Programs Help Residents Cope With Patient's Suicide

At some point in their careers, a number of psychiatrists will find that one of their worst fears—that a patient has committed suicide—has become a reality. But many psychiatrists—and especially many psychiatry residents—are woefully unprepared to handle such an event.

As a result, Herbert Hendin, M.D., CEO and medical director of the not-for-profit Suicide Prevention International (SPI) in New York City, recently prepared a Web-based program to help APA members deal with the loss of a patient to suicide (Psychiatric News, March 6). Several other psychiatrists are also spearheading initiatives to help psychiatry residents cope with such a loss.

One is Joan Anzia, M.D., an associate professor of psychiatry and the psychiatry residency training director at Northwestern University. The other is Ellen Haller, M.D., a professor of psychiatry and the psychiatry residency training director at the University of California, San Francisco.

Anzia's mission is to galvanize other psychiatry residency training directors to help residents handle a patient suicide. She does so through a workshop that she and some of her residents conduct at the annual meeting of the American Association of Directors of Psychiatric Residency Training. The first one took place in March 2007, the most recent one last month.

At the workshop, Anzia and her residents give the training directors an overview of what residents experience when they lose a patient to suicide. For example, they may have trouble making decisions or they may hospitalize patients more often to prevent another suicide. They may experience anxiety, insomnia, or guilt. They may lose self-confidence; they may even consider abandoning the field of psychiatry.

At the workshop, Anzia and her residents also give some guidance to the training directors on how to help residents when a patient commits suicide. For instance, since it takes residents a week or two to come to terms with their shock and dismay, a critical review of the tragedy should not be undertaken for a least a week afterward. The training director should meet with the resident and help him or her process what happened. And sometimes bringing in an outside therapist to talk with the resident can be very helpful.

But perhaps the most critical action that a training director can take, Anzia stressed during an interview, is to tell residents early in their training that if a patient commits suicide, they should contact the director immediately, and the director will help them deal with the experience.“ In many programs, the training director doesn't find out [about such a tragedy] until a few days later. Residents won't tell you about it unless they feel welcome and know that this is what they are supposed to do.”

Haller's mission is focused more directly on helping residents in her residency program. She and her colleagues have designed a symposium titled the“ Coping With Patient Suicide Symposium.” They rolled it out for the first time in January and plan to hold it every other year.

First a resident, or a recent graduate of the residency program, presents a case in which he or she has had a patient die from suicide. Then a faculty member provides some general information about the topic—how common patient suicide is, how it affects clinicians psychologically, how a clinician should respond to the patient's family and to attorneys in the event that the suicide has legal ramifications. After that, residents attending the symposium split into small groups, each of which is headed by a faculty member who has lost a patient to suicide. Each faculty member tells his or her story, and if a resident in the group has had a patient commit suicide, he or she can talk about it as well. Finally, the residents reconvene in a large group to hear a layperson who has lost a loved one to suicide tell his or her story.

In addition to the symposium, Haller and her colleagues have put a system into place where any resident who experiences a patient suicide can receive individual help. A chief resident and faculty member meet with the resident, provide the resident with guidance and psychological support, and give the resident a document that recaps a lot of the facts presented during the symposium. The chief resident and faculty member likewise help the resident“ think through what to disclose to [his or her] class and whether to invite the class to a debriefing and make it an educational experience.”

“We plan to promulgate this curriculum—write it up and share it with other residency training programs—so that they too can benefit from it,” Haller reported.

“We psychiatry residency training instructors teach residents a lot about how to do suicide risk assessments on patients,” Anzia noted.“ But we don't teach them enough about how to care for themselves if a patient suicides.”

Haller agreed: “Unfortunately, a patient suicide is something that most psychiatrists at some point in their career will experience. So the more we can do while they are in training to prepare them for the inevitable, the better.” ▪