Collage by Austin Hughes. Photographs courtesy Austen Riggs Center archive.

This article was originally published in 

For Erik H. Erikson there was more to psychoanalysis than individual psychology; he viewed humans as social animals existing in relationship to the people, culture, and society around them. This perspective grew out of his work in Vienna with Anna Freud, followed him to California where he taught at UC Berkeley, and stayed with him when Dr. Robert Knight recruited him to the medical staff of the Austen Riggs Center in 1951. He remained at the center for nearly a decade and provided clinical consultation to its staff into the 1980s.

Erikson’s sense that we both shape and are shaped by the world around us, and that who we are depends on our individual psychology, our experiences, and the social context in which we live, would become a critical organizing principle for Riggs; the mark he left was indelible.

In recognition of Erikson’s legacy, Riggs became home to the Erikson Institute for Education, Research, and Advocacy (EI) in 1994. The EI’s recent 30th anniversary provides an occasion for reflection on the power of a psychoanalytic approach that is grounded in the social world.

The Erikson Institute’s goal is to learn from others’ perspectives and impart knowledge from the clinical learning that happens in Riggs’s residential program in a mutual effort to understand and respond to problems individuals, groups, and society face. Edward Shapiro, MD, who is Riggs Medical Director/CEO starting in January 2025, stated, “We named the institute after Erik Erikson because of his groundbreaking ability to bridge different disciplines and apply the ideas from Riggs’s clinical work to the social issues around us.”

The EI exists alongside the clinical system at Austen Riggs, which has a unique approach to treatment. The fact that the Austen Riggs Center has existed for more than a century, with a firm psychoanalytic foundation since the late 1940s, is a testament to the transformative power of psychoanalytic treatment, and related therapeutic treatments like psychodynamic psychotherapy work—there are decades of robust empirical evidence to support it.

Every aspect of the Austin Riggs Center is informed by three principal tenets:

symptoms have meaning that can be understood; and

patients have authority in their lives, including in their treatment.

These principles make Riggs an outlier in the world of mental health treatment. Our open campus resembles a small New England college where nearly 60 adult patients at any time have the freedom and the responsibility to come and go as they please. There are no locked doors or privilege systems; rather, it is the relationships between and among staff and patients that hold people in treatment and keep them safe.

At Austen Riggs, patients see a doctoral-level therapist four times a week for intensive psychoanalytic psychotherapy, benefit from the resources of an interdisciplinary treatment team that follows them from admission to discharge, are immersed in a dynamic therapeutic community program, work with psychiatrists trained in psychodynamic psychopharmacology, and have access to a full continuum of care. They are also agents in their treatment, with countless opportunities to engage in groups, paid work, activities, patient government, and more.

Led by the Evelyn Stefansson Nef Director, 

, the El seeks to study the problems that bring patients to treatment and to help better understand the world around us, offering new insights, understanding, and solutions, particularly in conversation with other disciplines. In the same way Erikson viewed the individual as innately part of culture and society, the Erikson Institute seeks to apply psychoanalytic ideas broadly to areas related to education, research, and advocacy.

The EI was to be a “portal,” says Yale sociologist Kai Erikson, “through which findings and inspirations and ideas that originated within Riggs can flow out to the larger world, and through which findings and inspirations and ideas originating out there in the larger world can find their way here.” One way that portal is manifest is in the EI’s Council of Scholars, an interdisciplinary group of experts with a focused interest in psychoanalysis that consults to the director of the EI or medical director/CEO with specific projects.

Clinical Training, Research, and Advocacy

The psychoanalytic lens of all the EI’s educational offerings allows for a truly open, curious, and vibrant exchange of ideas. Riggs takes what it learns through the treatment of complex patients, many of whom have not found success in other treatment settings, and shares that knowledge as it relates to broader issues in behavioral healthcare and society. At the same time, the EI is the conduit for learning from other scholars, academics, artists, communities, and cultures to inform our understanding of human suffering and its alleviation, as well as the systems and structures that contribute to and get in the way of recovery.

 and Visiting Senior Clinician Program is a primary example of this conduit, allowing academicians, clinicians, and other professionals into the clinical and intellectual life of the center through participation in seminars, lectures, case discussions, and other learning activities. The EI’s other training offerings include

Adult Psychoanalytic Training Program and Fellowship in Hospital Based Psychotherapy

, which is an approved institute of the American Psychoanalytic Association (APsA) and is accredited by ACPEinc;

an elective for medical students and psychiatric residents;

a nine-month practicum internship for Smith College School for Social Work MSW students;

 of more than 60 free, on-demand CE/CME courses.

