Conference Agenda

Experiencing a patient’s suicide can have a considerable emotional and behavioral impact on psychiatrists. Knowledge about good aftercare for them is still lacking. We did an exploratory qualitative descriptive study using semi-structured interviews conducted with five psychiatrists working at a large Dutch mental health institution. Our goal was to gain more insight into the impact of suicide on them and how to improve their recovery.

Five themes were distinguished: emotional impact, stacking and workload, taking responsibility, feelings of being held accountable and perceived support. Suicides made a profound emotional impression on all psychiatrists. Experienced emotions varied in nature and duration. Due to the accumulation of incidents and workload, the psychiatrists experienced little room for recovery. They felt a great responsibility to provide good aftercare for family and colleagues as well as to manage formal matters properly. They also felt that they are held accountable. Emotional support from colleagues was experienced as very valuable. Practical support was missed.

In the symposium, we will present our results and discuss how both emotional and practical support in the aftermath of a patient’s suicide can be provided to psychiatrists. We will present our ideas and suggestions on how to make a joint approach from fellow practitioners as well as policy makers. On of our suggestions is a buddy system, that will be implemented in our mental health organization in 2026. In the symposium, we will present the first experiences with this buddy system.

This paper draws on recent evidence to question the long-standing assumption that suicide can be reliably predicted. Despite decades of research, prediction accuracy has not improved, and risk-assessment tools demonstrate extremely low positive predictive value. Suicidal behaviour arises from complex interactions of psychological, social, cultural, and somatic factors, many of which fluctuate rapidly or remain unarticulated. Equally, suicidal ideation is widely misunderstood: most who express it do not die by suicide, while many who die never express such thoughts. The paper argues that ideation often reflects symbolic capacity and psychic pain, not immediate lethality.

The common conflation of self-harm and suicide further distorts clinical and research approaches. While self-harm may express distress and maintain connection, suicide reflects a collapse of connection and a wish to escape unbearable psychic pain. Examining these together risks obscuring their distinct psychodynamic functions.

The paper also critiques the assumption that mental illness causes suicide or that psychiatric admission ensures safety. Only a minority of those who die by suicide have had recent service contact, and suicide rates are markedly elevated during admission and post-discharge. Institutionalisation, regression, and abrupt loss of structure may all increase vulnerability.

Ultimately, the paper argues that overemphasis on prediction creates fear-driven, defensive practice and fuels blame and scapegoating when suicide occurs. A more effective approach involves acknowledging uncertainty, engaging with the psychodynamics of suicidal states of mind, supporting mourning, and focusing on relational, compassionate, and evidence-informed care rather than unrealistic expectations of prevention.

Patient suicide can have a profound and significant impact on mental health professionals. Their well-being, professional identity, ability to work, and collegial relationships can all be severely strained and they often experience a range of grief reactions: shock, devastation, guilt, anxiety and even trauma symptoms. Unfortunately, patient suicide is not uncommon. Up to 81 % of all psychiatrists and approximately 60 % of all psychologists, psychotherapists, and social workers experience at least one patient suicide during their career (Castelli Dransart et al. 2017, Chemtob et al. 1988, Gibbons et al. 2019, Leaune et al. 2021). Losing patients to suicide is an occupational hazard. Nevertheless, many teams are not prepared for this tragic event and do not provide necessary support. This can have long-lasting negative consequences for mental health professionals: doubts regarding their own competence, insecurity and fear when dealing with suicidal patients and loss of trust in colleagues and superiors. Some even leave the professional field. However, targeted and sufficient support from superiors and colleagues aids significantly with processing the consequences of patient suicide in a constructive manner.

Therefore it is recommended that teams and organizations develop guidelines for dealing with patient suicide and complete postvention trainings. This ensures adequate preparation, both professionally and in terms of employee support. Postvention trainings aim to raise awareness of the frequency of patient suicide, anticipated reactions to this event and its far-reaching consequences. They introduce different models of postvention in mental health settings and encourage the use of resources within teams and organizations to foster an open, non-blaming and constructive approach to patient suicide. Furthermore, these trainings offer participants an opportunity to reflect on and evaluate their past experiences of patient suicide. In general, postvention trainings contribute to the understanding that postvention is an integral part of suicide prevention.

Drawing on her extensive work with over 200 clinicians who have lost patients to suicide or murder-suicide, this presentation examines the profound crisis of professional and personal identity born out of what can best be understood as a deep and potentially catastrophic experience of moral injury. This violation of the provider’s core professional imperative, to prevent patient suicide, strikes at the heart of a clinicians’ professional identity. For those who bring a deeply personal desire to help, it can challenge their moral compass and shake the core of one’s humanity.

Embedded in the language and fundamental to many suicide prevention frameworks, trainings emphasizing the preventability of suicide while utilizing overly simplistic risk assessments with misleading prognostic assumptions inadvertently contribute to the devastating impact of a patient loss. Regardless of training, experience, or clinical competency, too often the failure to prevent a patient's suicide is perceived as causal responsibility for their death prompting too many providers to leave the field and a shocking number to become suicidal themselves. Recommendations for 'self care' and the implementation of 'restorative just practices,' when offered, can help but are often inadequate in undoing earlier messaging and healing these deeper wounds.

The subsequent need to protect oneself from further injury inflicted by another potential suicide can obscure objectivity, impair clinical judgement and place both clinicians and patients at increased risk. Preliminary qualitative and quantitative findings from anonymous surveys of nearly 40 clinicians who completed 10-week support groups identify blind spots in their suicide prevention trainings that contributed to poor patient outcomes contributed to the extent of injury they suffered. Recommendations for both suicide prevention and postvention are offered highlighting the efficacy of short term support groups to help mitigate harm, foster healing, and promote post-traumatic growth among clinicians navigating this potentially life changing occupational hazard.