Impact of Client Suicide on Psychologists in Australia

Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review

OBJECTIVE

This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts.

METHODS

An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool.

RESULTS

Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±<1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%-100% of professionals in these samples. Perceptions of support ranged widely, with 11%-87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%-82%), more suicide prevention or postvention training (4%-70%), debriefing or supervision (41%-75%), formal case review (18%-20%), time off (12%), and legal assistance (4%).

CONCLUSIONS

HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs' needs.

Exploring the Role of Coping Strategies on the Impact of Client Suicide: A Structural Equation Modeling Approach

Client suicide refers to cases where a mental health practitioner is exposed, affected, or bereaved by a client's suicide and is known to have a profound impact on MHPs. The current study investigated the role of coping styles in understanding short- and long-term impact of client suicide. An international sample of 213 mental health practitioners who experienced a client suicide completed a survey on coping strategies (i.e., Brief-COPE) and the impact of traumatic events (i.e., impact of event scale-revised, long-term emotional impact scale and professional practice impact scale). Results indicate coping strategies explain 51% of the short-term, 64% of the long-term emotional and 55% of the long-term professional differences in impact of client suicide. Moreover, while an Avoidant coping style predicted more impact of client suicide, Positive coping and Humor predicted less impact of client suicide. Social Support coping did not predict impact of client suicide. Implications for both research and clinical practice are discussed.

Experiences and support needs of consultant psychiatrists following a patient-perpetrated homicide

AIMS AND METHOD

To investigate the experiences and support needs of consultant psychiatrists following a patient-perpetrated homicide, an anonymous online survey was sent to all consultant psychiatrists registered as members of the UK's Royal College of Psychiatrists.

RESULTS

Of the 497 psychiatrists who responded, 165 (33%) had experienced a homicide by a patient under their consultant care. Most respondents reported negative impacts on their clinical work (83%), mental and/or physical health (78%) or personal relationships (59%), and for some (9-12%) these were severe and long lasting. Formal processes such as serious incident inquiries were commonly experienced as distressing. Support was mainly provided by friends, family and colleagues rather than the employing organisation.

CLINICAL IMPLICATIONS

Mental health service providers need to provide support and guidance to psychiatrists following a patient-perpetrated homicide to help them manage the personal and professional impact. Further research into the needs of other mental health professionals is needed.

Scoping Review of Postvention for Mental Health Providers Following Patient Suicide

INTRODUCTION

As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention).

MATERIALS AND METHODS

We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach.

RESULTS

Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels.

CONCLUSIONS

The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.

When a Patient Dies From Suicide: A Survey Among Mental Health Professionals in Israel

Death of patients by suicide can have powerful impacts on mental health professionals (MHPs). The National Program for the Prevention of Suicidality and Suicide at Israel's Ministry of Health decided to invest in MHPs who have lost patients by suicide. Two hundred and two MHPs completed an online self-report survey regarding their emotional response, professional identity, and clinical practice, and the aid they felt would be supportive following a patient's suicide. Results indicated that 35% of MHP experienced at least one death of a patient by suicide. Respondents experienced difficult emotional reactions, and many felt responsible for the suicide. Nearly 50% reported that the patient's suicide affected their clinical practice. Most respondents reported the need for a support framework and information about the processes following a patient's suicide. It is important to increase awareness of the possibility of losing a patient by suicide and offer an appropriate supportive framework.

Exploring the impact on primary care mental health practitioners of the death of a patient by suicide: An IPA study

OBJECTIVES

There have been numerous qualitative studies into the impact of the death of a patient by suicide on clinicians, but the majority of studies have focussed on psychiatrists and psychologists, primarily in inpatient or secondary care settings. To date, little has been done to explore the impact of such deaths on other mental health practitioners working in primary care, such as those working in Improving Access to Psychological Therapies (IAPT) services.

DESIGN

This qualitative study used purposive sampling and adopted an interpretative phenomenological analysis (IPA) methodology.

METHOD

All participants had experienced the death of a patient in their role as a practitioner in an IAPT service. Seven practitioners were recruited from services across the North of England. Semi-structured, one-hour telephone interviews were audio recorded and then transcribed verbatim.

RESULTS

Analysis of the transcripts identified a number of themes, which were represented in the majority of cases. Specifically, the analyses yielded four superordinate themes: (1) feeling shocked and upset about the death of a patient; (2) attempting to understand the causes of the suicide; (3) learning from the tragic event; and (4) reflections on what helped in coping with the tragic event. The emotional responses of shock, upset, guilt and fear of blame by IAPT practitioners following the death of a patient through suicide is consistent with that found in studies of other mental health practitioners.

