Heidi Wehring, PharmD, BCPP, Adjunct Associate Professor of Psychiatry
Maryland Psychiatric Research Center
Almost 1 out of 5 mental health providers will experience patient loss to suicide in their career, and, although many providers will note this as a career-defining moment, those clinicians may not receive support in navigating patient suicide loss. The AAPP Foundation sponsored the presentation “Living Through Loss- Navigating Loss by Suicide as a Clinician-Survivor” by Dr. Julie Cerel, Professor of the College of Social Work at the University of Kentucky, and Director of the Suicide Prevention and Exposure Lab (SPEL), to educate the AAPP membership on what it means to be a “clinician-survivor”, to identify appropriate postvention strategies for suicide loss, and to describe the impact that suicide loss may have on professional practice.
To focus the topic on the experiences of psychiatric pharmacists, AAPP and Dr. Cerel surveyed the membership about members’ professional and personal experiences with loss to suicide before the Annual Meeting. The members’ responses were incorporated into the presentation to provide vital insights into the losses faced by our membership, how those losses impacted the member, and what, if any, postvention strategies were offered by the psychiatric pharmacists’ administrator or employer.
Dr. Cerel began her presentation with some perspective about why it is so important to identify and intervene with persons who experience a loss to suicide. Although most literature focuses on family members, research suggests that an estimated 9% of people bereaved by suicide subsequently make a suicide attempt, and people bereaved by suicide report significantly higher scores on measures of perceived stigma, shame, responsibility, and guilt than people bereaved by sudden natural or unnatural death.1 These issues both occurred whether the bereaved was a blood relative or not.
The number of people who experience life-changing effects when a person with whom they are connected ends their life is much larger than previously reported estimates in the published literature. Recent research suggests that each death by suicide leaves approximately 135 people exposed.2 With 800,000 suicides occurring yearly, 108 million people worldwide are exposed to suicide. This number also includes clinician-survivors.
A clinician-survivor includes a clinician who has lost someone important to suicide, whether a patient/client, family member, or someone else close to them. Because psychiatric pharmacists have not been well-represented in the published literature on clinician-survivors, Dr. Cerel presented data representing suicide loss in mental health clinicians in general. Dr. Cerel also incorporated AAPP members’ anonymous survey responses about being a clinician-survivor to convey some of the unique aspects of suicide loss experienced by psychiatric pharmacists.
Between 20% and 80% of mental health clinicians experience the loss of a patient to suicide3 and approximately two-thirds of mental health professionals reported experiencing at least one personal loss to suicide.4 Mental health clinicians report a range of responses, including acute stress responses, self-doubt, more defensive clinical practices, or consideration of leaving their position or career entirely.3
Although most mental health professionals feel prepared to handle a suicide situation, more efforts are warranted to encourage help-seeking and resources for support for clinicians who treat suicidal clients. Clinicians often report hyperfocus on cues related to suicide, self-doubt, thoughts about leaving their position, and increased collegial or peer consultation following a patient loss to suicide.5 Responses from the AAPP survey responses reflect these experiences, in addition to stating the lack of meaningful postvention strategies after the loss.
These findings underline the need for postvention strategies to support clinicians following a suicide loss. Dr. Cerel presented data about existing strategies and cited recommendations from a VA study that encouraged supervisors to proactively reach out to affected clinicians, to provide concrete resources, and additional support to clinicians who undergo formal review.5 Certain types of formal reviews, such as root cause analysis or peer review, have not always been seen as helpful to clinicians, as more of the clinicians undergoing these reviews were more likely to consider leaving their positions, less likely to be willing to see suicidal patients in the future, and were likely to experience emotional distress about the suicide longer relative to their counterparts.5
Dr. Cerel shared the Coalition of Clinician Survivors (http://www.cliniciansurvivor.org/) resource and stated that some of the AAPP survey respondents believed having a postvention plan should be a plan in all behavioral health workplaces. Psychiatric pharmacists, like their colleagues in other mental health disciplines, may experience loss to suicide in their professional and personal lives, and addressing the needs of the clinician-survivor is an important issue that deserves increased attention.