Preparing Residents for the Aftermath of Patient Suicide

Losing a patient to suicide is one of the toughest professional experiences encountered by mental health clinicians. It can be even more harrowing in training—but salutary—because the student or resident receives support and education.

This past fall, to complement my course “Losing a Patient to Suicide,” I decided to show the residents the first 20 minutes or so of the DVD “Fierce Goodbye: Living in the Shadow of Suicide.”¹ This production, aptly named, includes interviews and fragments of conversation with men and women who speak openly about losing a family member to suicide. The viewer learns a bit about the deceased, their strengths and personalities, their illnesses, their relationships, and more. It puts a human face to this tragedy and exhibits how dying by suicide profoundly impacts those left behind. The interviewees are candid, raw, thoughtful, clear—and most patently, gracious. It is riveting viewing.

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My impetus for this departure from “teaching as usual” is the result of a paper published by Jefee-Bahloul et al.² This group utilized a panel of suicide loss survivors to speak to psychiatric residents during an educational event. The data collected from the residents afterwards confirmed that hearing the stories had a positive impact on their understanding of suicide loss, especially towards engagement with family members of patients who die by suicide. This is tremendously important. Not all mental health professionals who lose a patient to suicide reach out to immediate relatives, while it is known that most families want this. The most common deterrents are medical legal cautions and misunderstandings. But another argument for sound information and education is that when grieving individuals seek help on their own accord they are often disappointed by the lack of empathic understanding of the therapist.

I prepared my residents in advance about the subject matter of the DVD. I also told them that it is not easy to watch but nonetheless important for their education. I stopped the film at two points to take a bit of a breather and to invite questions and ask for comments. At the first pause, most were silent. Understandably. But the questions posed by those who asked were all about treatment issues with suicidal patients. Someone asked about the use of the Columbia-Suicide Severity Rating Scale (C-SSRS) and my thoughts about it. Someone asked about clinical practice guidelines for follow-up after discharge of patients from an inpatient unit or Comprehensive Psychiatric Emergency Program. Someone asked me to comment on lithium vs anticonvulsant mood stabilizers in bipolar illness. No one asked about any of the grieving individuals. I addressed this by saying something like “It seems to me that it’s a bit easier to ask questions about diagnostic and treatment issues of psychiatric patients than to focus on the speakers in this program. I understand. This is not easy stuff. We’ve got about 10 minutes left in our session today. Let me show you a bit more of the film and I’ll leave time for a few questions before the end.”

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I stopped again after about 5 minutes and asked for questions and comments. This time a different group asked questions. No surprise. Every question was a variant of the earlier ones. Nothing about the aftermath of suicide.

But I am not discouraged. I have no doubts whatsoever that this session had a huge impact on the hearts and minds of my residents. My hunch is that they will talk among themselves, they will talk with their supervisors, and they will read more on the unique aspects of suicide bereavement. Most important, I think they got the message that our job is never done when we lose a patient to suicide. There are lots of hurting people in its wake and there is much we can do—and must do—to comfort and to ease the journey.

References

1. Fierce Goodbye: Living in the Shadow of Suicide. DVD. Mennonite Media Productions. Harrisonburg, VA. 2004

2. Jefee-Bahloul H, Hanna RC, Brenner AM. Teaching psychiatry residents about suicide loss: Impact of an educational program. Academic Psychiatry. 2014;38(6):768-770.

Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr. Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention.  

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.