Exploring the impact on primary care mental health practitioners of the death of a patient by suicide: An IPA study

Abstract

Objectives
There have been numerous qualitative studies into the impact of the death of a patient by suicide on clinicians, but the majority of studies have focussed on psychiatrists and psychologists, primarily in inpatient or secondary care settings. To date, little has been done to explore the impact of such deaths on other mental health practitioners working in primary care, such as those working in Improving Access to Psychological Therapies (IAPT) services.

Design
This qualitative study used purposive sampling and adopted an interpretative phenomenological analysis (IPA) methodology.

Method
All participants had experienced the death of a patient in their role as a practitioner in an IAPT service. Seven practitioners were recruited from services across the North of England. Semi-structured, one-hour telephone interviews were audio recorded and then transcribed verbatim.

Results
Analysis of the transcripts identified a number of themes, which were represented in the majority of cases. Specifically, the analyses yielded four superordinate themes: (1) feeling shocked and upset about the death of a patient; (2) attempting to understand the causes of the suicide; (3) learning from the tragic event; and (4) reflections on what helped in coping with the tragic event. The emotional responses of shock, upset, guilt and fear of blame by IAPT practitioners following the death of a patient through suicide is consistent with that found in studies of other mental health practitioners.

Conclusions
It is hoped that the current study will help raise awareness amongst primary care mental health practitioners, services and training centres, of the impact of losing a patient to suicide and will encourage them to consider how best to prepare and support practitioners in this eventuality. Recommendations include raising awareness of the potential for patient suicide in primary care services, providing clarity on the individualised support available and on the requirements of investigations.

Practitioner points
Be aware of the likelihood of experiencing a patient suicide. (i.e. the ‘career prevalence’ of such an event).
Have regular training in risk assessment, formulation and safety planning, including recognition of the poor predictive power of risk assessment tools and the importance of the therapeutic encounter to enable open discussion of risk.
Receive clear guidance on self-care and support available in the event of a patient death and have an understanding of the service and statutory procedures following a suicide.
Benefit from a clear procedure for communicating to the practitioner in the event of a patient death (by those with direct management or clinical responsibility for that person) in a caring and supportive manner.