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.