Aftermath: Clinicians Coping with Patient Suicide
A suicide has repercussions for all parties involved. Primary care providers can be as, or more, vulnerable to patient suicides than psychiatrists. As reviewed by Luoma and colleagues (2002), they are more likely to have been in recent contact with a suicide victim than mental health professionals. In their review of 40 studies, last contacts with mental health services compared with primary care providers within 1 month and 1 year of death were 19% versus 45%, and 32% versus 77%, respectively. The lifetime rate of contact with mental health services averaged 53%.
Kaye and Soreff (1991) had a number of recommendations in the aftermath of a patient suicide, with the caveat that a patient suicide is a very personal event, and the approach has to be individualized in recognition of nuances. They believe that families should be contacted and met with, told realistically of all the efforts on the decedent’s behalf, and contact maintained through the funeral and autopsy report. Hospital staff should be contacted and, if possible, informed as a group. Attendance at the funeral can be beneficial. They advocate the psychological autopsy as an opportunity to vent as well as facilitate learning and any policy reform. In some instances, inpatients or surviving group members should meet with staff, with a concern toward patients’ devaluing staff and increased suicidal risk to surviving patients.
The treating psychiatrist should seek support, solicit formal or informal consultation with colleagues, consider attending the funeral or sending forms of condolence, and offer expressions of sympathy. The latter is not felt to represent an admission of guilt. A psychological autopsy should be conducted, and attending the autopsy is not verboten in their opinion. Billing for past services, although difficult, is typically appropriate. If affiliated with an institution, cooperation with its risk management is advised, with due caution. Medical records should be accurately completed, with those submitted after the patient’s death clearly reflecting so. Although the suicide of a patient reminds the psychiatrist of powerlessness, the psychiatrist should function as team leader in the aftermath (Kaye and Soreff, 1991).