Riggs has also long supported clinical research, starting with its first 

study of factors related to therapeutic change

 in a sample of over one thousand patients. The research program has specialized in the use of multimethod longitudinal approaches to the study of complex clinical phenomena. Studies focusing on suicidal and self-destructive behaviors, personality psychopathology, and long-term predictors of psychological change and resilience have made important contributions to the field of mental health, expanding understanding of treatment-resistance and other barriers to clinical progress.

 both internally and in collaboration with other scholars and institutions under the leadership of Research Director Katie C. Lewis, PhD. These projects incorporate innovative methodology in pursuit of deepening our understanding of the social determinants of mental health, evaluating the many biopsychosocial factors that contribute to adaptation and resilience over time, and examining what psychoanalysis and psychodynamic approaches can contribute to our knowledge base.

Finally, the EI supports advocacy and outreach initiatives that range from supporting local community partnerships to work at the national level promoting equitable access to care, reduction of health disparities, and full implementation of the Mental Health Parity and Addiction Equity Act. Though diverse in scope, these efforts share a common theme: finding ways to improve the lives of people who struggle with mental disorders.

In 2021 the Erikson Institute received the major psychoanalytic recognition of the 

, established by Mary Sigourney to honor the expansion and connection of psychoanalysis to many fields of study and experience. While this was certainly a high-water mark for the EI, it also felt like a natural progression in an ongoing story about how psychoanalysis continues to matter to the world—how we need it in order to understand who we are, where we are, and how we can help one another survive and thrive.

Where the EI goes from here will be built both on what has proved successful and an openness and curiosity to explore new avenues to remain a leading national and international hub of psychoanalytic education, clinical training, research, and advocacy.

Director Tillman says, “I see the EI continuing to stand for something in the world that is very important and that has to do with how to understand identity and community, both individual problems and how they are related to history and the systems in which people are embedded.” Indeed, given the current state of mental healthcare and society, former EI Director M. Gerard (Jerry) Fromm, PhD, ABPP, calls the continued work of the EI a “social responsibility.”

News

The EI’s recent 30th anniversary provides an occasion for reflection on the power of a psychoanalytic approach that is grounded in the social world.

The Erikson Institute Turns 30: Psychoanalysis Meets the World at the Austen Riggs Center

Expanding the Toolbox for Suicide Prevention

Suicide prevention remains one of the most critical challenges in mental health care. Traditional suicide risk assessment frameworks often prioritize classification and risk documentation, potentially at the expense of fostering meaningful therapeutic relationships. In her CE/CME presentation, “

, Director of Research at the Austen Riggs Center, outlines a transformative approach that emphasizes empathy, collaborative engagement, and the integration of dynamic, context-sensitive assessment strategies.

 for Austen Riggs Center patients with nearly half having made a suicide attempt prior to being admitted and 80% reporting recent suicidal ideation. Lewis's approach combines evidence-based tools with innovative practices to more effectively understand and address the complexities of suicide risk.

Suicide risk is dynamic, influenced by fluctuating situational and emotional factors that complicate its prediction. Lewis highlights the limitations of relying solely on static risk factors, such as prior attempts, and underscores the importance of addressing psychological pain and lived experiences that contribute to suicidal ideation.

 indicates that suicide risk is highly context-dependent. For example, during the COVID-19 pandemic, reduced social contact was strongly associated with increased suicidal ideation, while greater social connection corresponded with lower risk. These findings reinforce the importance of considering short-term, situational triggers alongside broader risk factors to develop a more nuanced understanding of suicide risk.

 (C-SSRS) provide essential structures for suicide risk assessment but often fail to address the relational aspects of care. Patients frequently report feeling objectified or dehumanized during these assessments, as the focus on compliance and documentation can overshadow meaningful interaction.

