Impacts of patient suicide on GPs

Following a patient’s suicide, you may experience a mix of shock, grief, guilt, anger or self‑doubt. It is common to replay clinical encounters with the deceased, question your decisions, and search for answers to ‘Why?’. Although this is a normal response, it can become distressing if it turns into persistent self‑blame.

Suicide bereavement can be exacerbated by fears about responsibility for the death, and fears of professional judgement and scrutiny from families, colleagues and the wider community. This is particularly the case in rural and remote settings where GPs are highly visible.

In addition, confidentiality constraints can make it hard to seek support, and this can lead to isolation.

As you might also experience additional stress relating to procedural and medico‑legal stress (eg contact with the coroner), it is strongly advised that you seek early guidance from your professional indemnity insurer.
 

Many GPs who have had a patient die from suicide feel unable to talk about their experience, even to close colleagues¹. Typically, this is because they:

• are worried about being judged or seen as incompetent
• are worried about breaching confidentiality
• are worried about medico‑legal consequences
• feel responsible and therefore undeserving of support
• feel they must remain ‘professional’ and emotionally unaffected.

After a patient dies from suicide, it is common for their GP to:

• feel less confident during mental health consultations, and consequently:
  • experience increased anxiety, particularly about assessing suicidal risk
  • fear that they might miss warning signs in other patients
  • avoid high‑risk presentations
  • over‑service patients with mental health conditions
• become more cautious or hypervigilant about likelihood of other patients to attempt suicide
• lower their thresholds for referrals
• provide more intensive follow‑ups.

These reactions are understandable, but are often temporary, and generally diminish with support, reflection, and supervision.

Suicide bereavement in a professional context is different from personal grief, and it can feel harder to receive an appropriate level of support. If you have lost a patient to suicide, you may benefit from specialised, confidential support services, such as those listed below.

Confidential services

• drs4drs
• Professional services provided by a psychologist or your own GP
• RACGP members can contact the RACGP GP Support Program (1300 361 008)
• ACRRM members can contact their Confidential Member Support (EAP) line (1800 818 728)
• Doctors’ Health Advisory Services
• State-based Doctors’ Health Programs
• Other Employee Assistance Programs (EAP)
• CRANAplus Bush Support Service for rural and remote GPs (1800 805 391)
• Lifeline
• StandBy Support After Suicide

Professional supervision and/or groups

• Professional supervision
• Balint Groups
• RACGP case base discussions groups
• ASPM peer reflection groups
• GPMHSC mentorship program
• Black Dog groups for health professionals

Peer support

• Talking with peers who have also lost a patient can reduce feelings of isolation and shame.
• Confidential peer support provided by medical colleges and GP networks can help normalise your experience.
• Talking to other people in your practice team who worked with that patient (they might not have the same confidentiality constraints).

If you’re working in a small community, you might have additional burdens that can intensify your distress and limit your opportunities for privacy and support. These burdens include:

• identifying the deceased
• confirming the death when emergency services are limited
• communicating with police or the coroner
• supporting multiple bereaved people across one or more families and communities
• being personally connected to the patient.

In these situations, adopt some of the GP self-care and wellbeing strategies listed below.

• Acknowledge the impact on yourself (that losing a patient to suicide can evoke shock, sadness, guilt or self-doubt), and that your reactions and emotions are real, valid and common.
• Seek support early, even if you feel uncertain about whether you need it or not:
  • find out what support services your workplace has available to you
  • where possible, access peer support, professional supervision, medico-legal advice, or confidential counselling (eg doctor health services, EAPs), even if this requires telehealth or out-of-area options
  • engage in regular supervision or check-ins with others.
• Give yourself time and space:
  • ensure you take adequate rest and breaks
  • reduce your workload, and/or reduce your workload of patients who are high risk.
• Limit self-blame by recognising the complexity of suicide.
• Practise grounding and stress-management strategies.
• Maintain your boundaries in the community. Where informal contact is common, be mindful of your limits around availability and emotional labour and allow yourself time away if needed.
• Remember that reflecting on the experience over time can contribute to deeper empathy, clinical insight and resilience, even though this growth does not negate the loss.
• Attend to professional obligations as soon as practicable (eg coronial processes, clinical documentation, and risk-management), and seek advice if you are unsure of the correct processes.

If the death involves Aboriginal and Torres Strait Islander people, defer leadership to Aboriginal Community Controlled Health Organisations (ACCHOs), SEWB teams, Elders or community-nominated leaders, and adopt a supportive, collaborative role rather than independently coordinating community responses.

If you are also a suicide loss survivor

If you have experienced suicide bereavement at any time in your personal life, the emotional impact of losing a patient may be amplified when a patient dies by suicide.

In these cases, consider the following actions, all of which can be beneficial:

• personal grief support services
• time away from work
• peer support from clinicians with lived experience
• adjustments to your workload

Best practice is to extend to yourself the same compassion you extend to your patients.

When a clinic’s patient dies by suicide, the impact can be felt across the whole practice, including GPs, nurses, reception staff, practice managers and allied health professionals. They may all experience shock, grief, guilt or anxiety, even if their contact with the patient was brief. Early acknowledgement of this impact helps reduce their sense of isolation and distress.

To provide practical help to staff:

• hold a timely, optional staff check‑in to connect with others
• communicate clearly and openly
• acknowledge the loss
• remind yourself and your team that suicide is complex and influenced by many factors that are beyond the scope of clinical care
• normalise a range of emotional responses: remind yourself and others that people will have different coping styles, and that these need to be respected
• remind staff about what they can say to other patients to reduce uncertainty and fear (and what they shouldn’t talk about)
• encourage staff to take care of themselves and to watch for signs of distress in each other
• encourage staff to access support such as employee assistance programs, peer support, or external counselling if needed
• it is suggested to consider the circumstances of the person you are speaking to before sharing specific details of the death. Vulnerable people may be adversely impacted by this information