Objective To identify the effect of patients' suicide on consultant psychiatrists in Scotland. Design Confidential coded postal questionnaire survey. Participants Of 315 eligible consultant psychiatrists, 247 (78%) contributed. Setting Scotland. Main outcome measures Experience of patient suicide; the features and impact of "most distressing" suicide and what helped them to deal with it. Results 167 (68%) consultants had had a patient commit suicide under their care. Fifty four (33%) reported being affected personally in terms of low mood, poor sleep, or irritability. Changes in professional practice were described by 69 (42%) of the psychiatrists-for example, a more structured approach to the management of patients at risk and increased use of mental health legislation. Twenty four (15%) doctors considered taking early retirement because of a patient's suicide. Colleagues and family or friends were the best sources of help, and team and critical incident reviews were also useful. Conclusions Suicide by patients has a substantial emotional and professional effect on consultant psychiatrists. Support from colleagues is helpful, and professional reviews provide opportunities for learning and improved management of suicide and its aftermath.

Aims and MethodThis survey is the first UK study of trainee psychiatrists' experiences of patient suicide. One hundred and three senior and specialist registrars in psychiatry working in Scotland completed the questionnaire, representing an 81% response rate.ResultsAlmost half (47%) had experienced suicide of a patient in their care or otherwise known to them (e.g. through on-call experiences). Although only 28% recalled previous training on issues to consider following a suicide, all of these doctors found this to be of value. Many reported that patient suicide had a deleterious impact on their personal and professional lives. The most valuable supports were informal, and the trainees' consultants appeared particularly well placed to offer support and advice.Clinical ImplicationsMany trainee psychiatrists experience the suicide of a patient. Such experiences have potential for adverse effects on doctors' professional practice and personal life. Greater availability of training in this area would allow trainees to be better prepared for such an event. Trainees' consultants have a pivotal role to play in providing appropriate advice and support after a patient suicide.

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Introduction Programmes are developed in hospices to meet the needs of patients and have the potential to be life changing for people in the wider community. This project stemmed from work with patients on using meditation (mindfulness) as a therapeutic tool and extended outwards into the wider community. Aim Bring together experience and praxis of work with patients, extract life lessons and turn these into life skills for non patients. Methods Combining the experience of the facilitator (20 years of teaching meditation) and the insights gained from working with patients, a 6 week introductory course was developed for the wider community to buy into. Each session is 1.5 hours in length and there is an upper limit of 10 people per course. Data is gathered verbally as the course progresses and the course is flexible by design so that changes in emphasis can take place according to group need. Feedback sheets are issued at the end of the 6 week course. Results The course for non-patients is now into its fourth programme, numbers are growing – 4 on the first course, 10 on the third - and it is generating regular publicity for the hospice. At £99 per person per course for non-patients it is also generating income. More significantly feedback indicates that people are coping better with anxiety, changing attitudes to life situations, volunteering for the hospice and many report continuing to practise after the completion of the course. Discussion Expected and unexpected are words that relate to this project. Expected reductions in anxiety where met. One of the most surprising things (needing further research) is where participants reported improvements in physical awareness and health as a result of meditation practice. Conclusion Meditation (mindfulness) offers a model of how certain hospice skills are eminently transferable to different settings enhancing the hospices model of care, community engagement and profile.

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