Lewis notes that the emphasis on liability management or clinician anxiety during these evaluations may detract from the therapeutic relationship. This disconnect can limit the utility of these tools and potentially reduce their efficacy in suicide prevention.

A Relational Approach to Suicide Risk Assessment

Lewis advocates for reimagining suicide risk assessment as a collaborative and relational process rather than a checklist-driven task. Key components of her approach include:

Exploring Psychological Pain: Recognizing that suicidal ideation often arises from profound psychological pain, clinicians should create space for open and empathetic conversations about patients' emotional distress. Learn more about 

Identifying Contextual Triggers: Beyond static risk factors, Dr. Lewis recommends focusing on individualized patterns and situational triggers to better understand fluctuations in suicide risk. Explore 

Fostering Collaborative Relationships: Risk assessments should aim to strengthen the therapeutic alliance, empowering patients to participate actively in their care and fostering a sense of trust and safety. Learn about the 

Collaborative Assessment and Management of Suicidality (CAMS)

This approach aligns with a broader shift toward person-centered care, integrating the patient’s unique experiences and perspectives into the assessment process.

Several novel interventions align with Lewis’s relational framework, offering mental health professionals additional tools to enhance their practice:

Attempted Suicide Short Intervention Program (ASSIP): 

 focuses on exploring psychological pain and constructing a coherent narrative to understand the origins of suicidal impulses. It aims to build curiosity and insight while mitigating risk.

Collaborative Assessment and Management of Suicidality (CAMS): 

 emphasizes a partnership model, focusing on identifying psychological pain and protective factors while collaboratively developing safety plans.

Real-Time Monitoring Techniques: Methods like 

 provide actionable data by capturing real-time fluctuations in suicidal thoughts and contextual triggers, facilitating timely and targeted interventions.

Therapeutic Questionnaires: Instruments such as the 

 enable deeper exploration of emotional distress and help clinicians tailor interventions to individual needs.

A Paradigm Shift in Suicide Risk Assessment

Lewis envisions suicide risk assessment as an opportunity to foster trust and build therapeutic alliances rather than a purely diagnostic exercise. By prioritizing connection and relational engagement, clinicians can help patients regain faith in relationships as sources of safety and protection. This approach redefines the assessment process as an avenue for restoration, not merely risk stratification.

Mental health professionals are uniquely positioned to make every clinical interaction with a suicidal patient an opportunity for meaningful connection. By embracing this relational model, clinicians can create a stronger foundation for intervention, support, and hope.

For more insights from Lewis’s presentation, the thoughtful Q&A that followed, and to earn CE/CME credits, visit the Austen Riggs Center’s 

. This transformative approach invites clinicians to rethink how they assess and engage with suicide risk, fostering deeper connections and more effective care.

Katie Lewis, PhD, is the director of research at the Austen Riggs Center.

Katie Lewis, PhD

We need more than traditional suicide risk assessment to save lives; Dr. Katie Lewis proposes a new approach that pairs good existing tools with novel applications.   

Rethinking Suicide Risk Assessment: Fostering Connection and Trust 

In the depths of the pandemic, things could not have been harder for someone struggling with Obsessive Compulsive Disorder. Anxious, depressed, unable to leave the house, Liz Jezierski felt life was not worth living. But through hard work and perseverance during her seven months at Riggs, “I got my life back and I got it back better.”

Born in 1997 and raised in Connecticut, she described her family of four as being shaped by rigid values and an environment that didn’t actively engage emotions. “Mental illness was something that happened to people with trauma or—quote-unquote—bad lives or something like a parent died or they had a bad situation growing up.”

Early on, however, Liz recalls a sense of unease permeating her life. “I was always that kind of kid that was really anxious about fitting in and connecting with other people,” she said. Grade school days were marked by episodes of being bullied, developing an eating disorder, and struggles with anxiety, depression, and intrusive thoughts.

“I remember my first intrusive thought. I don’t remember how old I was, but I was a kid. I remember thinking, what would happen if I just unbuckle my seatbelt and open the car door?” (Liz subsequently learned that intrusive thoughts are often part of 

Liz began seeing a therapist in her early teens, but she described the sessions as being “surface-level,” and that she held back from opening up because she was concerned about what her therapist might share with her parents.

