When a patient takes their own life, it can be a devastating experience for a health professional, particularly if their professional relationship with the patient has been long and intense. Feelings of shock, grief, sadness, remorse, guilt and anger are common and normal.
One of the many challenges for health professionals, and particularly for GPs, is that they become involved in the lives of their patients. It may be impossible for them to be completely objective about the stories of joy and sadness that their patients have shared with them. A personal/spiritual connection is often established. The quality of a health professional’s relationship with patients is part of the healing process. Because of this relationship, health professionals can be deeply affected if a patient takes their own life. In addition to the normal grief felt from losing someone they were close to, health professionals may feel a sense of failure that they were not able to help their patient to find reasons to stay alive.
Health professionals, and particularly GPs, have a higher suicide rate than many other sectors in society. Perfectionism, high workloads and long hours, difficulty sustaining close relationships, reluctance to disclose psychological difficulties, a sense of being a ‘fraud’, lack of time or energy to look after themselves properly, trying to balance family, patient expectations, finances, and keeping up with the latest research can all add up. It is not surprising that many health professionals ‘burn out’, become depressed, anxious and lonely, and some consider taking their own life.
Coping with the death of a patient or client through suicide
The education of health professionals provides little preparation to help them to cope if a patient takes their own life. Workplaces also generally provide minimal support, despite the fact that the statistics show that a majority of professionals will experience the suicide of a patient. In fact, health professionals working in large communities and those serving populations with high rates of mental illness may even experience several suicides in a working lifetime. They are often left to feel fearful and alone and this can be particularly so for country practitioners.
It should be acknowledged that it takes courage to work with suicidal patients. Sometimes, health professionals who have been working closely with a patient who later takes their own life can lose confidence in their professional abilities and experience a loss of self-esteem. If they are also experiencing other personal or professional stresses or lack of support, they may develop stress reactions and depression which affect their ability to work. Because of this, some health professionals have withdrawn from working with suicidal patients and have even abandoned their profession or considered suicide themselves.
Other practitioners and staff within the workplace such as receptionists, nurses and managers who have known the person who has taken their own life may also be affected. A collaborative approach supporting each other within the workplace can help each other to cope.
Practitioners may also fear facing the family. Although there may be anxiety about approaching grieving relatives, those health professionals who do so, or who attend the funeral, often find this helpful as supporting the family may offer a sense of mutual healing.
It is important for health professionals to allow themselves to grieve and not expect themselves to be immune to this important emotion. Talking to colleagues who also knew the patient may help to put questions into perspective. Occasionally, health professionals may need to seek formal help to assist in settling back into their normal working lives.
Preventing suicide in health professionals
Firstly it is important that health professionals look after themselves. Following these recommendations may help:
- be familiar with the early signs of depression and burnout so that steps can be taken to address the problems
- try to ensure that work and professional organisations are able to support their members to stay healthy
- try to maintain a good work/non-work balance
- take time off when sick and have adequate holidays
- nurture the relationships that occur in the variety of different roles in medical practice
- find people to debrief with
Secondly, health professionals need to look after each other. It may be useful to:
- ask a colleague if they are okay. This can be difficult as the most likely answer will be ‘Sure I’m fine’. Mentioning that a colleague is looking tired, putting on weight, not keeping up with their paperwork, arriving late for work, being irritable with the staff, and emphasising that this is not what they are usually like, can help someone open up about what is worrying them
- assist other health professionals to look after themselves before they start to make mistakes. Listening and supporting can make an enormous difference
- acknowledge that we are all human, have human needs and human failings, and that medicine and other health professions are extremely complex and often unsupportive, so the care and understanding of family and friends is important
- assist colleagues to work through how they can increase their resources, change their outside circumstances and find appropriate people with whom to talk through their experience
- remember that health professionals are not the doctor or counsellor for their distressed colleagues but rather, are their friend. Therefore they should encourage their colleagues to seek appropriate assistance