The Impact of Patient Suicide Loss on Mental Health Clinicians in Veterans Affairs Health Care Facilities

Department of Veterans Affairs (VA) clinicians are at elevated risk of patient suicide loss due to the high rates of suicide in the veteran population. Clinician support structures and administrative procedures following patient suicides vary widely across facilities. The present study examined how mental health clinicians' experiences vary according to institutional responses to patient suicides. The authors disseminated an online survey to clinicians at 15 VA sites. Institutional responses such as supervisory support, postvention support services, and administrative postsuicide procedures were examined in relation to the clinicians' emotional and professional practice outcomes. The multidisciplinary sample included 87 licensed mental health providers who had experienced a VA patient suicide. Most were experienced clinicians (licensed for 6 or more years) who worked daily to weekly with patients who were suicidal. After their patient's suicide, over half of the participants reported self-doubt about their competency. Nearly three quarters of respondents reported changes in professional practice such as hypervigilance to suicide cues and an increased focus on documentation. Participants consistently described formal postvention supports and collegial outreach as constructive and helpful; however, experiences with supervisor outreach varied. Clinicians who experienced formal retrospective case reviews were more likely to report feeling blamed for the suicide, lengthier periods of emotional distress, reduced willingness to work with suicidal patients, and consideration of leaving their position. Strategic postsuicide procedures that include emotional and instrumental support for clinicians as well as thoughtful, nonblaming retrospective review policies may reduce negative clinician outcomes related to patient care and staff burnout and turnover.