Her mental health struggles, however, were far from surface-level. She developed an overwhelming fear of leaving her house. She quit her job. She experienced panic attacks about cleanliness and loss of control. “I was going through a bottle of hand soap a day because I was washing my hands so much.” And she thought more and more about taking her life.

In August of 2020 she was hospitalized at an in-patient facility for a week and a half. But that stay was focused on crisis stabilization, not the level of treatment she felt she needed.

She began looking into longer-term care and discovered Riggs through an internet search. She said the description of the Center’s approach—in particular Riggs’ experience with so-called 

—struck her as a good fit. There was a hitch, however. Her parents’ insurance at the time (which she was on) wouldn’t cover treatment at Riggs and they couldn’t afford to pay out of pocket.

Within a few months, things had reached the breaking point. “Shortly after Christmas of 2020, I remember coming downstairs and telling my mom ‘I can’t do it anymore.’ Something has to give. I need treatment.”

Her parents, understanding the grave risk she was facing, were able to get a different insurance plan that would cover Riggs treatment.

Though relieved to be admitted, the transition to the Center was not easy for Liz. She arrived at a point in the pandemic when Riggs isolated new patients for several days to ensure they were COVID-free. Upon entering the isolation admission room where she would live and start her treatment, she saw a bar of hand soap in her bathroom and that immediately brought her to tears. “It was something so small, but it felt like the end of the world.”

Challenges would persist over the first several weeks. She stopped eating regularly, resulting in significant weight loss. Riggs provided support through a dietitian, nurses, and her clinical social worker, but the Center does not offer primary care for eating disorders. To ensure proper care, Liz was facing transfer to a facility that specializes in that area. Engaging with other patients in the 

—one of the core elements of the Center’s residential treatment approach—also proved difficult for Liz who was still wracked by the childhood trauma of feeling like an outsider.

Though there wasn’t a singular breakthrough moment, she slowly began to make advances. Seeing a doctoral-level therapist four times a week—the foundation of Riggs care—enabled her to build trust she had not previously experienced with a doctor. Taking the lead in conversations with her therapist proved to be a marked departure from Liz’s previous treatment experiences. These conversations went beyond the superficial, probing deep-rooted experiences, to examine things often buried in the unconscious. “It’s a very different type of therapy. They are not going to do it for you, but they will be there with you as you do it.”

Her work in therapy, coupled with the fear of discharging to an eating disorder center, enabled Liz to overcome her reluctance to take meals. “If I left and went to eating-disorder treatment, in the back of my head, I knew I would die if I left here. I knew this is where I needed to be, and I really fought hard to do that,” she said. 

And then there was coming to terms with being part of the patient community. “I realized it felt very similar to when I was in high school. I felt like there was a group of cool kids and things like that. And then I put it into perspective: we're in a psychiatric hospital, for lack of better terms there are no cool kids,” she said. “Everyone is here with their own struggle. And one day I just sat down with them and started talking.”

That understanding helped Liz navigate two of the most intense elements of the community experience, the case conference, and the Task Group. The former is the culmination of the initial 

six-week period of evaluation and treatment

. The event brings together a patient’s interdisciplinary treatment team along with numerous clinical staff from all facets of the treatment experience to share their assessments and recommend next steps. The Task Group is a patient-run group with elected patient roles that attempts to identify, clarify, and resolve individual and group conflict or alienation through communication; it discusses the often-troubling behavior of an individual patient with the goal of helping that patient understand the effect of their behavior on the community and on themselves.

“It was really interesting to see that dynamic and have other people chime in and give their advice on how your existence in a community impacts everyone else,” Liz said. She summed up the transition from isolation to integration: “You can come here and do nothing, but it's not going to be productive and it's going to get expensive. You have to come in with the mindset that what you're doing is hard work. But in my opinion, it was worth the hard work in the end.”

While life after Riggs still presents challenges, for Liz new opportunities have arisen. She finds her work as a hospice volunteer coordinator both engaging and rewarding. She’s taken up burlesque dancing—in large part because the other dancers offer a sense of community very similar to what she experienced at Riggs. And next year, she and her fiancé are looking forward to a June wedding.

