14 After a Suicide | A Toolkit for Physician Residency/Fellowship Programs • Remind the residents of the processes in place for accessing care: — — Provide a list of individuals, such as attendings who are available to residents, and who the residents can reach out to talk about the loss and to debrief; this is not mental health treatment, but rather supportive debriefing with an advisor/mentor — — Include institutional and community-based mental health providers — — Clinical treatment may be indicated for sleep, anxiety, mood and prevention of a depressive episode (e.g., in a resident with a history of recurrent depressive episodes); explain how residents can access treatment, if indicated • Address barriers to engaging in self care: — — Explain the process for taking time off and how CRs or PDs will help arrange coverage; emphasize that over the course of training everything evens out and colleagues are happy to cover for them — — Remind residents that the PDs will not know who is receiving mental health care; consider having people in the audience speak about their own experience about seeking mental health care, or stating that many people who have never sought mental health services find speaking with a trained mental health professional at times like these very helpful — — Some residents may have heard that seeking mental health services may have negative ramifications on licensure; in fact, unaddressed mental health problems are much more likely to negatively impact safe practice or medical licensure than appropriate help-seeking behaviors • Remind residents if they have struggled with depression themselves or are actively getting mental health care, they may want to check-in with their therapist • Inform them of a clear mechanism to help identify anyone they are concerned about (e.g., who should they bring that information to if concerned) • Share information about suicide bereavement groups in the community (afsp.org/SupportGroups has a list of over 800 nation-wide support groups) • Ask if residents know if there are others (outside of the institution) who may need to be notified or sent resources; for example, the resident may have a significant other in the local area who is not known to the family but whom friends of the deceased know • As applicable, inform the residents about the funeral and process for requesting time-off to attend the funeral • Discuss plans for a memorial service (see Appendix E) Residents may also experience guilt about not recognizing the signs of distress and suicide risk in a co-resident. As physicians, residents tend to be people who are sensitive to others, and not having “noticed” the signs of distress can induce guilt. It is important to remind everyone that residents often feel the need to appear strong as part of their identity as physicians, and may likely cloak their feelings of anxiety, worry, and/or other psychiatric symptoms in order to carry out their job. This both makes it difficult to identify those in distress so they can receive assistance and ends up making individuals feel more isolated as no one knows how they really feel. Remind residents that hindsight is 20/20; as with all health outcomes, while many suicides can be prevented, not all can. This is really a great opportunity to highlight the importance of reaching out and the complexity of suicide — that it has multiple “causes” and that often, we do not know all of the things that the person was contending with, physically, emotionally or in terms of their life stressors/past experiences (for tips on how to talk about suicide, see the textbox on Page 10, and Appendix B).