Skip to content
University of Colorado Anschutz Medical Campus CU Anschutz
  • Webmail
  • UCD Access
  • Canvas
  • Quick Links
 

Tools & Resources

  • Events Calendar
  • Newsroom
  • Strauss Health Sciences Library
  • Department A-Z Directory
  • Campus Directory
  • Leadership
  • Faculty & Staff Resources
  • Supporter & Alumni Resources
  • Student Resources
  • Campus Map
  • University Policies
  • Give Now

CU Campuses

  • CU Anschutz Medical Campus
  • CU Boulder
  • CU Colorado Springs
  • CU Denver
  • CU System
  • CU Online

CU Anschutz Medical Campus

  • School of Dental Medicine
  • Graduate School
  • School of Medicine
  • College of Nursing
  • Skaggs School of Pharmacy and Pharmaceutical Sciences
  • Colorado School of Public Health

Department of Psychiatry

School of Medicine

18
  • Home
    • About the Department of Psychiatry
    • Our Divisions
      • Division of Adult Psychiatry
      • Division of Neuroscience
      • Division of Community, Population, and Public Mental Health
      • Division of Addiction Science, Prevention and Treatment
      • Division of Child and Adolescent Psychiatry
    • Department of Psychiatry Wellness Initiatives
    • Faculty Directory
    • Newsroom
    • The Good Newsletter
    • Mind the Brain Podcast
    • Employee Intranet
  • Community
    • Behavioral Health & Wellness Program
    • CeDAR
    • The Community Based Intervention and Implementation Research Group (CIIRG)
      • Family Journey Assessment Research and Training Materials
      • Mental Health Behavior and Literacy Scale Research and Training Materials
    • Community Engagement Services
      • Community Education
      • Professional Education
      • About Us
    • COVID-19 Support
      • Resources for Parents
      • Resources for CU Anschutz Students, Faculty and Staff
      • Resources for Our Patients
      • Resources for Healthcare Providers
      • Resources for Telemental Health
      • Resources For Special Populations
      • Resources for Mindfulness, Relaxation, Anxiety and Well-being
      • Resources for Community Needs
      • Faculty and Staff Mental Health Services
    • Faculty and Staff Mental Health
    • Immigrant and Refugee Mental Health
    • Mind the Brain Podcast
    • Veteran Suicide Prevention
  • Education
    • Affiliated Programs
      • Behavioral Neurology & Neuropsychiatry Fellowship
    • Externships
    • Internships
      • Psychiatry Undergraduate Research Program and Learning Experience
        • Our Students
        • Student Outcomes
        • Application
        • Symposium Archive
        • FAQs
        • Our Partners
      • Master's of Social Work Internship
    • Fellowships
      • Addiction Psychiatry Fellowship
      • Child and Adolescent Psychiatry Fellowship
        • Eligibility and Application
      • Consultation-Liaison Psychiatry Fellowship
      • Developmental Disabilities Fellowship
      • Developmental Psychobiology Research Group T32 Training Program
      • Emergency Psychiatry Fellowship
      • Forensic Psychiatry Fellowship
      • Harris Program Fellowships
        • Meet The Faculty
        • Clinical Training Sites
        • Apply Harris Program
          • University-based Fellows
      • Clinical Health Psychology Postdoctoral Fellowship
      • Psychiatry Fellowships
      • License Clinical Social Worker Fellowship
    • Irving Harris Program in Child Development and Infant Mental Health
    • Medical Student Education
      • Leadership Team
    • Office of Education and Training
    • Psychiatry Residency
      • Rotations & Sites
      • Research & Clinical Training Tracks
      • 2022-23 Recruitment Information
      • Resident Profiles
    • Volunteer Faculty
    • PEACS Education & Training
  • Patient Care
    • CU Medicine Outpatient Psychiatry Clinic
    • Behavioral Health & Wellness Program (BHWP)
      • About Us
      • Resources
    • Child & Adolescent Services
      • Children's Hospital Pediatric Mental Health Institute
      • Children's Hospital Pediatric Mental Health Institute (PMHI)
    • Colorado Center for Women's Behavioral Health & Wellness
      • Clinical Services
      • Research and Clinical Trials
    • Connections Program for High-Risk Infants and Families
      • Our Team
      • Clinical Services
      • Resources for Families
      • Resources for Providers
      • Current Research
      • Training and Education
    • Faculty and Staff Mental Health
      • Frequently Asked Questions
    • Immigrant and Refugee Mental Health
    • JFK Partners
    • Johnson Depression Center
    • Obsessive Compulsive Disorder Program
      • Group Therapy
      • Reclaim™ Deep Brain Stimulation Therapy for OCD
      • Referral Process
      • Intrusive Thoughts - OCD Program Newsletter
      • OCD Program Clinical Team
    • PEACS
    • Stress, Trauma, Adversity Research, and Treatment (START) Center
      • Clinical Services
      • Our Team
    • Student and Resident Mental Health
      • Clinical Team
      • FAQs
      • Group Therapy
    • Substance Use Disorders
      • Addiction Research and Treatment Services (ARTS)
      • Center for Dependency, Addiction, and Rehabilitation (CeDAR)
      • Encompass: Integrated Mental Health/Substance Treatment
      • Project Safe
      • Center for Dependency, Addiction, and Rehabilitation (CeDAR)
    • Transcranial Magnetic Stimulation (TMS) Clinic
  • Programs & Centers
    • Colorado Center for Women's Behavioral Health & Wellness
    • Connections Program for High-Risk Infants and Families
    • Developmental Psychobiology Research Group
    • Project Safe
    • Psychiatry Research Innovations (PRI)
      • PEACS
        • Understanding Risk
        • PEACS Referrals & Consultation
        • PEACS Clinical Services
        • PEACS Research
        • PEACS Meet our Team
        • PEACS Education & Training
        • Related Programs
        • Further Resources & Information
        • How You Can Help
    • Stress, Trauma, Adversity Research, and Treatment (START) Center
    • VA Rocky Mountain MIRECC
    • Women's Behavioral Health and Wellness
  • Research
    • Affiliated Programs
      • Coleman Institute
      • JFK Partners
      • Colorado Journal of Psychiatry and Psychology
        • Submission Guidelines
    • Faculty Labs
      • Behavioral Immunology and Endocrinology Lab
      • TrAIL Lab
      • Colorado Neuroscience of Behavioral Health and Wellness Research Group
      • CHAOS Lab
      • Neurodevelopmental and Neuropsychiatric Genetics Research Lab
      • Emotion and Development Lab
      • Developmental Psychiatry Research Lab
      • Behavioral Immunology and Endocrinology Lab
      • CONA Lab
    • Psychiatry Research Innovations (PRI)
      • Cores & Services
    • Services
      • Brain Imaging Center
        • How To Set Up A Study
  • Diversity, Equity & Inclusion
    • Report an Incident of Bias
    • Department Vision & Mission
    • Resources
    • DEI Committee & Subcommittees
    • About DEI
    • Psychiatry Wellness Initiatives
  • Site Directory
  • Colorado Bipolar Education Project
    • Patients & Families
    • Providers
    • About Us
University Quick Links

