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The Impact of Suicide Loss on Clinicians and Healthcare Organizations: Research, Responses, and Support Strategies
In a comprehensive recorded CE/CME presentation, “The Effect of Suicide Loss on Clinicians and Organizations: Research and Response,” Dr. Jane G. Tillman 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.
Register here to view the full CE/CME presentation for free and earn credits.
Learning Objectives
- 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?
Tillman discusses key 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.
Key Findings:
- 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 research has shown can save lives.
Are Physicians at Higher Risk for Suicide?
Tillman highlights a 2021 study from the Journal of Psychiatric Practice, which analyzed data from the 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.
Who is Impacted by Suicide Loss?
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.
How Can We Respond After a Suicide?
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.
- Use Dr. Julie Cerel’s Nested Model of Suicide Survivorship: This model categorizes the different levels of impact on those affected, from exposure to bereavement.
Common Emotional Reactions:
- Stigma and shame: 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).
- Mental health impacts: Survivors of suicide loss often experience depression, anxiety, and PTSD.
Supporting Clinicians After the Loss of a Patient to Suicide
Research has shown that one in two psychiatrists and one in five psychologists 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
- Risk management: fear of a lawsuit
- Grandiosity, shame, humiliation, guilt, judgment, blame
- A sense of crisis: professional identity, loss of faith about psychodynamic/intensive treatment, concerns about competence
- Effect on work with other patients
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.
Key interventions include:
- Team-based debriefings: These provide an opportunity for staff to process their emotions together.
- Late detection: Identifying staff members who might be struggling later, even if they initially seem unaffected.
- Long-term support: 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:
- Physical health: Nutrition, exercise, and sleep.
- Mental health: Seeking consultation, therapy, and engaging in professional support networks like the Coalition of Clinician Survivors.
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 mourning is a lifelong process. 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, register here.