or prepared for one can be, there is always
a lingering question of “could I have done better?” or “could I have prevented
this somehow?”. With suicide patients, these questions can be haunting for
years to come for several people, most affected among them being their
therapists.
Between
30% to 40% of therapists who have lost a patient to suicide report severe
distress—including anxiety and depressive experiences. This is even more
devastating when a psychiatrist experiences this situation during training. It
was found that 33% of all psychiatric residents had had a patient commit
suicide during their residency. The resident’s vulnerabilities were noted
during training and of those who had the experience of a patient suicide, 77%
felt the impact to be ‘severe’ or ‘strong’ and 62% found it to have a ‘major
effect’ on their development.
Dr.
Herbert Hendin, the medical director of the American Foundation for Suicide
Prevention and the lead author of the report on patient suicide, which appeared
last month in The American Journal of Psychiatry, said that for most of the
therapists, having a patient commit suicide was ''the most traumatic event of
their professional lives.'' The loss of a patient by suicide can be so psychologically
traumatic that it may become a career-ending event for some clinicians (American
Association of Suicidology). If not career-ending, many begin to fear to work
with suicidal patients. Some families sue the therapists for damages, making
them even more hesitant to agree to take on suicidal patients under their care.
This can seriously impact the livelihood of the mentally ill. Another effect
seen is hostility from colleagues or change in relationship with their
colleagues as the patient suicide is now seen as a failure on the part of the
therapist, hence furthering the stigma associated with patient suicide.
A
repeat workshop conducted by Jane G. Tillman highlights her studies with mental
health professionals where 8 common themes emerged from the analysis of the
transcription of the interviews she had taken.
These are: traumatic responses, affective responses, treatment-specific
relationships, relationship with colleagues, risk management concerns, shame &
guilt, a sense of crisis and the effect on work with other patients. She also
illustrates how in her findings, the training provided for mental health
professionals post patient suicide focuses on how to prepare the clinician to
speak with the family of the patient, to manage inquiry from institutions and
go through their procedures and to engage in risk management-driven methods.
Legal advice, she finds, often involves not talking about the suicide. Laws
about how to invoke peer review protection vary from state to state and hence
it is essential for the psychiatrist to seek a peer-protected space to speak
about the event. They need a protected space to speak about their feelings and
effect on morale or professional capability but they also need an event review
which focuses on studying treatment and outcomes.
Managing
group process may also require a sensitive and determined leader. Post the
event, there may be intense emotions, anger, blame and other destructive
projective processes that the group will need to recognize and work through in
order to work productively. There may be individual feelings that may also
hinder the group process as is the tendency for guilt and shame associated with
stigma, scapegoating and blame may become prevalent within the group. There
needs to be a serious recognition of the complex intricacies of the group
processes and work through them.
Similarly,
when in situations where the clinician is a trainee and the dynamics of
supervisors or others in charge of evaluating the trainee may inhibit more full
participation in a group process. As mentioned earlier, the trainees report
feeling blamed, demoralized and isolated more often than other clinicians.
Hence, systems anxiety and its transmission in the hierarchical structures is
important to acknowledge. The supervisors were found to frequently be
ill-equipped to support a trainee whose patient has committed suicide.
There
is no report of any formal “therapy” or training given to mental health
professionals post patient suicide in India either. More research needs to be
conducted to understand better the consequences of patient suicide and what
kind of ramifications it has on the therapists.
BibliographyCollins, J. (2003). Impact of patient suicide on clinicians. Journal Of The American Psychiatric Nurses Association, 9(5), 159-162. http://dx.doi.org/10.1016/s1078-3903(03)00221-0
Goode, E. (2018). Patient Suicide Brings Therapists Lasting Pain. Nytimes.com. Retrieved 30 April 2018, from https://www.nytimes.com/2001/01/16/science/patient-suicide-brings-therapists-lasting-pain.html
Anderson, S. (2018). How Patient Suicide Affects Psychiatrists. The Atlantic. Retrieved 30 April 2018, from https://www.theatlantic.com/health/archive/2015/01/how-patient-suicide-affects-psychiatrists/384563/
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