Mar 11, 2020
Lorenzo Norris, MD, interviews Nina J. Gutin, PhD, a
psychologist with a private practice in Pasadena, Calif., about
losing patients and loved ones to suicide.
Gutin wrote two evidence-based reviews on the topic late last
year. The reviews were published in Current Psychiatry.
- When mental health clinicians lose a patient to suicide, the
sequelae can include stigma, potential legal consequences, impact
on future clinical work, and restraints on processing the loss
because of confidentiality concerns.
- The American Association of
Suicidology founded the Clinician Survivor Task
Force (CSTF), which provides consultation, support, and
education to mental health professionals to help them respond to
the personal/professional loss from the suicide of a patient or
- Mental health institutions can benefit from protocols on how to
respond to a potential completed suicide, so clinicians and
families are not left in a vacuum of uncertainty and blame.
- After a patient suicide, clinicians need an anonymous or safe
space to talk about the patient and the suicide without breaking
confidentiality. This can be an online forum, such as the one
sponsored by the CSTF, or an institution can identify a supportive
colleague who has suffered a similar loss.
- The CSTF forum allows clinicians to remain anonymous.
Several domains require attention after
the loss of a patient from suicide:
- Confidentiality restrains the ability to talk about the details
of the loss, which stymies grief and learning from the event.
Restraints of confidentiality pertain to individual clinicians and
clinical teams. On a team, it might feel as if the clinicians are
unable to process the loss as a group and talk about important
- Legally, clinicians worry about potential lawsuits, and
autopsies” can lead to retraumatization. Clinicians might
struggle with how – or whether – to talk to a patient’s family
after suicide. Some lawyers advise compassion over caution. In
collaboration with lawyers who advise what can be disclosed, a
clinician can speak with a family, and this compassion toward
families might decrease the risk of a lawsuit.
- Clinicians should be prepared for a patient suicide to affect
their clinical work. A clinician might become hypervigilant about
suicide risk and overreact, or they might experience denial about
the risk and avoid asking questions about suicide.
- Ethically, suicide is an “occupational hazard” of working in
the mental health field. Blaming clinicians for patient suicide
hampers the depth of working with people with mental illness by
causing some clinicians to avoid “high-risk” patients.
- The stigma around death by suicide extends to the survivors of
the loss. When clinicians express vulnerability about loss, it can
be interpreted as guilt. Clinicians are expected to keep going no
matter what, which is unrealistic. Grief over a patient’s death
should be neither pathologized nor shamed.
- Guilt and blame are the flip sides of each other; both express
the complexity and ambiguity of these kinds of losses.
- Institutions should have “postvention” protocols in
place to respond to the likely event of a completed suicide.
Guidelines can address what needs to be covered in a review of the
case while also supporting clinicians, so they don’t feel like it’s
a tribunal. Clinicians should be warned of the normal sequelae of a
client suicide, and institutions can make accommodations based on
the expected impact of suicide on a clinician’s work. Institutions
can provide support by connecting clinicians who have also lost
clients to suicide to dispel the belief that they are alone in
their loss and to mitigate self-blame.
- The CSTF provides support through in-person and online support
groups, and postvention protocols for institutions. It also and
maintains a bibliography of research on clinician
Gutin NJ. “Losing a patient to suicide: What we know.”
Current Psychiatry. 2019 Oct 18(10):14-6,19-22,30-2.
Gutin NJ. Losing a patient to suicide: Navigating the aftermath.
Current Psychiatry. 2019 Nov 18(11):17-18,20,22-4.
American Association of Suicidiology. Clinicians as Survivors: After
a Suicide Loss.
Owen JR et al. Suicide symposium: A multidisciplinary approach
to risk assessment and the emotional aftermath of patient suicide.
2018 Nov 28;14:10776.
Myers MF and Fine C. Touched by suicide: Bridging the
perspectives of survivors and clinicians.
Suicide Life Threat Behav. 2007 Apr;37(2):119-26.
Show notes by Jacqueline Posada, MD, associate producer of the
Psychcast and consultation-liaison psychiatry fellow with the Inova
Fairfax Hospital/George Washington University program in Falls
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