“It’s a vast difference from the girl that was just barely surviving,” Liz said.

Asked what she would share with people wrestling with mental health issues, Liz underscored the need to understand you’re not alone. “It's okay to reach out for help. We are not meant to do this alone. It's too hard.” She added, “I believe there's something out there for everyone that can help them, whether it's here (Riggs) or not. But for me, here was the place. I don't like to say it saved my life because I saved my own life, but it gave me the tools to do that.”

Editor’s note: The privacy of current and former patients is of paramount importance to the Austen Riggs Center, which strictly adheres to the Health Insurance Portability and Accountability Act of 1996. The subject of this article has given permission for us to disclose the personal details that this story contains.

If you are a former Riggs patient who benefitted from treatment at the Center and would like to share that experience with others, please contact John Zollinger, Director of Communications, at: 

 or 413.931.5816. Alternatively, you can fill out this form.

In the depths of the pandemic, things could not have been harder for someone struggling with Obsessive Compulsive Disorder. Anxious, depressed, unable to leave the house, Liz Jezierski felt life was not worth living. But through hard work and perseverance during her seven months at Riggs, “I got my life back and I got it back better.” 

Getting My Life Back: Liz Jezierski, Austen Riggs Former Patient, 2021 

Ron Auerbacher, former Austen Riggs Center patient, 1965-67

“Dark and depressing,” said Ron Auerbacher as he recalled the day in January 1965 when he first arrived at the Austen Riggs Center. The depths of the New England winter weather outside matched his internal feelings. “I was really scared. I was really depressed.”

Ron was 18 when he came to Riggs, and he had been plagued for years with 

. Additionally, he struggled to understand his emerging identity as a gay man—which society at that time regarded as an aberration and the American Psychiatric Association (APA) listed in the 

Diagnostic and Statistical Manual of Mental Disorders

“I thought there was something horribly wrong with me, producing years of shame, self-loathing and comparison to others,” he said.

Though it would take time to realize, Ron’s experience with the Center’s therapeutic community-based treatment and his involvement with Riggs’ theatre program would give him a foundation to navigate the challenges that lay ahead in the ensuing decades of his life.

Ron was born in 1946 to parents, now-deceased, of German-Jewish heritage in St. Louis. His mother’s family immigrated to the United States in the 1800s. His father and his family fled Germany at the outset of WWII in 1939.

He reflected upon his relationship with his father (whom Ron described as a “rageaholic”) as neither close nor warm, “Probably due to post-traumatic stress from being a teenager in 1930s Nazi Germany.” He said his mother, who attended Stanford, was secular and progressive by nature, but burdened by mid-20th century mother and housewife expectations and her own severe 

This upbringing left a mark. “I can remember, in middle school, I was extremely depressed,” Ron said. “By the 12th grade, I had some vague feeling that there was something severely wrong with me.”

As a teen, immersing himself in writers such as 

, gave Ron social and political perspective beyond what he was taught in school.

Ron entered Yale in the fall of 1964 but immediately felt consumed by multiple conflicts. The abundance of wealth at Yale contrasted starkly with the poverty in surrounding Black areas of New Haven; his growing awareness that he was attracted to men was amplified by the discomfort of sharing a room with another man; and he found no value in the Greek classics he was assigned. He became obsessed with finding meaning amidst so many contradictions.

With exams approaching, Ron lost his will to study, his focus, and his direction. “I could barely function, and called my parents.” His father told Ron to see a rabbi, who recommended that Ron consult a psychiatrist. “I think they were worried that I would kill myself.”

After two or three conversations with the psychiatrist, Ron was put in a police car and driven to a locked facility. He was administered medications that resulted in severe shaking, agitation, and significant weight gain. Clearly the treatment was not working.

Riggs and Yale mental health professionals have had a long association with one another and through this network, Ron made his way to Stockbridge.

At first, he found the Riggs experience alien. As an introvert, it was difficult for him to relate to the other patients. “I remember people telling me they found me very cold, aloof, and distant,” he said.

Therapy also presented challenges. One of the hallmarks of the Center’s psychoanalytic 

—then and now—is for the patient to play an active role and lead the discussion with their clinician. At times, this can create long pauses while waiting for thoughts and feelings to emerge. Ron’s shame about his sexuality created 20-minute pauses.

