Suicide by patients: questionnaire study of its effect on consultant psychiatrists

Abstract

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.

Coping with suicide: a perspective from Scotland

“…In the context of this article, in terms of their personal response to events, it is noteworthy that 15 of the 31 consultants who had attended a fatal accident inquiry reported this to have been either 'unhelpful' (for 8) or 'very unhelpful' (for 7). By contrast, of the 83 consultants who had experienced an internal critical incident review, this was deemed unhelpful/very unhelpful by only 9 respondents, while 56 (69%) rated the experience as helpful or very helpful (Alexander 2000). It is also reassuring that, when medical defence organisations were involved, this was deemed helpful or very helpful by 76% of respondents (Alexander 2000).…”

“…By contrast, of the 83 consultants who had experienced an internal critical incident review, this was deemed unhelpful/very unhelpful by only 9 respondents, while 56 (69%) rated the experience as helpful or very helpful (Alexander 2000). It is also reassuring that, when medical defence organisations were involved, this was deemed helpful or very helpful by 76% of respondents (Alexander 2000).…”

“…The largest survey was conducted in Scotland (Alexander 2000;Dewar 2000). In the context of this article, in terms of their personal response to events, it is noteworthy that 15 of the 31 consultants who had attended a fatal accident inquiry reported this to have been either 'unhelpful' (for 8) or 'very unhelpful' (for 7).…”

“…In essence, it is important to appreciate that it is usual for psychiatric professionals to experience emotional trauma following the suicide of a patient, and to expect that support will be required by everyone involved, irrespective of their level of seniority (Alexander 2000;Dewar 2000;Courtenay 2001;Ruskin 2004). All of these papers give useful insights and advice relevant to psychiatrists in coping with the emotional aftermath of a patient's suicide, and in this area the paper by Campbell & Fahy (2002) may be found to be especially helpful.…”

Terapeuter som etterlatte ved selvmord

“…Chemtob et al (1988a;1988b) viser at det å miste en pasient i selvmord i saerlig grad påvirker unge og uerfarne klinikere, noe som blir bekreftet i studier av terapeuters reaksjoner på selvmord blant pasienter i psykiatriske døgninstitusjoner (Brown, 1987a;Brown, 1987b;Ellis et al, 1998). Vårt tidligere arbeid (Hendin et al, 2000) og andre undersøkelser (Alexander et al, 2000;Gitlin, 1999;Kahne, 1968;Litman, 1965;Marshall, 1980;Menninger, 1991;Neil et al, 1974) viser at klinikere som mister en pasient i selvmord, kan reagere på liknende måte som familiemedlemmer og venner med sjokk, sorg, skyldfølelse og sinne.…”