The aftermath of suicide on the psychiatric inpatient unit

Suicide in the hospital setting results in a complex array of reactions by the staff, the institution, the remaining patients, the family of the patient, and the outpatient caregivers. In the aftermath of a suicide survivors pass through four predictable and parallel stages: shock, recoil, posttrauma, and recovery. Specific approaches to these stages are addressed. The management of the shock phase requires carefully orchestrated crisis-intervention strategies, containment, and risk management. The numbness and disbelief of this period gives way to the reactions of the recoil phase, which include guilt, shame, anger, depression, self-doubt, and a search for meaning. Group meetings, outreach to the family, the suicide review conference, and, in particular, informal peer contact, are key aspects of recovery in this stage. Family survivors require specialized interventions that take into account the stigmatization that commonly accompanies suicide. In addition, as one fourth to one third of hospital suicides result in lawsuits, specialized approaches to assessment and documentation are indicated. In the posttraumatic phase more general issues of professional efficacy are addressed. The resolution of this phase is enhanced by an open dialogue focusing on the limitations of assessment and treatment of the suicidal patient. Final recovery for staff includes a posture of anticipation appropriate to the clinical setting.