     

     

    Response to Patient Suicide 

     

    2012 Task Force Members: Laura Martin, MD; Jennifer Hagman, MD; Joel Yager, MD; Hal Wortzel, MD; Colleen McGuire, MD; Ergi Gumusanelli, MD

    Updated 2016: Rachel Davis, MD and Jenna Cook, MD

     

     

     

    Visit the Suicide Risk Assessment Page

     

     

     

    Learning Objectives and Introduction

    Suicide Risk Assessment and Response is a four-hour didactic course for R-1 psychiatry residents.   It involves interactive case discussion, a lecture on suicide risk assessment, and a panel discussion of psychiatrists who have lost patients to suicide.

    ​

    Goals and Objectives for the course include:

    ​

    • Developing a beginning understanding of how to structure a suicide risk assessment.

     

    • Increasing familiarity with suicide risk factors and protective factors.

     

    • Understanding that some patients will die from suicide as a result of their illness. 

     

    • Understanding that we cannot accurately predict suicide risk for any individual patient.

     

    • Understanding that clinical failures are not personal failures.

     

    • Developing an awareness of post-suicide reactions.

     

    • Developing an awareness with resources for support after a suicide. 

     

    • Familiarity with University of Colorado Department of Psychiatry residency guidelines for response to patient suicide. 

