13 After a Suicide | A Toolkit for Physician Residency/Fellowship Programs Notification should occur as soon as possible, ideally the same day of the death or before work starts in the morning. If there are residents who were very close to the deceased who are known to the institution (significant others, close friends), they should be notified first and separate from the others. Members from the Crisis Response Team should connect regularly with these individuals over the next few weeks. Although it is permissible to disclose a resident has died, the cause of death should not be disclosed unless approved by the emergency contact person. In situations where the family does not want the cause of death shared with other residents, it is still important to acknowledge the death and follow that immediately by saying or writing about the supportive mental health resources that are available to the residents. If the cause of death has not been confirmed and there is an ongoing investigation, individuals on the Crisis Response Team should state that the cause of death is still to be determined and additional information will be forthcoming. Suggested processes and oral as well as written scripts to help convey this information are provided below and in Appendix C and D. Notifying Residents in the Same Program as the Deceased Resident • Should occur in-person the same day of the death or before work starts in the morning • If possible to divide the residents into small groups to deliver the news, this is recommended in order to encourage honest dialogue and to avoid group escalation in anxiety, which is more likely in a large group setting; if not possible, the office staff should secure a room large enough to hold all residents in the same program as the deceased resident • The office staff should page/call every resident telling them of an emergency mandatory meeting; residents who cannot be reached by phone can be emailed with instruction to call in as soon as possible regarding “sad news”; residents who are off from work should be called and asked to come in to attend the meeting • Program Leadership including APDs and PCs should attend this meeting • It can be helpful to have mental health counselors/psychologist, chaplain services, and employee assistance counselors available at the meeting when possible • During the meeting, the Crisis Response Team members should introduce themselves (if not known to the residents) and other guests. Tips for how to talk about suicide and avoid contagion are provided above. Sample scripts to relay information in person about the death can be found in Appendix C. Share accurate information about the death of the resident, as permitted by the emergency contact person. • If the emergency contact person refuses to allow disclosure, members of the Crisis Response Team can state: “The family/emergency contact person has requested that information about the cause of death not be shared at this time.” Members of the Crisis Response Team can take the opportunity to talk with residents about suicide in general terms, and state: “We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed, struggling, or may be suicidal.” • Allow residents to express their grief, and identify those who may need additional support and resources. Explain that everyone’s grief response is different — some residents will need time off and others may find solace in working. Commit to providing coverage or changing schedules as needed. Remind all residents of the importance of seeking help if they are experiencing difficulty, and how to do so.