Patient Suicide and the Toll on Clinicians

Interesting article dated 12/31/14 that appeared in Psychiatric Times about suicide and the impact on clinicians.

Noting that “patient suicide is now recognized as an occupational hazard for psychiatrists”, the following eight common themes based on several interviews were reported:

  • Traumatic responses: dissociation, traumatic intrusion, avoidance, somatic symptoms participants associated with the suicide, and dreams (nightmares) about the patient
  • Affective responses: crying, sadness, anger, grief, and fear or anxiety about the consequences
  • Treatment-specific relationships: clinicians reviewed and reconstructed some of their work with the patient, particularly their last session, and spoke about contact with the patient’s family
  • Relationships with colleagues: this proved to be one of the most complicated experiences and included contacts with the clinician’s personal analyst or psychotherapist, supervisors, peers, trainees, and other institutional staff
  • Risk management concerns: many had to do with potential for being sued
  • Grandiosity, shame, humiliation, guilt, judgment, and blame were spoken about (using this language) by the clinicians seeking to understand their own ongoing internal response and their projected fear about how others would respond to them as “the person whose patient killed himself or herself”
  • A sense of crisis was part of the experience of most clinicians interviewed; trainees were uncertain about their work and choice of a specialty; others felt unsure that they wanted to continue work, feeling that psychotherapy exposed them and their patients to an unsettling vulnerability
  • The effect on work with other patients: clinicians spoke about how they were changed for better and, at times, for worse in their work with other patients; some spoke of no longer accepting suicidal patients for treatment, or quickly moving into management and action rather than seeking to deepen the relationship and understand the suicidal patient; a few felt calmer in the face of suicidal crises with patients.

There are a number of issues of relevance pertaining to intervention with suicidal patients and the aftermath of a suicide; but the clinician’s own self-care may be neglected which in turn can lead to chronic stress-related problems. As a conclusion, “preparing for the possibility of patient suicide will help the clinician anticipate the types of support that our colleagues or we may need to weather the event. Improved training about the effects may help clinicians and organizations respond effectively when a patient commits suicide.”

In this regard, the Latin saying, Medice, cura te ipsum! (Physician heal thyself!) rings true. Heal yourself first before dealing with patients. Or, in plain terms, if you don’t take care of yourself you won’t be much good to others (including your own patients).


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