CLINICIANS AS SURVIVORS OF SUICIDE: BASIC INFORMATION

Who We Are

The Clinician Survivors Task Force was originally formed in 1997 to develop and provide postvention for clinicians who had lost a patient to death by suicide. AAS recognized that, although approximately 1 in 5 psychotherapists* (and as many as 1 in 2 psychiatrists and psychiatric trainees**), loses a patient to suicide during the course of their career, the aftereffects of suicide received very little attention. They recognized that for clinician-survivors, litigation issues, stigma around suicide, and the feared negative reactions and judgments of colleagues often exacerbated the pain and grief of the loss itself. They also found that, in general, those colleagues who had not experienced a suicide loss were ill prepared to support those who had. The initial goal of the Task Force was to begin to shed light on the topic of the clinician’s suicide loss, so that clinicians could start to reduce their isolation, speak about their experiences and begin the healing process. They developed this national website in order to provide education, resources and contacts, opportunities for clinicians to share and post their experiences, as well as a bibliography of publications relevant to clinician-survivors. In recent years, the Task Force decided to include clinicians who have lost family members to suicide. Although there are clear differences between the nature of patient and family suicide losses, it is clear that there is great deal of commonality in the impact of these losses, particularly in the ways in which they affect clinical work, professional relationships and professional identities. In addition, Clinician Survivors of each type of loss may face potential stigma and isolation from colleagues, both in relation to the suicide itself and to subsequent personal vulnerability. >8/5/08< NJG/VLM * Task Force study of community therapists, McIntosh, J. L., Talcott, L., & Jones, F. A., Jr. (1999, April 16). "Therapists as survivors of client suicide." Presentation made at the annual meeting of the American Association of Suicidology, Houston, TX. Summary appears in M. Weishaar (Ed.), (2000). Suicide ‘99: Proceedings of American Association of Suicidology 32nd annual conference (pp. 75-78). Washington, DC: AAS.. ** Ruskin R., Sakinofsky, I., Bagby, R. M., Dickens, S., & Sousa, G. (2004). Impact of patient suicide on psychiatrists and psychiatric trainees. Academic Psychiatry, 28, 104-110.

Current/Future Goals of the Clinician Survivor Task Force

The task force hopes to continue to provide support, education and resources to Clinician Survivors. This website (see above tabs) offers opportunities to post and share individual experiences, to reach out to “veteran” clinician-survivors who have offered to be (geographical) contacts to “new” survivors, and to access an updated bibliography of relevant publications (thanks to Dr. John McIntosh). If you would like to become a phone and/or email "contact" for new Clinician-Survivors, please send your contact information (and geographic location) to Dr. Gutin or Dr. McGann. Each year at the AAS conference, the Task Force provides several opportunities (workshops, breakout groups, luncheons) in which Clinician Survivors meet to obtain education and support, share their experiences and offer their involvement. We now have a listserve for clinician survivors (please email Vanessa McGann at VLMcGann@aol.com if you would like to join). This listserve provides additional year-round opportunities for clinicians to share their thoughts, ideas and support with each other. Our future goals include: 1) Using our collective experiences around suicide loss to create and disseminate educational materials for training institutes and clinics. 2) Update website with more testimonials and members' contact information. 3) Encourage and initiate more research on topics related to clinician suicide loss. Thank you for visiting the Clinician Survivor Task Force website. We welcome your involvement and suggestions. Nina J. Gutin, Ph.D. ngutin@earthlink.net Vanessa L. McGann, Ph.D. VLMcGann@aol.com 8/05/08

Basic Information About the Task Force Efforts: An Open Letter to Clinician Survivors

