The effects of patient suicide on general practitioners

Suicide is a major health problem. In England, around 5,000 people end their own lives annually – that is one death every two hours and at least ten times that number of attempts, according to the Office for National Statistics. Suicide is a tragedy that is life-altering for those bereaved and can be an upsetting event for the community and local services involved. Our previous research demonstrated the:

• Majority of suicide patients (over 90%) have consulted their General Practitioner (GP) shortly before death;
• Variation in risk assessment between professional groups and a lack of suicide risk assessment training in primary care;
• Dilemma GPs faced when managing patients who were non-adherent to treatment;
• Very real struggles experienced by GPs in their attempts to make sense of patient communication of suicidality, to get patients the treatment they need and to respect patient autonomy while fulfilling their professional responsibilities;
• Concerns GPs expressed about the quality of primary care mental health service provision and difficulties with access to secondary mental health services;
• Need for formal support and guidelines within primary care for GPs following patient suicide.

Do GPs want or need formal support following a patient suicide?

Although patient suicide is uncommon in a GP’s career – one in every 3-7 years per GP and six in every ten years per GP practice; it is important to place appropriate emphasis on the effects of patient suicide on GPs. The role of the GP in this context includes suicide treatment and prescription, prevention, professional attendance at the scene of a suicide, comforting the bereaved, and the critical incident review following a patient suicide. GPs support requirements may differ following a patient’s death by suicide compared to death from other causes related to physical ill health because GPs may see suicide patient deaths as preventable. Practices are increasingly exploring the use of critical incident reviews in primary care following patient suicides to highlight the lessons that may be learned to improve patient outcomes and reduce future suicides.

What did we do?

Having carefully co-developed interview schedules, we collected data to explore GPs views on how they are affected by patient suicide and the formal support available to them following the death of their patients who died by suicide to provide findings that are relevant to primary care service providers and practitioners. The study used a mixed methods approach which involved data collection about patients who had died by suicide in the North West of England between 1st January 2003 and 30th June 2007. The GPs who took part in this study were aged between 31-67 years, three out of four GPs were male, and the number of years in practice varied between 8-40 years. Two thirds of the GPs were based at urban practices and one third rural practices. The majority of practices had two or more GPs.

What did we find?

Our findings suggest that the majority of GPs are affected by patient suicide. Those that were more affected by patient suicides tended to have fewer years in practice. On the other hand, many GPs who were not affected reported that they’ve accepted the psychological toll of patient suicide as a part of their profession. Most GPs we surveyed sought informal support from their peers and colleagues. An interesting finding was the apparent lack of formal support systems and the varied responses from GPs about what encompasses support. This opens up an area for concern where formal support mechanisms may need to be put in place – or where they are available, to be more visible. Although GPs can also make use of generic medical support mechanisms for formal assistance (e.g. British Medical Association and the National Counselling Service for sick doctor), the extent to which specific services are accessible to GPs working in primary care seems to be poor.

These findings are of interest to those who plan and provide support services for GPs dealing with the impact of patient suicides. More GPs are seeking legal advice after the suicide of a patient and this also adds additional stress to their circumstance, driven by additional health service scrutiny. Although many GPs expressed that informal support systems through friends and colleagues were adequate, procedures and guidelines should be developed for those who may require professional counselling. Formal support guidelines should also be made available for greater mental health protection for GPs who are more at risk of experiencing psychological injury after suicide by one of their patients. In addition to GPs, such procedures may potentially be useful for Clinical Commissioning Groups (CCGs), those who plan services in primary care, and postgraduate and Continued Professional Development educators. The recent structure of CCGs and the rapid development of GP postgraduate education, through the introduction of Practice Professional Development Plans, provide a great opportunity for improvements regarding formal support procedures for GPs. Further research should be undertaken to establish whether the implementation of such procedures are effective in supporting GPs who may be bereaved by a patient suicide.

Featured image credit: Doctor and patient by daizuoxin, iStockphoto.