18 After a Suicide | A Toolkit for Physician Residency/Fellowship Programs Working with the Community It may become necessary in the aftermath of a suicide to communicate with community partners such as the coroner/medical examiner and police. If warranted, the coroner or medical examiner is the best starting point for confirming that the death has in fact been declared a suicide. (In some cases, it may also be necessary to contact the police department to verify the information). However, given how quickly news and rumors spread (including through media coverage, email, texting, and social media), institutions may not be able to wait for a final determination before they need to begin communicating with the residents and faculty. There may also be cases in which there is disagreement between the authorities and the family regarding the cause of death. For example, the death may have been declared a probable suicide but the family believes it to have been an accident or possible homicide. Or the death may have been declared a suicide, but the family does not want this communicated, perhaps due to stigma, for fear of risking contagion, or because they simply do not (yet) believe or accept that it was suicide. Institutions have a responsibility to balance the need to be truthful with the community while remaining sensitive to the family. As mentioned above, this is an opportunity to educate the community (including potentially vulnerable residents) about the causes and complexity of suicide and to identify available mental health resources. Communication scripts can be found in Appendix C and D. The police will likely be an important source of information about the death, particularly if there is an ongoing investigation (for example, if it has not yet been determined whether the death was suicide or homicide). The Crisis Response Team will need to be in close communication with the police to determine (a) what they can and cannot say to the community so as not to interfere with the investigation, and (b) whether there are certain residents who must be interviewed by the police before the Crisis Response Team can debrief or counsel them in any way. In situations where law enforcement need to speak with residents to help determine the cause of death, a Crisis Response Team member may offer to accompany the residents for this discussion and notify institutional legal counsel. Memorialization Communities often want to memorialize a resident who has died. It can be a challenge to balance meeting the needs of distraught residents and staff while preserving the day-to-day activities of taking care of patients and learning. It is very important to treat all resident deaths in the same way to the extent possible. The approach for responding to the death of a resident from a car accident or cancer should be the same as for a resident who dies by suicide. This approach minimizes stigma and reduces the risk of suicide contagion. In the case of suicide it is very important not to inadvertently glamorize or romanticize the deceased resident or the death. It is best to emphasize the link between suicide and underlying mental health problems (such as depression, anxiety, and burnout). These conditions can cause substantial psychological pain while not being apparent to others. The first step is to discuss with the emergency contact person if they approve of a memorial service or remembrance event, and if so what an acceptable venue would be. Particular religious beliefs may make a chaplain service inappropriate, for example. A memorial service planning checklist can be found in Appendix E.