Clinicians Coping with Patient 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%.
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.
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).