That said, the one-on-one sessions offered something novel to Ron: “I had never had anyone to talk to privately in my whole life.”

Exploring the Riggs community through group work that focused on the relationship between individuals and others, in conjunction with his interest in the performing arts program, yielded a richer experience, Ron recalled.

, who was on the Riggs clinical staff during Ron’s time at the Center, was a key proponent of the 

, another one of the central facets of Riggs’ treatment approach. In the Therapeutic Community Program, patients learn how other people see them and how one person’s actions relate to other individuals and the group as a whole. 

“We learned that if someone were to act out or cut their wrists, that has an impact on everybody who's living together,” said Ron as he looked back upon what he took from this social learning which Riggs now calls “examined living.” “There was definitely something stimulating—and unusual from my previous experience—regarding what Edelson was getting at about creating community,” he added.

Years later, he realized that some other Riggs patients shared his feelings about same-sex orientation. He never spoke with other patients about it at the time, but it proved helpful to finally understand that he was not alone. In 1973, the APA took its first steps to 

declassify homosexuality as a mental disorder

 made an even more profound impression on Ron. Riggs’ performing arts program, in which patients produced plays for the public, built on his life-long interest in the theatre. That passion was further fueled by the program’s director, 

“Although Jayne had no formal theater training, she had an intuitive genius not only for directing, but for working with people and seeing them as creative artists, not as mental patients,” Ron said. The selection of plays Riggs put on included Oscar Wilde’s “

 seemed extremely attractive, rebellious, and articulate, given that it was about a guy who couldn’t fit into normal society.”

Ron dove right into the program. “The Theatre Group at Riggs offered so much," Ron said. "It allowed patients to express deep emotion that in other circumstances would have been considered ‘acting out;’ it gave us a sense of self-worth and a different identity than ‘helpless and hopeless;’ and it enabled us to learn to work cooperatively for a collective goal,” he added.

Through his involvement, he became Jayne’s assistant director and she his mentor. “For the first time in my life, I had the exhilarating experience of having someone who really encouraged my talent, loved me, and cared about me.”

In the fall of 1967, Ron was discharged from Riggs and went to New York City, where he encountered both obstacles and opportunities. He pursued his love for the performing arts by enrolling in theatre studies at New York University but found the system competitive and cut-throat compared with the supportive, convivial, and collaborative experience in the Riggs theatre program. He joined the 

 (GLF), the activist political organization which formed after the 

 in 1969, motivated both by his emerging acceptance of being gay as well as the sense of community that the movement represented.

His trajectory would lead from New York City to Cuba, San Francisco, India, rural Oregon, and finally to San Diego, where he has lived since the mid-1980s. This physical journey went hand-in-hand with experimenting with a variety of ways to expand his ability to engage with others and learn about himself. Those insights stemmed from the informal learning that came from living in various communal settings to his formal studies of 

 and Zen Buddhism, both of which feature the same kinds of mindfulness and self-reflection that is often critical in the patient-therapist relationship at Riggs. Through these experiences, he was able to come to terms with and effectively manage the anxiety and depression that plagued his youth. 

His personal and intellectual pursuits were accompanied by a diverse career in which he has been a Holistic Health practitioner, Non-Violent Communication instructor, and lecturer/ performer of Shakespeare for middle- and high-school kids. His work with students continues in his retirement, including mentoring, reading aloud young adult books with themes of social justice, and participating in a San Diego Unified speakers bureau in which he shares with students his experiences of the 1960s. He said his goal is not so much to relate historical tales from the past, but rather “to inspire them to know that they can make a difference.”

Asked what advice he would have for others facing mental health issues, Ron offered this: regardless of the modality of treatment you choose—psychoanalytic, cognitive behavioral therapy, dialectical behavioral therapy, or other—“it makes a huge difference to know that the person you’re working with really, genuinely cares about you. That was certainly true at Riggs!”

The 1960s was a time of social upheaval for millions of people. One of them was Ron Auerbacher, who wrestled with deep anxiety and depression, while struggling to understand his emerging identity as a young, gay man. At a point of dire stress in his life, Riggs marked a key step at the beginning of a decades-long journey to successfully understand himself and his place in a community. 

