Impact of homicide by a psychiatric patient on forensic psychiatrists: national survey

Abstract

Aims and method To explore the experiences and support needs of consultant forensic psychiatrists, whose patients had committed homicide while under their care. We circulated a survey to all forensic psychiatrists in the UK, through the Royal College of Psychiatrists, asking about their experiences of a homicide by a patient under their care. Respondents were invited to discuss their experiences further in a structured telephone interview and themes were identified from these discussions. Data were analysed quantitatively and qualitatively. Results One-third of the 86 respondents had had at least one patient who had committed a homicide while under their care. Of these, over three-quarters (78%) reported that the homicide had a significant impact on their personal life, professional life and/or mental/physical health. For some respondents, the impact was severe and long term. Respondents generally felt that they would have been helped by receiving more support in the aftermath of the homicide. Clinical implications Greater recognition is needed of the impact on treating psychiatrists of homicide by a patient and more support is needed for affected clinicians. Further research is necessary, including the effects of such events on colleagues in other specialties and examination of the costs versus the benefits of mandatory inquiries after homicides.

Psychiatrists’ Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study

“…Previous research has shown that psychiatrists can be reluctant to seek support after a patient suicide or homicide [ 6 , 26 ]. Brooks et al [ 27 ] have identified multiple barriers to doctors seeking help for mental health including anticipated negative career implications from either taking time off work or in disclosing their condition.…”

“…Rates of homicide carried out by patients are lower, averaging 54 a year [ 3 ], but the personal and professional repercussions of such an event appear both more common and more severe. In a survey assessing the impact of patient homicide on forensic psychiatrists, 81% of respondents said the experience had impacted their mental health, 25% of which described it as ‘very significant’ [ 6 ].…”

“…The impact of patient suicide is more widely covered than homicide, due in part to its higher frequency. A recent systematic review outlined the different ways that psychiatrists are affected by patient suicide, whilst Mezey et al carried out a survey looking at the impact of homicide on the care team [ 6 , 7 ]. Both papers highlight the emotional effect on the individual (such as guilt, shame, blame and anger) and the impact on their professional practice (such as taking on lower-risk patients, prescribing more antidepressants).…”

“…Sandford et al found that the most significant risk factor for a negative impact was fear of blame or self-blame [ 7 ]. Previous research has also found feelings of stigma and persecution to be prevalent [ 6 , 8 ]. To that end, the psychiatrist’s experience echoes the wider literature on experiences of suicide and homicide bereavement.…”

“…Such policies can be unhelpful in exaggerating the degree to which health professionals can prevent these kinds of tragic incidents and risks implying that a ‘failure to prevent’ a suicide equates to it being the healthcare professional’s fault [ 2 , 12 ]. In the wake of a traumatic death, the difficult emotions that arise and the fact that the patient is not there to speak for themselves, means clinical responsibility and blame can conflate [ 6 ]. In this context, seeking support can be challenging [ 12 ].…”