    As you are aware, one of the most difficult challenges during the career of a psychiatrist is having a patient commit suicide.  This challenge can be especially difficult for psychiatrists in training.  This toolkit is meant to provide you with an introduction to basic concepts of suicide risk assessment.  It is also meant to provide you with information about what it can feel like for a psychiatrist after a patient commits suicide and how to handle these reactions.

    Between 32 – 61% of residents will have a patient who commits suicide prior to or during residency, and 50% of residents who have had a patient commit suicide will have encountered this within their first post-graduate year.  This high rate may be due to the large number of patients treated, the high level of psychopathology in these patients, the inexperience of the residents, or the frequent transitions in care-settings and providers experienced by these patients.  The death of a patient by suicide has a profound impact on any treating physician.  Residents in training may be more vulnerable because they are forming their professional identity.  Formal training can help enhance risk assessment and documentation.  Supervisors and residents also need to learn how to recognize and handle their reactions through formal support, informal support, and the recognition that any support may need to occur over months, as the effect of the suicide is not merely an acute event.

    There is no way to fully prepare for this event.  However, you should walk away from this toolkit with (1) the expectation that some patients will die from suicide as a result of their severe illness, (2) an awareness that although we can recognize and assess risk factors, we cannot accurately predict suicide risk for any individual, (3) the knowledge that clinical failures are not personal failures, (4) a review of risk assessment, and (5) an introduction to post-suicide reactions and mechanisms for support (Simon, RI and Hales, RE. Textbook of Suicide Assessment and Management).

     

     

     

    Following a Suicide (Resident Guidelines)

    Patient suicide guidelines for RESIDENTS

     

     

    This document is to serve as a guideline for residents and faculty and should not take the place of sound clinical judgment.  Each event should be evaluated on a case by case basis.  The particular sequence of actions taken should be tailored to the specific patient, resident(s) and attending involved with the case. 

     

     

    In the event of suicide, or news of suicide event, during regular work hours: 

     

    • Contact chief resident and attending on service.
    • Discuss with chief resident and attending how contact with the family of the patient will be handled.
    • If unable to complete clinical duties that day, let your chief resident and attending know what work needs to be done so they can ensure the completion of this work.
    • If time off is needed, contact chief resident and attending for assistance in making arrangements.
    • Team debriefing including all involved residents, attendings, medical students, and other staff should occur within 72 hours of event.
    • Notify residency director, Dr. Robert Davies, of event.
    • Meet with Dr. Rachel Davis, the designated support person for patient suicide, within 72 hours of the event.

       Rachel Davis, MD              (W) 303-724-8244, (C) 303-579-5748

     

                  Rachel.Davis@CUAnschutz.edu

     

    • Follow up meetings with Dr. Davis as needed for the first month and arrange a second meeting 8 weeks following the event for follow-up – this is not intended to be therapy.   However, a determination of whether additional therapy is needed should be made and if appropriate, a referral can be placed.
    • Participate in a quality assurance and M&M presentation of the case.  For the M&M case the attending and chief resident involved in the case should also be in attendance.  Attendings and residents should present portions of the case and should all be involved in the preparation of the presentation per hospital policy.

     

    *If you have switched to night float or another service when the debriefing or M&M is to take place, contact the training    office for assistance in getting time off to attend this event. 

     

     

    In the event of a suicide event during on-call hours:

     

    • Contact the on-call attending to relay information about the event.
    • Contact chief resident and patient’s service attending.
    • Option to sign out to jeopardy if needed, to be discussed with chief resident and on-call attending.
    • Otherwise follow resident protocol above.

    Patient suicide guidelines for CHIEF RESIDENTS

     

    This document is to serve as a guideline for residents and faculty and should not take the place of sound clinical judgment.  Each event should be evaluated on a case by case basis.  The particular sequence of actions taken should be tailored to the specific patient, resident(s) and attending involved with the case. 