Lessons for Life: Ron Auerbacher, Austen Riggs Former Patient 1965-1967 

Photo by Zoshua Colah on Unsplash - empty chairs

In a comprehensive recorded CE/CME presentation, “

The Effect of Suicide Loss on Clinicians and Organizations: Research and Response

 explores the emotional and professional consequences of suicide loss—particularly in institutional settings where a patient dies by suicide. This summary highlights key findings from her and others’ research and offers practical recommendations for healthcare organizations and clinicians on how to manage and respond to suicide loss effectively. 

 to view the full CE/CME presentation for free and earn credits. 

Identify three experiences specific to suicide loss survivors, including clinicians and colleagues. 

Explain three research-based findings on the impact of patient suicide on healthcare professionals. 

Describe two effective postvention responses to suicide loss in organizations. 

What Does Suicide Data in the United States Reveal? 

suicide statistics from the Centers for Disease Control and Prevention (CDC)

, showing a troubling year-over-year rise in suicide deaths. In 2022, there were 49,449 suicides, averaging one death every 11 minutes. Alarmingly, 12.3 million adults seriously considered suicide, and 1.7 million attempted suicide—posing significant risks for future suicide attempts or death by suicide. 

High Suicide Rates Among Minority Populations: 

Native American and Alaska Native populations experience the highest suicide rates

, followed by white individuals, Native Hawaiians, Pacific Islanders, multiracial groups, and Black non-Hispanic individuals. 

Firearm Use in Suicide: Firearms were involved in over 50% of U.S. suicides. This underscores the importance of gun safety initiatives and laws to restrict access to lethal means, which 

Are Physicians at Higher Risk for Suicide? 

CDC’s National Violent Death Reporting System

. The study found that, between 2012 and 2016, nearly 500 physicians died by suicide—mirroring the suicide rate of the general population. However, female physicians face a disproportionately higher suicide risk compared to women in the general public. 

The ripple effect of suicide extends beyond the immediate family, impacting 

communities, healthcare professionals, and organizations.

 Tillman cites research estimating that each suicide affects, on average, 60 people, equating to nearly three million individuals affected annually in the U.S. While the range of experiences is broad in response to a suicide, it can leave individuals, families, and organizations deeply traumatized.

For healthcare professionals, the trauma of losing a patient to suicide is significant. Historically, many reported a lack of support from colleagues and administration, but efforts are underway to destigmatize suicide and provide more comprehensive support in the aftermath. 

While much research focuses on crisis intervention for those at imminent risk of suicide, there is less information on how organizations and individuals should respond after a suicide occurs. Tillman outlines key strategies for managing suicide loss: 

Acknowledge the range of affected individuals:

 Suicide impacts not only clinicians but also non-clinical staff, patients, and families. The psychological responses vary, so a broad, inclusive response is necessary. 

Dr. Julie Cerel’s Nested Model of Suicide Survivorship

 This model categorizes the different levels of impact on those affected, from exposure to bereavement. 

 Suicide loss survivors often face higher levels of shame, guilt, and blame, which are less common in other types of traumatic death (e.g., car accidents). 

 Survivors of suicide loss often experience 

Supporting Clinicians After the Loss of a Patient to Suicide 

 will lose a patient to suicide. This event can trigger intense emotional and professional challenges, including the fear of legal repercussions (e.g., malpractice suits). Tillman conducted a qualitative study that revealed how a small sample of mental health professionals responded to patient suicide and identified eight emergent themes:

Traumatic responses: initial reaction, dissociation, traumatic intrusion, avoidance, somatic symptoms

Affective responses: crying, sadness, anger, grief

Treatment specific relationships: review and reconstruction of work with the patient; contact with, or sense of responsibility to, the patient's family

Relationships with colleagues: personal analyst, supervisor, peers

Grandiosity, shame, humiliation, guilt, judgment, blame

A sense of crisis: professional identity, loss of faith about psychodynamic/intensive treatment, concerns about competence

What Kind of Support is Important in the Aftermath of Suicide? 

