The impact of patient death and suicide on mental health professionals: mixed-methods study

Although all patient deaths affect clinicians, it remains unclear how the impact of suicides differs from other deaths. Is the trauma of losing a patient by suicide qualitatively distinct, or are the emotional, professional and organisational consequences of suicidal and non-suicidal deaths more similar than assumed?

To investigate the impact of patient suicide compared with other patient deaths on clinicians' psychological well-being, clinical practice and career. To explore clinicians' perspectives on how current support systems do, or do not, meet their needs.

A mixed-methods approach was used. An online survey with two subsets of questions (one for suicidal and one for non-suicidal patient deaths) was circulated to clinicians across South London and Maudsley NHS Foundation Trust.

A total of 122 responses were collected: two-thirds of respondents had experienced a patient suicide, with 53% reporting moderate and 12% reporting severe impact versus 36.6% reporting moderate and 4.2% severe for non-suicidal deaths. Non-suicidal death was associated with significantly lower impact (odds ratio 0.14, 95% CI [0.05, 0.41], p < 0.001) and less disruption to clinical practice. Blame emerged as a key factor shaping clinicians' responses: 98% of respondents rated suicide as <60% predictable in secondary care, and 69% rated the 'zero-suicide' policy as unachievable.

Patient suicide has a heavier impact on clinicians, qualitatively distinct from other patient deaths. Blame shapes defensive responses in suicides, and internal questioning in non-suicidal deaths. The low-risk paradox and perceived unachievability of zero-suicide policies call for re-evaluation. Acknowledging predictability limits and clinicians' support needs can help systems navigate the complex impact of patient suicides.