a brief summary of common experiences after a clinician’s loss of a client/patient:
Despite the fact that suicide loss is an occupational hazard, mental health communities treat suicide as an aberration:
In US suicides, up to 1/2 under care of mental health professionals
Up to 51% Psychiatrists, 22% mental health professionals lose clients to suicide during career
Interns, residents and other novice clinicians have been found to experience higher rates of suicide among their clients than more seasoned clinicians (they often work with very high-risk clients.)
There is a consequent lack of:
Preparedness before the event (pre and postvention training)
Clear guidelines for postvention protocols
Optimal support for clinicians after a client loss
Clinicians, Professional Caregivers* and Suicide Grief
Caregiver loss to suicide is often a complicated, potentially traumatic grief process.
It impacts clinicians/caregivers both personally and professionally.
This is also true for clinicians/caregivers who have family/loved one suicide loss!
Research has found loss of a client is the: “most profoundly disturbing event of one’s professional career”. (Hendin et al. 2000)
Many grapple with:
Assumptions around one’s competence, responsibility, and agency
A desire to leave the field
Up to one third of clinicians experience severe distress after the loss of a client for more than one year
Disenfranchised Grief: The extent to which therapeutic relationship may be acknowledged is compromised by confidentiality/legal issues
There is limited access to grief rituals that facilitate healing and validate grief (funerals, memorial attendance, shared spaces)
There is a scarcity of available places to process loss with others who are familiar with its sequelae
The loss often brings negative/unsupportive reactions from colleagues
There is also stigma around suicide and professional vulnerability
These factors combined are likely to lead to personal and professional isolation
*Teachers, school counselors, clergy and other professional caregivers may experience similarities in ways they are impacted.
Effects on Clinical Work
There is often:
Loss of confidence, and feelings of competence, particularly in relation to suicidal clients
Clinical impairment in relation to suicide potential ranging from hyper-vigilance to minimization
Clinical impairment of empathic responses, defensive avoidance of a client’s and one’s own pain
Difficulty trusting clients and one’s own clinical judgements
Legal/Ethical Issues
Suicide malpractice is the leading cause of legal action against all mental health providers (Is this true? I thought it was boundary violations)
Confidentiality restricts the acknowledgement and processing of patient/client loss
Dealing with surviving family is often confusing and anxiety provoking with little available guidance
Fear and presence of legal actions complicate and extend the grief process
Positive change/Post-traumatic growth can occur via:
Education and training re: the actual likelihood of patient suicide
A deepening understanding of the complexities of suicide and the inherent limitations within our roles
Access to and use of postvention guidelines and protocols
Accessible resources and support in the face of suicide loss
Citations:
Alexander D, Klein S, Gray NM, et al. Suicide by patients: questionnaire study of its effect on consultant psychiatrists. BMJ. 2000;320(7249):1571-1574.
Chemtob CM, Hamada RS, Bauer G, et al. Patients’ suicides: frequency and impact on psychiatrists. Am J Psychiatry. 1988;145(2):224-228.
Grad OT, Zavasnik A, Groleger U. Suicide of a patient: gender differences in bereavement reactions of therapists. Suicide Life Threat Behav. 1997;27(4):379-386.
Hendin H, Lipschitz A, Maltsberger JT, et al. Therapists’ reactions to patients’ suicides. Am J Psychiatry. 2000;157(12): 2022-2027.
Kleespies, P. M. (2017). The Oxford handbook of behavioral emergencies and crises. New York: Oxford University Press.
Ruskin R, Sakinofsky I, Bagby RM, et al. Impact of patient suicide on psychiatrists and psychiatric trainees. Acad Psychiatry. 2004;28(2):104-110.
Prabhakar D, Anzia JM, Balon R, et al. “Collateral damages”: preparing residents for coping with patient suicide. Acad Psychiatry. 2013;37(6):429-30.