Sandford, D.M., Kirtley, O.J., Thwaites, R., & O’Connor, R.C. (2021). The impact on mental health practitioners of the death of a patient by suicide: A systematic review. Clinical Psychology and Psychotherapy, 28, 261-294.
In the UK, it is estimated that up to 27% of those who commit suicide have been in contact with a mental health professional in the past year. Even though suicide is a rare event, a mental health practitioner is likely to experience at least one instance of a patient suicide during their career. A psychotherapist who experiences a patient suicide could experience symptoms of burnout, PTSD, grief, and a sense of being overwhelmed. Sandford and colleagues conducted a systematic review of the existing research on the impact of a patient’s suicide, experiences of support by the practitioner, and factors that may minimize the negative impacts of patient suicide. They reviewed 54 quantitative and qualitative studies in order to synthesize the research. Professionals included psychiatrists, psychologists, psychotherapists, counsellors, and other mental health professionals. The most common responses of professionals to a patient suicide were guilt, blame, shock, anger, sadness, and grief. Over 20% of practitioners met criteria for PTSD in some studies. Many practitioners across all studies reported some negative impact on their personal life, with 24% identifying severe emotional impact (lower mood, poor sleep). Following a patient suicide, practitioners reported an increased focus on risk assessment, greater caution in their practices, and increased self-doubt about their own judgement. The average practitioner reported an impact that lasted about 4 weeks. A closer therapeutic relationship with the patient, patients who were younger, and the fear of blame and litigation were each associated with a higher level of distress in therapists. However, the impact was not related to therapist gender, age, or experience. Most practitioners felt inadequately prepared for dealing with a patient suicide. But protective factors included support from colleagues, friends and family, and supportive supervision.
Even if suicide is a rare event in the population, an important minority of patients who commit suicide were in contact with a mental health professional in the preceding year. And so, one might expect to have a patient who commits suicide during one’s career that will have a negative impact on one’s own well-being and professional practice. Increased awareness of the incidence of suicide, informal social supports, and empathic supervision may mitigate the negative impacts. So will tailored training experiences on managing one’s own reactions to patients, as well as a professional work environment that is non-blaming and supportive.