Impact of patient suicide on clinicians ‘profound and devastating’

The impact of a patient suicide on a clinician can be “profound and devastating”, the College of Psychiatrists of Ireland Spring Conference 2024 heard.

Dr Rachel Gibbons, Chair of the working group on the effect of suicide and homicide on psychiatrists, Royal College of Psychiatrists, UK, spoke powerfully on the topic at the meeting.

Dr Gibbons described her own experiences as a clinician, saying that patient suicide had totally “annihilated” her confidence.

She said she blamed herself, became withdrawn, and that it affected her family life.

“I was terrified of going into work,” Dr Gibbons said, adding, however, she did not take any time off work

“I know in retrospect that I had a serious post-traumatic stress disorder, but at that time I didn’t know it, and nobody seemed to notice it. Nobody said a thing to me.”

She questioned the silence around this important issue, and spoke about how she and two other colleagues, with similar experiences, came together to support each other.

“We decided to form a – at the time – confidential group… to talk through these experiences,” she said.

The effect of this group was like a “miracle” and it “has been rolled out in many other organisations and recommended in the College guidance,” she said.

Dr Gibbons said her research in the area challenged accepted some ‘truths’ about suicide.

She also stated that the way out of the trauma, in the aftermath of suicide, was to work through it.

“There is a whole area around post-traumatic growth, and that trauma doesn’t need to be destructive. That it can fuel a lot of development and growth,” she said. However, she said that the impact of suicide remained devastating, comparing it to being caught up in a bomb blast.

She said that suicide was not an “accident” but rather the result of complex and probably universal unconscious mental mechanisms that were not fully understood.

“You will never know why someone has died by suicide,” Dr Gibbons said. “That is really difficult for us to acknowledge and one of the unbearably painful things for the bereaved.”

The person themselves often does not know why they have tried to take their own lives, she added.

Suicide can be impulsive “but a lot of suicides look very clearly premeditated”, Dr Gibbons said, giving the example of people putting all their affairs in order months in advance.

“You really do not know what is going on in someone else’s mind. We believe that we do, we are given that poison chalice by society. Reading people’s minds is also different than predicting other people’s behaviour,” she said.

She continued: “Looking at the National Confidential Inquiry [into Suicide and Safety in Mental Health] data, year on year, 73 per cent of the people who die by suicide were not under the care of the mental health services at all. And, of that group, around 50 per cent had no history of mental health problems.”

Dr Gibbons told the meeting that risk assessment forms do not predict a future risk for suicide. The impact and uncertainty created by suicide can ultimately lead to doctors and the bereaved creating a false narrative where they blame themselves, the meeting heard.

Evidence shows public health measures, such as putting up barriers on the Golden Gate Bridge and limiting access to paracetamol, do reduce the number of suicides. Talking about it also reduces the risk, the meeting heard.

“No one is to blame for anybody else’s death by suicide,” Dr Gibbons said, describing blame as a ‘non-mentalising’ word. “It shouldn’t be anywhere in our discussion around this.”

During the question-and-answer session, it was highlighted that the specialty needed to change in order for the next generation of trainees to avoid lifelong guilt following patient suicides.

She urged health services to plan and prepare for the occurrence of patient suicide and the “disarray” that can follow.

“The only way out is for us to start discussing and talking about it, and providing support for each other,” she concluded.