After a client death: Suicide postvention recommendations for training programs and clinics.

Abstract

Experiencing a client suicide or another form of client death is not uncommon for health service psychology trainees, or trainees in other mental health disciplines (e.g., psychiatry, counseling, social work). Yet, the majority of training programs and training clinics do not have procedures in place for managing a client death. The purpose of the current paper is to provide a set of recommendations for client death postvention procedures, focused primarily on client death by suicide. The aim is to help training programs and clinics respond appropriately to trainees in the aftermath of a client death. Our recommendations are based in a review of existing literature around therapists and trainees experiences with client suicide, and involve suggestions for notification procedures and 2 separate meetings with the trainee who served as the primary therapist for the deceased client. The first meeting involves provision of support to the trainee, with secondary goals of planning around communication of the client death to program staff and students, and additional future planning around trainee needs. The second meeting serves as a critical incident review, with administrative and educational goals around understanding the case progression to help the trainee, supervisor, clinic, and program improve client care. We provide a basic template that can be amended for specific programs and settings, and discuss the extant research support for the recommendations, as well as implications for longer term training needs.

Notification of Unexpected, Violent and Traumatic Death: A Systematic Review

“…From the notifier's point of view, the notification process is mostly judged as difficult and stressful (Adamowski et al, 1993 ; Stewart et al, 2000 ; Janzen et al, 2003-2004 ; Hart and DeBernardo, 2004 ; Douglas et al, 2012 ; Williams-Reade et al, 2018 ). The reactions most commonly described by the notifier are: anxiety, guilt, sadness, identification with the target, discomfort, avoidance, anguish, frustration, isolation, insomnia, lowering of mood, recurrent nightmares, feelings of helplessness, substance abuse, marital conflict, PTSD, chronic stress response syndrome, and professional burnout (Spencer et al, 1987 ; Veilleux and Bilsky, 2016 ; Tuffrey-Wijne and Rose, 2017 ). In general, professionals involved in communicating the death of a person highlighted a lack of sufficient preparation for carrying out the task and the need to acquire more skills for managing the emotional reactions of those who receive the bad news and own emotions (Olsen et al, 1998 ; Douglas et al, 2013 ).…”

The impact of patient suicidal behavior on the personal and professional well-being of mental health providers: A systematic review.

“…Offering specialized training to professionals tailored to their role (e.g., clinical psychologists, psychiatric nurses) could help prepare them for the likely event of experiencing patient suicidal behavior. Clinical trainees are not exempt from experiencing patient suicidal behavior, yet there is a reported lack of protocols and policies on dealing with patient suicidal behavior in clinical training programs (Knox et al, 2006; Veilleux & Bilsky, 2016). Incorporating such training as early as possible in the careers of professionals could be very beneficial in dealing with patient suicidal behavior.…”

Effects of Patient Suicide on Professional Practice Among Mental Health Providers

“…26 Prematurely focusing on administrative and legal issues may adversely affect clinicians, and the complex emotional reactions associated with a recent patient suicide loss can impair clinicians' abilities to carry out critical case reviews. 23,27 Guidelines also recommend making more intensive services available to clinicians (ie, consultation, education, support, and resources offered by the American Association of Suicidology Clinician Survivor Task Force 24 ), but not presuming that they will be required. 25 Only after sufficient time for bereavement has passed should efforts be made to enhance clinical training and patient services, 28 including the provision of suicide prevention training and considering what may have "gone wrong" via psychological autopsy or critical case review.…”

“…Guidelines are available for clinics interested in implementing postvention protocols,23–25 and they typically recommend that psychological first aid (ie, support, reassurance, information, and time) should precede exhaustive case reviews even if there are concerns about liability and/or clinical conduct 26. Prematurely focusing on administrative and legal issues may adversely affect clinicians, and the complex emotional reactions associated with a recent patient suicide loss can impair clinicians’ abilities to carry out critical case reviews 23,27. Guidelines also recommend making more intensive services available to clinicians (ie, consultation, education, support, and resources offered by the American Association of Suicidology Clinician Survivor Task Force24), but not presuming that they will be required 25.…”