CONCLUSIONS

It is hoped that the current study will help raise awareness amongst primary care mental health practitioners, services and training centres, of the impact of losing a patient to suicide and will encourage them to consider how best to prepare and support practitioners in this eventuality. Recommendations include raising awareness of the potential for patient suicide in primary care services, providing clarity on the individualised support available and on the requirements of investigations.

Effects of patient deaths by suicide on clinicians working in mental health: A survey

In the UK, at least a quarter of suicides occurs in patients whilst under the care of mental health services. This study investigated the effects of such deaths on non-medical mental health clinicians. An online survey was conducted within a single NHS mental health Trust to elicit both quantitative and qualitative responses from staff across a range of professions. The survey focused on personal and professional impacts and available support. Participants reported significant negative emotional and professional effects that were long-lasting for some. These included mental health difficulties, loss of confidence regarding clinical responsibilities, and actual or contemplated career change. However, there was also some evidence of positive effects and professional growth. Support from colleagues and line managers is clearly important following deaths of patients by suicide. Clinicians' experiences of the support they had received in the workplace were polarized, suggesting that there is no single nor ideal approach that will meet everyone's needs. Participants made recommendations for the types of support that may be helpful. Most commonly, clinicians desired opportunities for focused reflection and support and help with the formal processes following the death. Sensitivity around how clinicians are notified about the death was highlighted as being particularly important. Conclusions are drawn as to how training institutions and employers can help staff to be better prepared for the potential occurrence of patient suicides and the formal processes that follow, with a view to mitigating risks of more serious harm to staff and hence indirectly to patients, and potential loss of highly trained clinicians to the workforce.

Attitudes toward Suicide and the Impact of Client Suicide: A Structural Equation Modeling Approach

Previous research has revealed that mental health professionals (MHPs) often experience significant short- and long-term impacts in the aftermath of client suicide. Individual differences are significant, yet what factors explain these differences remain unclear. The current study aimed to investigate to what extent MHPs' attitudes toward (client) suicide could predict the short- and long-term impacts of client suicide. A total of 213 MHPs, aged between 18 and 75, reported on a client suicide and their attitudes toward (client) suicide using self-report questionnaires. The results indicate that MHPs who believe it is one's "rightful choice" to die by suicide report less and MHPs who believe "suicide can and should be prevented" report more impact of client suicide. Predictability and preventability of client suicide proved strongly, positively correlated; yet, neither predicted the impact of client suicide. Taken together, these findings highlight the importance of MHPs' attitudes toward (client) suicide with respect to clients and MHPs (self-)care.

Suicide Exposure and the Impact of Client Suicide: A Structural Equation Modeling Approach

OBJECTIVE

Client suicide, used to refer to situations where a mental health practitioner (MHP) is exposed, affected, or bereaved by a client's suicide, is known to have a profound impact on MHPs. The current study investigated (1) the short- and long-term impact of client suicide and (2) to what extent gender, years of experience, therapeutic background, and exposure to suicidality predicted impact.

METHODS

An international sample of 213 mental health practitioners completed an online survey on the impact of client suicide.

RESULTS AND CONCLUSION

Overall, results indicate MHPs are significantly affected by client suicide. A two-factor model in which impact of client suicide was predicted by two latent variables, MHP Characteristics and Exposure to Suicidality, explained 43% of short-term, 69% of long-term emotional, and 60% of long-term professional impact. Whereas MHP characteristics did not significantly predict any of the three impact variables (ps >.05), Exposure to Suicidality significantly predicted all three outcome variables (ps <.001). Interestingly, lived experience or exposure to suicidality of friends/family members predicted more impact, while exposure to suicidality at work predicted less impact of client suicide. Implications for both research and clinical practice are discussed.HIGHLIGHTSMHPs are significantly affected by client suicide;Previous exposure to suicidality predicts the impact of client suicide;MHP characteristics do not predict the impact of client suicide.

Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders

Exposure to suicide is a major factor for suicidality. Mental health professionals and first responders are often exposed to suicide while on-duty. The objective of this scoping review is to describe the state of current research on exposure to suicide among mental health professionals and first responders, focusing on the prevalence and impact of exposure to suicide, and to identify current gaps in the literature. We searched MEDLINE, Scopus, PsychNET, and Web of Science and identified 25 eligible papers. Between 31.5–95.0% of professionals had been exposed to suicide. Exposure to suicide had impacts on personal life, professional life, and mental health; and caused emotional distress. There was little research investigating exposure to suicide among police officers, firefighters, and paramedics. More research existed on mental health professionals, but none assessed exposure to suicide as a risk for suicide amongst this group. The review concludes that exposure to suicide is distressing for mental health professionals, and likely to be for first responder however, more research on these groups, especially paramedics, is required.