Supporting Mental Health Care Providers in the Wake of Patient Suicide: A Needs Assessment

Background: Instances of suicide are prevalent among veteran populations, where rates are nearly twice that of non-veterans. Patient suicide is a critical event in the lives of mental health care providers (MHCPs) and, as such, has been identified as an occupational hazard by the American Psychological Association. Many MHCPs experience significant traumatic stress symptoms, including guilt, depression, and isolation following the loss of a patient to suicide. This can be a career-defining event for some MHCPs causing them to leave their chosen profession, thus contributing to the critical shortage of MHCPs serving the veteran population. Local Problem: Programs implemented to protect MHCPs from traumatic stress injury have not been assessed for efficacy. While robust research calls for it, professional and academic institutions have yet to standardize guidelines to prepare clinicians for the sequela of patient suicide. As a result, MHCPs are rarely educated about what to expect, nor are they provided the necessary support to protect themselves from this occupational hazard. Methods: We conducted a needs assessment at the Salt Lake City Department of Veteran Affairs to determine awareness, utilization, and efficacy of programs designed to support MHCPs when a patient dies by suicide. This was achieved through the dissemination of surveys to MHCPs, data extraction from VA program records, and focused discussion groups. Intervention: Findings from the needs assessment were synthesized into site-specific recommendations and presented to VA mental health leadership. Results: Ninety-nine percent of surveyed MHCPs (n=71) believe it is important to have supportive therapy services when working with suicidal patients. Most respondents (n=42, 71.2%) felt they were not adequately prepared when their first patient died by suicide. There was a 71% (n=52) positive response rate to domains of traumatic stress injury following a patient suicide. Forty-one percent (n=30) of responders reported that someone from the VA contacted them to provide therapeutic support after their patient died by suicide, and 92.6 % (n=25) found this support helpful. Three major themes arose from a focused discussion group: the desire for more support from colleagues, more time to properly grieve, and a need for access to mental health services after patient suicide. Mental health leadership found the executive summary and recommendations informative, useful, and educational (n=7, 100%). They reported that it changed their views about the impact of suicide on healthcare providers. All respondents agreed that at least some part of the recommendations could feasibly be implemented at this site. Conclusions: Key leadership received guidelines well, and implementation was deemed feasible. If implemented, these recommendations may be measured for their efficacy in increasing clinical confidence and reducing instances of traumatic stress among MHCPs when faced with patient suicide and could be generalized to other clinical and academic settings.