Part 2 – Review of a study into the impacts of exposure to suicide on mental health professionalsPart 2
Article in Review: Sanford, R., Hawker, K., Wayland, S. & Maple, M (2020). Workplace exposure to suicide among Australian mental health workers: A mixed-methods study. International Journal of Mental Health Journal. DOI:10.1111/inm.12783
Summary: In part one of this two-piece article, the approach was taken by researchers seeking to better understand the impacts of suicide in a workplace context was summarised, along with a look at what the quantitative data collected as part of the study suggested about the overall closeness to the deceased, and the impact of the death. This article will cover the key themes presented in the qualitative aspect of this study, along with outlining why it is important to consider both data sets together to get a full picture of the experiences of mental health professionals involved.
Of the 153 respondents who contributed responses considered in the study, a further 53 provided qualitative information related to their own experiences and the impact of having a patient attempt or die by suicide. These comments were grouped, with three key themes emerging.
The authors of the study believe that this mixed methods approach “provides a more robust understanding of the experience” with the two data types offering “complementary perspectives aimed at identifying the ‘true version of events”.
The quantitative data indicated a relatively low level of distress, compared to that of the wider Australian population. However, analyses of the key themes present deeper insight into the experiences of mental health professionals who have been affected by patient suicide. As such, this qualitative data adds a rich understanding to the quantitative data described in Part 1.
Impact on the individual
“It has affected me considerably as I question what else I could have done”
Three key ideas emerged in this theme, so that the experience of the loss of a patient by suicide had influenced professionals to:
- Question their professional ability or decisions
- Change their professional goals
- Feel grief and emotional reactions
In many cases, where there was a close relationship between the professional and the person who had died by suicide, there was what is described as “mourning” for the loss of a human life. Some respondents had experienced multiple exposures and the loss of multiple relationships, exacerbating this feeling. Some respondents also reported that the death by suicide had changed their career trajectory. One responded saying “it changed my career path and suicide prevention is core work for me now”.
When combined with the qualities data related to how deeply mental health workers were impacted by the death of patient by suicide, it is apparent that workers experience emotions very similar to those of family members and friends; namely guilt, shock, sadness and anger. For clinicians, the loss is “both personal and professional” and in many cases is not recognised as grievers, which complicated and compounds their emotions.
Organization response to the death
“The lack of empathy towards staff involved by senior management was appalling”
In many cases, respondents indicated that after the death of a patient by suicide, the level of support provided by the organisation was left wanting. Mental health professionals reported experiencing negative reactions from senior officers. One responded said “there is little support of employees with a ‘complete all the paperwork, go to the EAP and just keep moving” attitude”
As recognised in previous research, there is a perceived and real need for protocols, guidelines, and formal supports to provide a better level of support to employees at the time of patient death. Some professionals may be able to only tend to their feelings after both administrative and legal actions had been completed. Indeed, these findings echo the experience of SRAA in supporting clinicians in understanding their workplace (and colleagues) response to the loss of their client, which in many cases was experienced as less than supportive (at best).
Lack of adequate resources and supports to prevent suicide
“I feel frustrated that I cannot change the system to the extent it needs changing”
Many respondents sought detail what they attributed as the reasons for their patient’s suicide. In many cases, this involved referring to inadequate supports and limited, unsuccessful or non-existent resources. This causes challenges for professionals when they are seeking to provide the best level of care possible within the constraints of the service. The issues related to lack of resources and supports were especially noticed by respondents in regional and rural areas. Systemic issues such as lack of communication among providers, lack of continuity of services and lack of follow through were noted, with one responded saying “I also feel sad and in some way a little responsible despite the required changes being outside of my sphere of influence”
The anger, irritability and frustration described by this responded was not unique in the study and raises an ideal novel to literature in this field. As responders tried to find a narrative that could explain the death of their patient, in many cases the ‘why’ was that the system failed that this was a causal factor in the resulting person who died. Systemic problems are thereby perceived to be contributors to both the death and distress experienced by the caring professional.
When considering the system in supporting appropriate pathways to care, SRAA regularly advocates for open collaboration and advocacy for clients across services. Yet, sadly, we see barriers that pertain to not only situational resourcing limitations but attitudinal factors continuing to inhibit effective communication and engagement.
Shame, frustration and disappointment
The data and information gathered in this study demonstrates a need for a better understanding of the experiences of workers who are disappointed in the system in which they work.
This research article is a significant contribution to our recognition that clinicians are impacted by the suicide loss of clients, with similar (if not the same in some cases) experiences of loss, guilt, shame and distress. This research also demonstrates that as a workforce, we need to prioritise the mental health supports available to clinicians, to support their capability to do what needs to be done. The article suggests that further research could be done to understand the moral injury that professionals sustain while “being unable to provide high-quality care and healing in the context of health care”. Certainly, when the suicide death is associated with systemic failure that is outside the control of individuals, we know that this is likely to contribute to greater distress across our suicide prevention sector.