Toolkit: Suicide Risk Assessment and Response to Patient Suicide
INTRODUCTION
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As you are aware, one of the most difficult challenges during the career of a psychiatrist is having a patient commit suicide. This challenge can be especially difficult for psychiatrists in training. This toolkit is meant to provide you with an introduction to basic concepts of suicide risk assessment. It is also meant to provide you with information about what it can feel like for a psychiatrist after a patient commits suicide and how to handle these reactions.
Between 32 – 61% of residents will have a patient who commits suicide prior to or during residency, and 50% of residents who have had a patient commit suicide will have encountered this within their first post-graduate year. This high rate may be due to the large number of patients treated, the high level of psychopathology in these patients, the inexperience of the residents, or the frequent transitions in care-settings and providers experienced by these patients. The death of a patient by suicide has a profound impact on any treating physician. Residents in training may be more vulnerable because they are forming their professional identity. Formal training can help enhance risk assessment and documentation. Supervisors and residents also need to learn how to recognize and handle their reactions through formal support, informal support, and the recognition that any support may need to occur over months, as the effect of the suicide is not merely an acute event.
There is no way to fully prepare for this event. However, you should walk away from this toolkit with (1) the expectation that some patients will die from suicide as a result of their severe illness, (2) an awareness that although we can recognize and assess risk factors, we cannot accurately predict suicide risk for any individual, (3) the knowledge that clinical failures are not personal failures, (4) a review of risk assessment, and (5) an introduction to post-suicide reactions and mechanisms for support (Simon, RI and Hales, RE. Textbook of Suicide Assessment and Management).
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