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The weeks following a death present a challenge for everyone in the community: trainees, faculty, program staff, and clinical partners in the hospitals and clinics. The sections below describe some of the best practices in providing support.
NOTE: Following the death of a trainee, particularly in the case of suicide, there is often a natural and immediate drive to imagine and/or determine causal factors. While natural, this tendency can also lead to misplaced blame, when the precipitating factors are much more complex, in the context of serious mental illness. The impacted teams should be cautious in too quickly "educating" on recognizing the signs of distress, inadvertently implying that the suicide could have been prevented if someone had acted. However, there are concrete things people can do when concerned about a colleague or friend. This section also outlines the realities faced by physicians and common sense approaches for reaching out when you are worried about someone else.
Helping Trainees Cope
In the aftermath of a death, trainees may feel emotionally overwhelmed, and this can disrupt patient care as well as learning and overall performance.
Most trainees have mastered basic skills to control their emotions, but these skills can be challenged, especially in the setting of a suicide. For some trainees it will be their first experience of death of an individual they personally know.
As physicians, however, the trainees are likely to recognize complex feelings and physical indicators of distress, such as stomach upset, restlessness, and insomnia. Some may experience death, especially suicide, as a psychological trauma, and will have symptoms related to that (hypervigilance, avoidant responses, intrusive memories, numbness, sleep disruption, or negative changes in mood).
These symptoms should lessen in intensity over time; if they do not lessen or if they are at a level of severity that interrupts the trainees functioning, the trainee should be encouraged to seek out mental health care.
Resource handouts on coping with grief:
Supporting Faculty and Staff
Although the faculty and staff will have known the trainee to varying degrees, the experience may still have a powerful personal impact. Taking the time to offer support in the aftermath of a traumatic event is important. Some faculty and staff deeply touched by the experience may need to discuss with their immediate supervisor whether they can take the rest of the day off and how to handle immediate workload. These individuals may also be directed to employee assistance program personnel or other in-house experts.
Faculty and staff should be reminded that:
Caring for self is an important part of professionalism and is critical in caring for others. Trainees learn from watching others model solid self-care practices. Faculty should rely on mental health support available to them.
Unattended feelings can lead to poor communication skills.
If you see something say something (speak with the trainee, call the PD if you see or notice changes in a trainee's behavior)
Build relationships with trainees deliberately
Trainees are working extremely hard. Remember to acknowledge that and thank them.
Share your own experiences mindfully - it is important for trainees to know that many of the difficulties are part of training.
If you are worried about a trainee, call the PD.
Ideally steps should be taken so that one individual, such as a PD, does not have to tell the story of the trainee’s death repeatedly.
Faculty and staff deeply affected and members of the Crisis Response Team should have a debriefing meeting with in-house experts. Reaching out to these individuals 2-8 weeks after the event is also a useful way to support their wellbeing and ongoing bereavement.
Talking with Someone You are Concerned About
When You Think a Colleague is Contemplating Suicide
Information about Physician Mental Health
References
AFSP American Foundation for Suicide Prevention and SpRC Suicide Prevention Resource Center. (2011). After a suicide: A toolkit for schools. Newton, MA: Education Development Center, Inc. Retrieved from www.afsp.org/content/download/1603/27543/file/toolkit.pdf.
Gould M., Jamieson, P., & Romer, D. (2003). Media Contagion and Suicide among the Young. American Behavioral Scientist, 46(9), 1269-1284, doi:10.1177/0002764202250670
Reeves, M.A., Nickerson, A.B., Conolly-Wilson, C.N., Susan, M.K., Lazarro, B.R., Jimerson, S.R., Pesce, R.C (2011) PREPaRE Workshop 1: Crisis prevention and preparedness: Comprehensive school safety planning (2nd ed). Bethesda, MD: National Association of School Psychologist.
Moutier, C., Norcross, W., Jong, P., Norman, M., Kirby, B., Mcguire, T., & Zisook, S. (2012). The Suicide Prevention and Depression Awareness Program at the University of California, San Diego School of Medicine, Academic Medicine. 87(3). 320-326. doi 10.1097/acm.)b)13e21824451ad
American Association of Suicidology, American Foundation for Suicide Prevention. Anneberg Public Policy Center, Associated Press Managing editors, Canterbury Suicide Project - University of Otago, Christchurch, New Zealand, Columbia University Department Recommendations for Reporting on Suicide. Retrieved from https://afsp.org/wp-content/uploads/2016/01/recommendations.pdf
Center, C., Davis, M., Detre, T., Ford, D.E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D.S., Mann. J., Mansky, P.A., Michels, R., Miles, S.H., Proujansky, R., Reynolds, C.F. 3rd, Silverman, M.M. (2003). Confronting Depression and Suicide in Physicians, JAMA, 289(23), 3161.doi:10.1001/jama.289.23.3161
Gold, K.J., Sen, A., & Schwenk, T.L. (2013). Details on suicide among US Physicians: Data form the National Violent Death Reporting System. General Hospital Psychiatry, 35(1), 45-49. doi:10.1016/j.genhosppsych.2012.08.005
Schernhammer, E.S., & Colditz, G.A. (2004) Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). American Journal of Psychiatry AJP, 161(12), 2295-2302.doi:10.1176/appi.ajp.161.12.2295
CDC National Center for Injury Prevention and Control. (2015). 10 Leading Causes of Death by Age Group, United States- 2014 Retrieved from http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif
Mata, D.A.,Ramos, M.A., Bansal, N., Khan, R., Guille, C., Angelantonio, E.D., & Sen, S.(2015) Prevalence of Depression and Depressive Symptoms among Resident Physicians. JAMA.314(22), 2373. doi:10.1001/jama.2015.15845
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Downs, N., Feng, W.,Kirby, B.,Mcguire, T., Moutier, C., Norcross, W., Norman, M., Young, I., Zisook, S. (2014). Listening to Depression and Suicide Risk in Medical Student: The Healer Education Assessment and Referral (HEAR) Program. Academic Psychiatry. 38(5), 547-553. doi:101.1007/s40596-014-0115-x.
Guille.C., Zhao, Z.,Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web- Based Cognitive Behavioral Therapy Intervention for the Prevention of Sucidal Ideation in Medical Interns, JAMA Psychiatry, 72(12), 1192. doi:10.1001/jamapsychiatry.2015.1880
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