     

    In the event of suicide, or news of suicide event, during regular work hours:

     

    • Make contact with residents who cared for patient – both resident on service and residents who previously cared for patient, if applicable.
    • Contact attending on service if not already done.
    • Discuss with resident and attending how contact with the family of the patient will be handled.
    • Meet with resident for immediate check-in and to determine how to help the resident if they are unable to complete their clinical duties that day.
    • When immediate responsibilities are taken care, discuss need for time off with affected resident and attending.  Involve training director as needed.
    • Meet with involved medical students for a check-in and to assess need for additional support.
    • Contact medical student educational coordinator.
    • Team debriefing including all involved residents, attendings, medical students, and other staff should occur within 72 hours of event.
    • Participate in a quality assurance and M&M presentation of the case. For the M&M case the attending and chief resident involved in the case should also be in attendance.  Attending and resident should present portions of the case and should all be involved in the preparation of the presentation per hospital policy.
    • Consider optional meeting with Dr. Rachel Davis, the designated support person for patient suicide.

    Rachel Davis, MD              (W) 303-724-8244, (C) 303-579-5748

               Rachel.Davis@CUAnschutz.edu

     

    In the event of a suicide event during on-call hours:

     

    • Check-in with on-call resident about event by phone and provide support as indicated.
    • Decide with on-call resident who will contact back-up attending and attending on service.
    • Discuss with on-call resident option of being relieved of call duties if needed.  If indicated, contact jeopardy call resident.
    • Discuss with resident and service or on-call attending any contact or notification of family members which needs to occur and assist as needed.
    • Otherwise follow chief resident protocol above.


      

    This document is to serve as a guideline for residents and faculty and should not take the place of sound clinical judgment.  Each event should be evaluated on a case by case basis.  The particular sequence of actions taken should be tailored to the specific patient, resident(s) and attending involved with the case. 

     

    In the event of suicide, or news of suicide event, during regular work hours:

    • Make contact with resident who cared for patient and chief resident for immediate check-in.
    • Discuss with resident and chief resident how contact with the family of the patient will be handled and assist residents with family interactions.
    • Attending should notify the Medical and Service Directors, Training Director, Chair’s office of the event.
    • Attending should determine if the Risk Management Office should be notified about the case.
    • When immediate responsibilities are taken care, discuss need for time off with affected resident and chief resident.  Involve training director as needed.
    • Team debriefing including all involved residents, attendings, medical students, and other staff should occur within 72 hours of event.
    • Participate in a quality assurance and M&M presentation of the case.  For the M&M case the attending and chief resident involved in the case should also be in attendance.  Attending and resident should present portions of the case and should all be involved in the preparation of the presentation per hospital policy.
    • Consider quarterly safety case conferences.

     

    In the event of a suicide event during on-call hours:

     

    On-Call Attending

    • Check-in with involved on-call resident by phone or in person for support.
    • If possible, come to hospital to evaluate and document regarding event.
    • Notify chief resident and service attending if not already done.

     

    Service Attending

    • Notify resident who cared for patient of event and provide immediate check in.
    • Otherwise follow attending protocol above.

    General Questions 

    • Should I talk with my colleagues?  
    • How much should I reveal to them?
    • Should I worry in my revelations to them or even the experience of losing future referrals, or their perception of me? 
    • How should I begin to address the suicide for myself? 
    • How is this going to affect my treatment with other patients? 
    • Is it best to try not to think about it and pretend it didn’t happen? Or should I engage in an activity that would help me to learn from the experience? 
    • Or would that be too painful in reliving it again? 
    • Is it unrealistic to think that this will affect my career?
    • What is the difference between a clinical case conference and an M&M? 
    • Which will be employed and when? 
    • How should I prepare? 

     

    Questions about interacting w/ the family 

     

    • Should I contact family? 
    • If so what method should I use (phone, letters, even visit?)
    • What should I say to the family (should I be supportive, explanatory?)
    • What should I do if they accuse or blame me? 
    • How much should I reveal to them about my thoughts on what went wrong?
    • What do I do if the family member needs urgent crisis management after I break the news?
    • How much of what I say and how I say it impacts the chances for litigation? 

