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How Patient Suicide Affects Mental Health Specialists


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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