Carolyn Chew-Graham is a GP in Manchester and Professor of General Practice Research. Her academic work focuses on management of people with mental health problems in primary care.
Sohrab Panday is a GP and Clinical Commissioning Lead in Derbyshire who delivers suicide postvention training nationally.
Over a general practice career, it is inevitable that we will encounter both trauma and loss. This article describes how we can support colleagues after a patient suicide. Both authors share their experiences and recommendations to prepare and support colleagues when a patient dies by suicide.
Personal experiences
Following the death by suicide of a patient one author felt there was an absence of support or guidance for colleagues. The initial shock is typical of bereavement, yet somehow the professionals are not expected to grieve. Thus, feelings are not expressed or explored, leading to a sense of isolation. This is termed ‘disenfranchised grief’.1 There is often also the inevitable anxiety over the subsequent inquest, which may be perceived as a fault-finding exercise. In cases involving the involvement of several services it takes much longer to reach a hearing. The coroner may call the GP to be a witness, which includes presenting a report at inquest and answering direct questions from legal representatives. The author reflected on how they felt when the verdict was suicide, and no fault was found: the loneliness and vulnerability of the whole process was deeply impactful.
“Responders disclosed an unpreparedness to deal with suicide.”
This GP reflected on the impact of suicide on themselves, the wider practice team, and indeed the local community. There is a need to reach out to the bereaved family in a sensitive way to ensure they can access postvention support. As a result of their experiences, this GP committed himself into learning all they could about postvention and how we in primary care can be better prepared and individuals better supported. This ultimately resulted in the production of a Postvention Support Pack for General Practice.2
A qualitative study
The feelings described by this GP were reflected in a qualitative study — interviews conducted with GPs who had experienced a patient suicide or who had been involved in supporting parents whose adult children had been bereaved by suicide.3 Responders disclosed an unpreparedness to deal with suicide. They reflected how they were emotionally affected by a suicide of a patient of theirs, often empathising with the family while experiencing feelings of guilt. Many felt they did not have the space to deal with their own grief or had to push aside feelings for the sake of their patients, potentially at the expense of their own wellbeing. Some responders felt these significant events impacted on the quality of care for subsequent patients. Some described mechanisms to protect themselves and the use of informal support from colleagues and family as an essential tool to give them the space to reflect and unburden feelings. Many GPs acknowledged the vulnerabilities of working in isolating and high-stress roles, most of them realising the importance of addressing these. However, they revealed (and confirmed) that there are no formal systems to protect them or alleviate the secondary impact on their patients.
Development of postvention support pack
The Derbyshire Postvention support pack2 created in response to the need to support clinicians and staff has been proactively shared across Primary Care Networks and has attracted national interest by leaders in the field of general practice, psychiatry, and suicide prevention. Hence, a National Template (and user guide) was created for any Integrated Care Board (ICB) in the UK to adapt and adopt for their local use (see Box 1 for resource URLs).4,5 This involves consulting system partners in their ICB to identify what are the key local resources and data; and putting this information in ten fillable PDF boxes. The postvention pack is endorsed by the RCGP and NHS Practitioner Health.
| Box 1. The Suicide Postvention Support Pack for General Practice resources |
| The Derbyshire Support Pack 2024 |
| The National Template 2024 |
| The User Guide 2024 |
Responsibilities of the practice
After the suicide of a patient, general practices have an obligation to provide reports for the ICB patient safety team, a report to the Learning from Patient Safety Events, the CQC, the coroner, and rarely even the GMC.
In addition, the practice needs to take stock of any potential deficiencies in the care provided without delay, be non-judgemental, as rarely is there simply one causal factor, be open and keen to learn and improve. Yet this happens at a time when some staff or sometimes the whole team are in shock and grieving.1 There are important pastoral needs that may need to be addressed within the team and indeed some may need specialist support themselves. The family and close friends of the deceased will need support and the offer of postvention specialist therapy; not least because they now have a raised risk of suicide as a result of their bereavement. The family may have been directed to such via the coroner’s office already, but primary care can re-emphasise it and offer ongoing support.
Reflecting on the use of the pack
“The postvention pack is endorsed by RCGP and NHS Practitioner Health.”
One of the authors reflected on a suspected death by suicide of a patient they had seen recently. When they were informed by a staff member of the death there was initial sense of shock; which was swiftly replaced by anxiety; “…did I do something wrong? …let me check the contemporaneously written notes … did I document everything?” After a sleepless night, the GP circulated the Postvention pack2 to GP colleagues and the practice manager, asking if they could work through it as a team.
This pack was perceived as really relevant to the practice and immediately acted upon. The legal requirements were followed; the manager and partners gave support to the GP most involved with the deceased patient, who in turn was enabled to give support to the bereaved spouse. The discussion around the Significant Event Analysis allowed the practice to reflect on whether there were things that could have been done differently.
- Please do look at the Suicide Postvention Support Pack.2
- Check out a similar resource developed for Psychiatrists impacted by suicide.6
- Make your colleagues aware that it can be adapted and adopted for local use by using the National Template and User Guide.2
- Read about how practices in Derbyshire are praising the support pack.7
Most importantly, please be alert to the need to support members of your practice when a suicide occurs. The impact may otherwise go unmitigated. We need to be there for each other as well as for our patients.
Deputy Editor’s note – see also:
- https://bjgplife.com/bandaging-our-own-wounds-how-do-we-support-each-other-when-a-colleague-dies-by-suicide/
- https://bjgplife.com/under-the-spotlight-supportive-guidelines-to-maintain-psychological-wellbeing-for-staff-involved-in-patient-coroner-investigations/
References
- Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA, England: Lexington Books/D. C. Heath and Com.
- Panday S. Suicide postvention. Support pack for general practice in Derbyshire – June 2024. 2024. https://www.derbyshirepathfinder.nhs.uk/wp-content/uploads/20210712-Suicide-Post-Vention-Practice-Guide.pdf (accessed 3 Jun 2025).
- Foggin E, McDonnell S, Cordingley L, Kapur N, Shaw J, Chew-Graham CA. GPs’ experiences of dealing with parents bereaved by suicide: a qualitative study. BJGP. 2016. Oct;66(651): e737-46. DOI:https://doi.org/10.3399/bjgp16X686605
- Panday S. Suicide postvention support pack for general practice (national template). 2024. https://s3.eu-west-2.amazonaws.com/crstl-assets/health-wellbeing/files/Suicide-Postvention-Support-Pack-for-General-Practice-National-Template-June-2024.pdf (accessed 3 Jun 2025).
- Panday S. User guide – suicide postvention. 2024. https://s3.eu-west-2.amazonaws.com/crstl-assets/health-wellbeing/files/June-2024-User-Guide-for-Suicide-Postvention-Support-Pack-for-General-Practice-National-Template.pdf (accessed 3 Jun 2025).
- Hawton K, Brand F, Croft A, et al. If a patient dies by suicide: a resource for psychiatrists. 2020. https://www.rcpsych.ac.uk/docs/default-source/members/supporting-you/if-a-patient-dies-by-suicide/when-a-patient-dies-by-suicide-a-resource-for-psychiatrists-2020.pdf (accessed 10 Jun 2025).
- Derbyshire support pack for suicide praised by practices 1st October 2024, https://joinedupcarederbyshire.co.uk/news/derbyshire-support-pack-for-suicide-praised-by-practices/ [accessed 15/5/25]
Featured photo by Cherry Laithang on Unsplash.
