Patient Suicide: The Experience of Flemish Psychiatrists

Abstract

The experience of the most distressing patient suicide on Flemish psychiatrists is described. Of 584 psychiatrists, 107 filled a self-report questionnaire. Ninety-eight psychiatrists had been confronted with at least one patient suicide. Emotional suffering and impotence were the most common feelings reported. Changes in professional practice were described and included a more structured approach to the management of suicidal patients. Colleagues and contact with the patient's family were the most frequently used sources of help, whereas team case review and colleagues were rated as the most useful ones. Patient suicide leads to emotional suffering and has a considerable professional impact.

Impact of Client Suicide on Psychologists in Australia

“…In Trimble et al’s () study the most commonly reported emotional reactions for psychologists to a client's suicide were sadness, shock, helplessness, guilt and anger. Such grief reactions were consistent with American studies on psychologists and psychiatrists (Chemtob, Hamada, Bauer, Kinney, & Torigoe, ; Chemtob et al, ), therapists (Hendin, Lipschitz, Maltsberger, Haas, & Wynecoop, ), social workers (Ting, Sanders, Jacobson, & Power, ), and most recently, Flemish psychiatrists (Rothes, Scheerder, Audenhove, & Henriques, ), and mental health practitioners in Switzerland (Dransart, Gutjahr, Gulfi, Didisheim, & Séguin, ).…”

“…Trimble et al () found that two of the most helpful coping strategies for psychologists were speaking to colleagues and/or supervisors. These findings have coincided with a number of other studies which have also revealed the importance of social support from colleagues and supervisors following the suicide of a client (Chemtob et al, ; Chemtob et al, ; Dransart et al, ; Gaffney et al, ; Grad, Zavasnik, & Groleger, ; Hendin et al, ; Kleespies, Smith, & Becker, ; Rothes et al, ).…”

“…Emotional reactions ‐ On the basis of past studies including Trimble et al () and Chemtob et al () it was anticipated that the most typical emotional reactions would include shock, anger, guilt, helplessness and sadness. In keeping with Rothes et al’s () study it was anticipated that distress would also receive a high ranking. 3. Professional impacts ‐ In line with Trimble et al’s () study and other studies (Gulfi et al, ; Hendin et al, ; McAdams & Foster, ) it was anticipated that common professional reactions would include increased focus on suicide cues, increased caution, increased collegial and peer consultation, increased attention to legal aspects and more conservative record keeping. ‐ In keeping with the findings of Hendin et al (), Gulfi et al (), and Sanders et al (), it was also anticipated that self‐doubt about competency would also be a common professional reaction amongst psychologists to a client suicide. 4.…”

“…Similarly, Dransart et al () found that feeling responsible for a client's suicide was a contributing mediator to distress. Moreover, where the suicide of a client contradicts the assumptions and/or assessment of a suicide being predictable and preventable, this is thought to give rise to unjustified blame towards the therapist and may contribute to their distress (Eagles, Klein, Gray, Dewar, & Alexander, ; Rothes et al, ; Walter, ).…”

“…Professional impacts ‐ In line with Trimble et al’s () study and other studies (Gulfi et al, ; Hendin et al, ; McAdams & Foster, ) it was anticipated that common professional reactions would include increased focus on suicide cues, increased caution, increased collegial and peer consultation, increased attention to legal aspects and more conservative record keeping. ‐ In keeping with the findings of Hendin et al (), Gulfi et al (), and Sanders et al (), it was also anticipated that self‐doubt about competency would also be a common professional reaction amongst psychologists to a client suicide. 4. Responsibility, Predictability and Preventability ‐ On the basis of the studies of Horn (1994) and Dransart et al (), it was anticipated that feeling responsible is associated with increased emotional reactions such as distress. ‐ The Authors considered it useful to also test whether heightened feelings of responsibility might be also associated with professional impacts, for example increased focus on suicide cues and increased collegial and peer consultation. ‐ On the basis of the studies of Rothes et al () and Eagles et al (), it was anticipated that ratings of low predictability and preventability of a client's suicide would be associated with increased emotional reactions such as distress, as well as professional impacts, for example increased focus on suicide cues. 5. Coping responses ‐Consistent with Trimble et al’s () study it was anticipated that the coping strategies found most helpful would be talking to colleagues and supervisors.…”