Overview
This panel discussion (Stegmann, Pickering, Keast, Bush) covers professional practice and ethical issues raised by patient suicide. It opens and closes with lists of support services for students themselves, presents two case vignettes in which a patient dies by suicide after clinical assessment, and poses discussion questions (pātai) about self-care and coping with family pressure after a patient’s death, before closing with a karakia.
Support services for yourself
- Student Health Services: free phone 0800 479 821 (including cell phones), tel 03 479 8212.
- Emergency Psychiatric Services (EPS): ph 03 474 0999, ask for EPS; alternatively via local DHB (healthpoint.co.nz/mental-health-addictions).
- Alcohol and Drug Helpline: 0800 787 797.
- 1737: free call or text, any time, for anyone needing to talk.
- Student Affairs Office: ph 03 479 7420, email oms.studentaffairs@otago.ac.nz, Sayers Building (Ground Floor), 290 Great King Street.
- Student Care Co-Ordinator: Ms Ayla Hawkins, ayla.hawkins@otago.ac.nz.
Case vignette 1: Mr C (Huntington’s disease)
Mr C, 43, whose father died at 52 from Huntington’s disease, had never been tested himself, saying he “didn’t want to know as he couldn’t change the outcome.” After a year of health concerns he was diagnosed with Huntington’s by his GP and admitted to hospital for care. He told the medical team he had always believed in suicide if life got too hard and would probably kill himself once the Huntington’s progressed. He was referred for psychiatric opinion on this basis; the psychiatrist concluded he did not have a psychiatric disorder. He was discharged home and died by suicide one week later.
Case vignette 2: Miss J
Miss J, 26, had been a patient of local psychiatric services for 8 years, with several prior presentations to Dunedin Hospital for suicidal behaviours, EPS assessment, and inpatient stays of up to 6 weeks, usually brought in by friends or family. More recently she was depressed and on medication; across 4 previous assessments she described suicidal thoughts and a suicide plan. Her family were greatly concerned and felt she was often discharged too soon, though J herself was usually keen to return home. On her final presentation to ED she was assessed by on-call EPS psychiatrist Dr B, who admitted her to the ward. After 24 hours of observation and further assessment she was discharged; six hours later she died by suicide. A week later her parents, angry about her care, came to the hospital accusing Dr B of negligence and demanded he be removed from the care of other patients.
Discussion questions (Pātai)
- What ideas/strategies help with managing self-care as a doctor when a patient takes their own life?
- What ideas/strategies help with coping with the stress and pressure felt from family members of patients who take their own life?
- What key messages should the audience take away?
Closing karakia
The session closes with a karakia whakakapi (closing blessing), presented in Māori with English translation: restrictions are suspended, the way is cleared, and there is a turn back to everyday activities, ending with “Haumi e, Hui e, Tāiki e” (unified, connected, blessed).
Self-test
- Describe the sequence of events in Case vignette 1, from Mr C’s diagnosis to his death.
- What did the psychiatric assessment conclude in Case vignette 1, and what decision followed from it?
- Describe Miss J’s history with psychiatric services prior to her final admission in Case vignette 2.
- Describe the sequence of events following Miss J’s final admission to ED, through to her family’s response one week later.
- List the three discussion questions (pātai) posed to the panel.
- List the support services for students given in the lecture, with one distinguishing contact detail for each.
- Compare the two case vignettes: what common professional practice and ethical issue do they both raise about assessing and discharging patients who express suicidal intent?
Answers
Reveal answers
- Mr C, 43, was diagnosed with Huntington’s disease (his father had died of it) after a year of health concerns. Admitted to hospital, he told staff he had always believed in suicide if life got too hard and would probably kill himself once the disease progressed. Referred for psychiatric opinion, he was found not to have a psychiatric disorder, discharged home, and died by suicide one week later.
- The psychiatrist concluded Mr C did not have a psychiatric disorder; he was subsequently discharged home, and died by suicide a week later.
- Miss J, 26, had been under local psychiatric services for 8 years, with several prior presentations to hospital for suicidal behaviours, EPS assessment, and inpatient stays of up to 6 weeks, usually brought in by friends or family; more recently she was depressed and medicated, and across 4 prior assessments described suicidal thoughts and a specific plan.
- J was assessed in ED by on-call EPS psychiatrist Dr B, who admitted her; after 24 hours of observation she was discharged, and died by suicide six hours later. A week later her angry parents came to the hospital accusing Dr B of negligence and demanded his removal from the care of other patients.
- (1) Ideas/strategies for self-care as a doctor when a patient takes their own life; (2) ideas/strategies for coping with stress and pressure from patients’ family members; (3) key messages the audience should take away.
- Student Health Services (0800 479 821 / 03 479 8212); Emergency Psychiatric Services (03 474 0999, ask for EPS, or via local DHB); Alcohol and Drug Helpline (0800 787 797); 1737 (free call/text, any time); Student Affairs Office (03 479 7420, oms.studentaffairs@otago.ac.nz); Student Care Co-Ordinator Ayla Hawkins (ayla.hawkins@otago.ac.nz).
- Both involve a patient who had clearly expressed suicidal intent (Mr C explicitly, J via repeated assessments and a stated plan) being clinically assessed and then discharged, after which they died by suicide within a short period (one week; six hours), raising the same underlying question of how clinicians judge and act on suicide risk versus discharge decisions.