In the aftermath of a suicide, clinicians must manage their own grief while also supporting the families of patients, bearing in mind their role, and dealing with reactions from colleagues. Tillman emphasizes the importance of knowing how to conduct a psychological autopsy to identify what may have gone wrong. However, it is essential not to jump to conclusions too quickly.

 These provide an opportunity for staff to process their emotions together. 

 Identifying staff members who might be struggling later, even if they initially seem unaffected. 

 Providing ongoing counseling or therapy for those impacted. 

During these interventions, administrators need to tend to the institution, consult their attorney and malpractice carrier, and plan and carry out a peer reviewed protected exploration of the suicide (it is important to seek legal advice about how to establish peer review protection). At the same time, it is important for administrators to hold in mind the emotional needs of their employees.

Tillman also notes the importance of regular trainings or presentations that address the impact of suicide on clinicians and organizations. “No two experiences will be alike” says Tillman. “You have to be aware that there are differences in experience and in the awareness of the inevitability of, guilt, anger, blaming, and those dynamics which are our human nature.”

Self-Care for Clinicians: A Critical Component in Suicide Loss 

Tillman stresses the importance of self-care for clinicians dealing with the aftermath of a suicide. Practicing self-care not only helps clinicians manage their own grief but also enables them to maintain healthy relationships and avoid burnout. Key self-care strategies include: 

 Seeking consultation, therapy, and engaging in professional support networks like the 

What Can Clinicians Learn from a Patient’s Death by Suicide? 

While the experience of losing a patient to suicide is undeniably traumatic, it can also be a source of potential professional growth. Some clinicians might shift their focus, either by choosing not to treat suicidal patients or by developing expertise in this area. Others may develop a deeper understanding of the human experience of pain, despair, and aggression, leading to more compassionate care in the future. 

There is also learning about how to care for the community–to identify and support those most at risk: those who are lonely and isolated; those who have a family history of suicide or other cumulative losses; those who have access to lethal means or unsecured firearms; those who are engaged in substance misuse or increasing substance misuse; those who are in severe mental pain or anguish; those with a prior history of suicidal thinking and behavior; and vulnerable or at risk groups.

Conclusion: The Ongoing Journey of Mourning and Learning 

Tillman concludes her presentation with the reminder that 

. Clinicians and organizations must be patient with themselves and each other as they navigate the complex emotional terrain of suicide loss. Support, education, and self-care are essential in ensuring that both individuals and organizations can heal and continue their critical work in supporting those at risk for suicide. 

For more information, to hear the engaging Q&A session, and to earn CE/CME credit, 

Photo by Zoshua Colah on Unsplash

 Dr. Jane G. Tillman explores the emotional and professional consequences of suicide loss—particularly in institutional settings where a patient dies by suicide.

The Impact of Suicide Loss on Clinicians and Healthcare Organizations: Research, Responses, and Support Strategies 

After six years as Medical Director/CEO of the Austen Riggs Center, 

“My fellow Board members and I are eternally grateful for Eric’s dedication to Riggs over the course of his career,” said Board Chair Lisa A. Raskin, PhD. “As the Medical Director and Chief Executive Officer, he guided us through the challenges of the Covid pandemic and upheld Riggs’ strong tradition of providing the highest quality residential psychiatric care. Eric’s vision of an Online Intensive Outpatient Program extended Riggs’ reach to college students and emerging adults. His achievements will benefit the entire Riggs community for the next century.”

Plakun started at Riggs in 1978 as a Fellow. He held posts including Director of Admissions and Associate Medical Director, and was appointed Medical Director/CEO in 2018.

“I came to Riggs as a Fellow and found a professional home that I loved from the start,” he said. “This project of treating people struggling with mental disorders as competent human beings has always spoken to my soul.”

His time as the head of Riggs included major initiatives. The 2019 Centennial Conference and Celebration drew leaders in behavioral healthcare from around the globe. Riggs’ 

Erikson Institute for Education, Research, and Advocacy

 (EI) capitalized on the pandemic use of Zoom technologies with its virtual events and 

Plakun spearheaded the Center’s Centennial Celebration, led Riggs through unprecedented challenges from the pandemic, launched innovative programs, and positioned the Center for the next 100 years.

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