How to cope after your patient commits suicide

A fear of blame, or of being sued, can materialize. So can anger, which can raise complicated questions. For example, are you angry at the patient for committing suicide? Is the family angry? And who are they angry at? Are they angry at you? Are they angry at the hospital? “If it’s in a broader system, let’s say a hospital system, there’s a hierarchy,” Dr. Gitlin said. “Staff could be angry at the ward chief, who could be angry at the attending physician. It can roll downhill. In a complex environment the possibility of projected blame can become a big deal.”

In his opinion, the most important coping technique is to decrease isolation. “In every major religion in the world, when there’s a loss, you rally around the person,” he said. “The rituals of the rallying around differ across cultures and religions, but the rallying around is universal. As humans, we know that it’s much more painful to sit alone with your pain than with the support of family members, friends, loved ones, and community. Find the right person [to confide in]. Not everybody you know will be the right person.”

After the death of a patient from suicide, Dr. Gitlin makes it a point to offer to meet with loved ones. “If you do meet with them, be prepared,” he cautioned. “You don’t know whether the families are a family of interjectors or projectors. Are they going to come in and say, ‘Doctor, thank you so much for doing your best for helping my relative,’ or are they going to come in and say to you, ‘You jerk; my kid died under your care.’ Be prepared for anything that happens in that room.” He also recommends asking the family’s permission to attend the patient’s funeral.

Another helpful coping strategy is to conduct a “psychological autopsy” with colleagues. “Ask what could have been done differently [in the case], not to blame, but to learn,” Dr. Gitlin said. “I have been to some psychological autopsies where it was just ‘Who can be blamed?’ and it was always the youngest person on the totem pole. If the institution can’t get it right psychologically, they shouldn’t do it. That’s more destructive than not doing it at all.”