Working with suicidal clients: Psychotherapists and allied professionals speak about their experiences

"You get tired of remaining in a state of fear"- professionals' experiences of self-care facing suicidality in psychiatric wards

AIM

The aim of this study is to explore mental healthcare professionals (MHCPs) experiences related to own emotions when encountering patients at risk of suicide in psychiatric wards and their family members.

METHODOLOGY AND METHODS, PARTICIPANTS AND RESEARCH CONTEXT

This study has a qualitative explorative design. Data consist of texts from twelve in-depth interviews with MHCPs belonging to six units in two psychiatric wards. Data were interpreted using a hermeneutical approach based on Gadamer's philosophical hermeneutics.

FINDINGS

Through an interpretation process, three themes emerged: Enduring own emotions, Balancing emotional engagement and the need to rest, and Being together in the community of colleagues.

CONCLUSION

This study shows the importance of being aware of own anxiety facing suicidality. MHCPs have to work emotionally and cognitively so that care is not guided by anxiety but by collaboration with the patient and his family members. The study highlights the need for a culture in the mental health service in which the MHCP can reflect on own emotional reactions and thoughts in a collegial environment characterized by openness, generosity and collaboration.

Rural suicide in Newfoundland and Labrador: A qualitative exploration of health care providers' perspectives

INTRODUCTION

Residents of rural regions may have higher and unique suicide risks. Newfoundland and Labrador (NL) is a Canadian province replete with rural regions. Despite an abundance of rural suicide research, heterogeneity in rural regions may preclude amalgamating findings to inform prevention efforts. Thus, exploring the unique needs of NL is needed. Importantly, health care providers (HCP) may afford unique perspectives on the suicide-related needs or concerns of rural life. We asked HCPs of residents of rural NL their perceived suicide risk factors, concerns, and needs for rural NL.

METHOD

Twelve HCPs of rural residents of NL completed virtual semi-structured interviews. Interviews were analysed using reflexive thematic analysis [13,14].

RESULTS

HCPs noted individual, psychological, social, and practical factors linked to rural-suicide risk and subsequent needs. Findings highlight the unique challenges of residing and providing health care in rural NL and inform prevention and intervention efforts.

Military mental health professionals' suicide risk assessment and management before and after experiencing a patient's suicide

OBJECTIVE

This study examines the association between a patient's suicide and the therapist's suicide risk assessment (SRA) and suicide risk management (SRM) of patients, following the occurrence.

METHOD

SRA values range from "absence of suicidality" to "immediate suicidal intent to die". SRM consists of therapists' written recommendations. Rates of the various SRA and SRM values in therapists' evaluations were assessed 6-months prior to the suicide and at the two three- and six-month time-points thereafter.

RESULTS

Of the 150 soldiers who died by suicides, 30 (20%) visited 50 military therapists in the 6 months preceding their deaths. Using Wilcoxon signed rank test, lower SRA rates of "threatens suicide" were found 2 months after a patient's suicide. Regarding SRM, the mean rates for "recommendations for psychotherapy treatment" were higher at the two (p = 0.022) and the 3 month time-points (p = 0.031) after a suicide.

CONCLUSIONS

The SRA findings may indicate therapists' fear of treating suicidal patients, causing them to overlook patients' non-prominent suicide-risk indicators. In SRM, the higher rate of recommendations for additional therapy sessions rather than military release or referrals to other therapists may relate to over-caution and attempts to control the patient's therapy ensuring it's done properly.

Identifying Risk Factors for Self-reported Mental Health Problems in Psychiatry Trainees and Psychiatrists in Mexico

OBJECTIVE

The objective was to determine and compare demographic features, professional activities and adversities, physical health conditions, and self-care behaviors related to the most frequently self-reported mental health problems among psychiatrists and psychiatry trainees.

METHODS

A cross-sectional, retrospective, comparative study was conducted on a total of 330 (48.2%) psychiatry trainees and 355 (51.8%) psychiatrists from Mexico through an online survey. Demographic features, professional activities and adversities, physical and mental health problems, self-care behaviors, and social support were examined. Comparative analyses and multiple logistic regression models were performed.

RESULTS

Major depression, anxiety, and burnout were the most common mental health problems reported with a higher frequency of anxiety disorders in psychiatry trainees. Being a woman, having a physical health problem, and lack of restful sleep were the main risk factors in both groups. Consultation in the government sector and having patients with severe suicidal ideation affected more psychiatry trainees. Perceived discrimination and inadequate eating schedules were risk factors for mental health problems for psychiatrists.

CONCLUSION

Psychiatry trainees constitute a vulnerable group for anxiety disorders. Particular attention should be paid to how students cope with the training experience to determine whether additional support is required. These professionals face major stressors leading to a high prevalence of depression, burnout, and anxiety. Encouraging psychiatrists to have better health habits is a step in the right direction, which must be accompanied by tangible organizational avenues to do so and creating a culture that truly promotes self-care.