Open Letter to Counselors, Clinicians and Professional Healthcare Providers from the American Association of Suicidology Dear Colleague: This brief letter has two purposes 1) to address an issue about which many of us in the healing arts are not fully aware, and for which very few are fully prepared, and 2) to offer assistance to clinicians who may lose a client to suicide. As a standing committee of the American Association, the Clinicians as Survivors of Client Suicide wish to offer the following facts: Many beginning clinicians are unaware that suicide is a leading cause of premature death for many of the emotionally distressed people they have been trained to serve. (1) Over 90% of all completed American suicides are by persons with an Axis I disorder. (2) Fully one in six psychiatric patients who die by suicide die in active treatment with a healthcare provider. (3) Approximately 50% of those who die by suicide in America will have seen a mental health provider at some time in their life. (4) Interns, residents and other novice clinicians have been found to experience higher rates of suicide among their clients than more seasoned clinicians. (5) Suicide malpractice is the leading cause of legal action against all behavioral healthcare providers, regardless of discipline. (6) Experiencing the loss of a client by suicide can be psychologically traumatic for the provider, and may even become a career-ending event. Unfortunately, few training institutions or graduate programs prepare students for this possible traumatic loss. (7) In summary, the odds that you will lose a client to suicide at some time during your career may be slim, but they are not zero. Based on our collective experience as clinicians and researchers, we wish to offer you the following suggestions to assist you both now and in the future should someone in your care die by suicide: If you are new to the helping profession and have not yet had training in suicide risk assessment and risk management, we encourage you to seek out such training and provide yourself with the best knowledge base you can find. In the event a consumer of your service dies by suicide while in your care, you will at least be comforted by the fact that you had received relevant training in assessing and managing consumers at risk for suicide. If you are still in training (student, intern, resident, etc.), we encourage you to seek out a professor or instructor and request specific training in suicide risk assessment and management. We strongly encourage you to routinely inquire about suicide with every consumer of your service so that you that you can immediately assess any suicide potential that may be present. We strongly encourage you to seek supervision and/or consultation when you are serving someone known to be at risk for suicide. In the event of a bad outcome, you will be comforted by the fact that more than one professional was participating in the treatment plan. In the event that you may have already lost one or more clients to suicide, we invite you to join us at our web page where we provide a variety of materials that may be of help: resources, connections to others, information, support and help. The loss of a client to suicide is something we all wish to avoid. However, preventing all suicides is simply not possible. Still, we believe that through training, education and research, we can help create a therapeutic "climate of safety" for suicidal persons. Therefore, we wish to encourage you and all clinical providers to learn as much as possible about suicide, its etiology, the psychological and medical conditions that enhance risk, and about how those interventions and therapeutic endeavors that reduce risk and enhance protective factors. We also believe that by sharing our experiences we can not only learn how to better prevent suicide among those we serve, but we may also learn important lessons for our own survival as clinicians. To explore membership and benefits of the American Association of Suicidology, click here or email may be sent to ajkulp@suicidology.org. Sources: (1) World Health Organization, 1999. (2) Multiple studies summarized by Morscicki, Eve K. 1999, in The Harvard Medical School Guide to Suicide Assessment and Intervention, Doug Jacobs, Editor. (3) Bongar, Bruce, 1991, The Suicidal Patient, Clinical and Legal Standards of Care, Washington, DC: American Psychological Association. (4) U.S. Department of Health and Human Services, 1999, Mental Health, a Report of the Surgeon General. (5) Bongar, Bruce, 1991, The Suicidal Patient, Clinical and Legal Standards of Care, Washington, DC: American Psychological Association. (6) Thomas G. Gutheil 1999, in The Harvard Medical School Guide to Suicide Assessment and Intervention, Doug Jacobs, Editor. (7) Bongar, Bruce, 1991, The Suicidal Patient, Clinical and Legal Standards of Care, Washington, DC: American Psychological Association. Original Open Letter version from March 2000 and the site creation >7/10/02< PQ

Sharing Your Story/Experience

Outline for Clinicians Sharing Their Story After Losing A Client/Patient or Family Member to Death by Suicide The Clinician Survivor Taskforce of the American Association of Suicidology appreciates your willingness to share your experience of suicide loss. We are interested in what the loss experience was like for you and how it has impacted you both personally and professionally (clinical work, professional identity and relationships with colleagues, etc.). We are especially interested in what you found helpful or not helpful. Please limit your story to 2 typed pages. If you are writing about the of a loss client/patient, please disguise any details and identifying information that might allow for their recognition. With your permission, we would like to potentially use your story at our AAS annual conferences .The decision to have your name on your story for the conferences and on the web page is up to you. Please let us know your what your preference is. The following questions are areas you might consider in writing about your experience. Please write what has most affected you, and what has been most and least helpful. What was your initial response to losing your client/patient/family member to death by suicide? What was most helpful to you at the time of the suicide? What was most helpful to you at the time of the suicide? What was least helpful? How did the experience impact you personally? How did the experience impact you professionally (clinical work, professional identity and relationships with colleagues, etc.)? What was most/least helpful to you in the weeks and months after the suicide? What has been most/least helpful to you in your healing? What would have been helpful to you at the time of the loss? How has the experience impacted the way you work with your clients/patients? What have you learned from this experience? What do you hope to offer others since you've experienced this loss? Please E-mail your story to: Dr. Nina J. Gutin (ngutin@earthlink.net) OR Dr. Vanessa L. McGann (VLMcGann@aol.com) Please include a text file of your story so that it might more easily be entered onto our website. The Task Force greatly appreciates your contribution. Thanks for your help, Drs. Nina Gutin and Vanessa McGann 8/01/08

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