     

    [Adapted from the Columbia University Medical Center Packet for Resident Whose Patient Committed Suicide] 

     

    Reactions to Suicide

    Initial Reactions

    • Disbelief
      Denial
    • Depersonalization (numbness, sense of unreality, spaciness)
    • Shock

    Second-phase Reactions

    • Grief (loss of patient, loss of hoped for goals with patient, loss of fantasies related to power, influence and the ability to make a difference)
    • Shame
    • Guilt
    • Fear of blame
    • Anger (feelings of betrayal, a waste of work together, for engendering guilt and shame, for inadequate support, to protect against guilt)
    • Relief
    • Finding of omens (identifying clues before the death may provide an illusory sense of control)
    • Subsequent behavioral changes
    • Conflicting feelings of specialness (isolation vs. rite of passage)

    Other Symptoms

    • Anxiety
    • Depression
    • Acute/post-traumatic stress disorder
    • Sleep difficulties
    • Suicidal thoughts
    • Accident Proneness
    • Intrusive thoughts
    • Exaggerated Startle (especially to pagers/late night calls)

    Predictors of Stress

    • Younger Age
    • Less Experience
    • Intensity of Involvement
    • Institutional Response
    • Female
    • Decreased flexibility/resilience
    • Pre-existing depression or anxiety

    Ways to Cope

    Decrease isolation by talking to people

  • Co-residents
  • Chief residents
  • Training directors
  • Attending Supervisors involved in case
  • Attending Supervisors NOT involved in case
  • Prior Attending Supervisors NOT involved in case
  • Therapist
  • Family
  • Friends
  •  



  • Consider being a resource for a younger resident
  • Consider giving a case conference on the topic
  • Consider giving an APA workshop on the topic
  • Consider writing a paper about your experience
  • Consider taking a day off of work to reflect
  • Read literature on suicide risk assessment
  • Read literature on dealing with the death of a patient
  • Engage in Reparative Behaviors
  •  

    [Adapted from Chapter 24: Psychiatrist Reactions to Patient Suicide by Dr. Michael Gitlin in Simon, RI and Hales, RE. Textbook of Suicide Assessment and Management. 2006. American Psychiatric Publishing, Inc. Washington, DC. snd the Columbia University Medical Center Packet for Resident Whose Patient Committed Suicide]

    • Immediately seek survivor-sensitive peer support and/or consultation
    • Be knowledgeable about survivor symptoms that are role-specific to care givers
    • Monitor personal activities of daily living as well as any increased hypervigilance, cognitive confusion or dissociation
    • Be aware of any change in the incidence of hospitalization and/or referral of patients who present with issues or problems similar to those of the deceased patient (this could be projection)
    • Be aware of any increased use of gallows humor, paranoia or inappropriate affect and content 
    • Avoid distancing, withdrawal or isolation from supports
    • Note any increased use of maladaptive behaviors (drinking, eating, drug use)
       

    [Adapted from Table 23-2 from Chapter 23: Aftermath of Suicide: The Clinician’s Role in Simon, RI and Hales, RE. Textbook of Suicide Assessment and Management. 2006. American Psychiatric Publishing, Inc. Washington, DC.]


     

    Resources

    Support Contacts 

    (CU residents, contact Rachel Davis for password)

    Articles

    (For University of Colorado psychiatry residents, email Rachel Davis if you have difficulty accessing full text articles)​

    Gitlin - A Psychiatrist's Reaction to a Patient's Suicide

    Hendin - Problems in Psychotherapy With Suicidal Patients

    Kaye - The Psychiatrist's Role, Responses, and Responsibilities When a Patient Commits Suicide

    Hendin - Therapists' Reactions to Patients' Suicides

    Chemtob - Patients' Suicides: Frequency and Impact on Psychiatrists

    Hendin - Factors Contributing to Therapists' Distress After the Suicide of a Patient

    Ruskin - Impact of Patient Suicide on Psychiatrists and Psychiatric Trainees

    Dewer - Psychiatric Trainees' Experiences of, and Reactions to, Patient Suicide

    Gulfi - The Impact of Patient Suicide on the Professional Practice of Swiss Psychiatrists and 

    Psychologists

     

    Web Resources

    Uniting for Suicide Postvention

    American Association of Suicidology (AAS) Clinician Survivor Task Force Bibliography

    • Clinical Section

    American Psychiatric Association – Helping Residents Cope with a Patient Suicide

    Survivors of Suicide

    Physician Litigation Stress Resource Center


     

    References

    Impact of Suicide on Practitioners

    ​

    Biermann B: When depression becomes terminal: the impact of patient suicide during residency. J Am Acad

    Psychoanal Dyn Psychiatry 31:443-457, 2003.

