I was delighted to get my first consultant psychiatrist job in 2009 in an inpatient unit in inner London. In my second week, I had my first patient die by suicide. In my third week, another patient I’d treated died by suicide. In my third month, we had a very distressing and violent death by suicide of a patient on the ward. This latter death was initially treated by the police as a murder. This was a shock to me at the time, but I know now that this is not uncommon.
After my first months as a consultant psychiatrist I was permeated by the experience of suicide. I could not understand how three patients I’d treated could have died like this and felt that I must have somehow caused—or at the very least contributed to—their deaths. As a result of this belief I felt deeply ashamed, humiliated, and alone. I continued working but I was incapacitated, unable to make even the simplest clinical decision, and was terrified by every patient I had contact with. I nearly left psychiatry before my career had begun.
Since then much of my work has focused on suicide bereavement and how to best support clinicians who have dealt with such a tragic event.
After my first months as a consultant psychiatrist I was permeated by the experience of suicide. I could not understand how three patients I’d treated could have died like this and felt that I must have somehow caused—or at the very least contributed to—their deaths. As a result of this belief I felt deeply ashamed, humiliated, and alone. I continued working but I was incapacitated, unable to make even the simplest clinical decision, and was terrified by every patient I had contact with. I nearly left psychiatry before my career had begun.
Since then much of my work has focused on suicide bereavement and how to best support clinicians who have dealt with such a tragic event.
Understanding the extent of the problem
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In collaboration with the Oxford Centre of Suicide Research, I conducted two surveys, one of psychiatrists and another of mental health professionals in general. The suicide of a patient had a significant impact on the emotional wellbeing of 92% of surveyed psychiatrists (105 participants), with 71% experiencing sadness, 33% fear, and 31% guilt and self-blame. Almost 50% (50 out of 106 participants) of mental health professionals of all professional backgrounds thought their mental health had been adversely affected by a patient’s suicide and they also reported similar feelings of sadness and culpability.
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92% suffered a significant impact on emotional wellbeing
71% experiencing sadness, 33% fear, and 31% guilt and self-blame Almost 50% thought their mental health had been adversely affected |
Resources
Support following a patients death by suicide
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RCPsych Peer Support Group
Bi monthly RCPsych Peer support group for any psychiatrists at any level in any of the devolved nations. To join please contact the Psychiatrists Support Service.
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Papyrus Debrief Service
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Papyrus’s suicide prevention helpline, HOPELINE247, is not only here to support young people who are experiencing thoughts of suicide, or those concerned for them. It’s also here for any professional who has had an experience with suicide and would like to talk it through with a trained professional.
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NHS Practitioner Health
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Practitioner Health is a free, confidential NHS primary care mental health and addiction service with expertise in treating health & care professionals.
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If a patient dies by suicide resources page
A prevention and postvention framework with the RCP
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More must be done to both recruit and retain psychiatrists if services are to be in place that effectively meet the needs of patients. That means the health and wellbeing of psychiatrists must be considered fully.
One area that can be particularly traumatic for psychiatrists and calls for support from employing bodies is when one of their patients dies by suicide. Families of those who died often want answers and therefore a psychiatrist who is able to participate effectively in any follow-up activity is also important to them. That is why the College, working with the Oxford Centre for Suicide Research, have produced this report which provides employers of psychiatrists and other policy makers with guidance, that, if implemented, can mitigate the damaging impact of patient death by suicide on staff involved in their care – which can include burnout, mental health problems and, in some cases, staff leaving the mental health sector altogether. |
Resources from the US: the Coalition of Clinician Survivors
The Coalition of Clinician Survivors exists to provide support, education, resources and consultation to mental health professionals and other professional caregivers who have experienced suicide losses in personal and/or professional contexts. We recognize that, regardless of whether the loss was of a loved one, a client/patient or a student, the repercussions are profound and are likely to impact a clinician both personally and professionally.
Resources for Clinicians Following a Patient Perpetrated Homicide
RCP College Report
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There is marked paucity of research in the area of the impact of patient-related homicide on clinicians.
● Most mental health professionals will experience a patient-related homicide at least once in their career. ● Patient-related homicide has significant emotional and clinical impact on clinicians, including:
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