     

    Brown HN: Patient suicide during residency training, I: incidence, implications, and program response. J Psychiatr Educ 11:201-216, 1987b.

    ​

    Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY:  Patients' suicides: frequency and impact on psychiatrists.  Am J Psychiatry 1988; 145:224-8

    ​

    Gitlin, MJ. A Psychiatrist’s Reaction to a Patient’s Suicide. American Journal of Psychiatry 156(10):1630-

    1634, 1999.

    ​

    Havens, LL. The Anatomy of Suicide. New England Journal of Medicine 272:401-406, 1965.

    Hendin H, Haas AP, Maltsberger JT, et al: Factors contributing to therapists’ distress after the suicide of a

    patient. Am J Psychiatry 161:1442-1446, 2004.

    ​

    Hendin H, Ligpschitz A, Maltsberger JT, et al: Therapists’ reactions to patients’ suicides. Am J Psychiatry

    157:2022-2027, 2000.

    ​

    Hendin H, Haas AP, Maltsberger JT, Koestner B, Szanto K.  Problems in psychotherapy with suicidal patients.
    Am J Psychiatry. 2006 Jan;163(1):67-72

    ​

    Kaye NS, Soreff SM. The psychiatrist’s role, responses and responsibilities when a patient commits suicide.

    Am Journal of Psychiatry 148(6): 739-743, 1991.

    ​

    Litman RE: When patients commit suicide. Am J Psychother. 19:570-576, 1965.

    ​

    Lomax JW: A proposed curriculum on suicide care for psychiatry residency. Suicide and Life-Threatening

    Behavior. 16(1): 56-64, 1986

    ​

    Misch, DA. When a Psychiatry Resident’s Patient Commits Suicide: Transference Trials and Tribulations.

    Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 31(3):459-475, 2003.

    ​

    Perr, HM. Suicide and the doctor-patient relationship. American Journal of Psychoanalysis 18:177-188,

    1968.

    ​

    Reeves, G. Terminal Mental Illness: Resident Experience of Patient Suicide. Journal of the American

    Academy of Psychoanalysis and Dynamic Psychiatry 31(3):429-441, 2003.

    ​

    Sacks MH, Kibel HD, Cohen AM, et al: Resident response to patient suicide. J Psychiatr Educ 11:217-226,

    1987.

    ​

    Simon, RI and Hales, RE. Textbook of Suicide Assessment and Management. American Psychiatric

    Publishing, Inc. Washington, DC., 2006.

    ​

     

    Books:

    Myers M.  Touched By Suicide: Hope and Healing After Loss
    Written with Carla Fine, author of the best-selling No Time to Say Goodbye: Surviving the Suicide of a Loved One (Broadway Books/ Doubleday 1999).

     

    Contact

     

    Rachel Davis, MD

    1890 N Revere Ct, Room 5066

    Aurora, CO  80045

    Rachel.Davis@CUAnschutz.edu
    Tel: 303-724-8244
    Fax: 303-724-8859

     

     

    • Education

    • Affiliated Programs
    • Externships
    • Internships
    • Fellowships
    • Irving Harris Program in Child Development and Infant Mental Health
    • Medical Student Education
    • Office of Education and Training
    • Psychiatry Residency
    • Volunteer Faculty
    • PEACS Education & Training

     

     

    Psychiatry (SOM)

    CU Anschutz

    Anschutz Health Sciences Building

    1890 N Revere Ct

    Suite 4003

    Mail Stop F546

    Aurora, CO 80045


    303-724-4940

    Campus Links
    • Anschutz Medical Campus
    • School of Medicine
    • Campus Directory
    • Maps
    Patient Links
    • Make an appointment
    • Find a researcher
    • Donate
    Faculty Links
    • Newsletter
    • Calendar
    • Faculty
    • Contact Us
    • Website Feedback
    • CU System
    • Privacy Policy
    • Terms of Use
    • Accessibility
    • Accreditation
    • Employment
    • Give Now
     

    © 2022 The Regents of the University of Colorado, a body corporate. All rights reserved.

    Accredited by the Higher Learning Commission. All trademarks are registered property of the University. Used by permission only.

    CMS Login

    Webmail

    UCD Access

    Canvas

    Opens in a new window Opens document in a new window