Not the Only Way Out! (3) – Systems that Hear

This is Post 3 of a 3-part Blog Series on Suicide and Prevention among Healthcare Workers titled "Not the Only Way Out!"

Content Warning: This article discusses suicide, mental health challenges, burnout, and emotional distress among healthcare workers. Some readers may find these topics difficult or triggering. Please read with care and take breaks if needed. Help is available, please find the helplines mentioned at the end of this blog - https://trc.community/blog/not-the-only-way-out-1-suicide-the-hidden-crisis/

In the absence of immediate, human-centered postvention, clinicians sometimes get met with administrative silence, or at best, a generic reminder about an Employee Assistance Program hotline if one exists...

By Nana Akua Dansoah Nuamah, Psychiatrist and Global Health Physician at Pantang Hospital, Ghana

Whether it is the quiet shock of unexpected news about a known patient, the frantic rush of a patient into the resuscitation bay, or the paralyzing news that a colleague won't be coming in for their next shift, suicide leaves an indelible mark on healthcare professionals. The operational reality is that clinicians often absorb the deep trauma of suicidal behavior. Across cultures and continents, the circumstances may differ, but the profound emotional weight remains painfully the same.

Evidence shows contact with health services before suicide death is common.

• A meta-analysis of 35 studies found 18.3% of persons deceased by suicide had contact with inpatient mental health services, 26.1% with outpatient services, and 25.7% with either in the year before death¹.
• This extends beyond mental health services. A French study of 19,144 suicide deaths found 8.5% saw a physician or ER on the day of death, 34.1% within the week before, and 60.9% within the month before².

Suicides also occur on both general³ and mental health units⁴. Studies demonstrate that healthcare workers face higher suicide rates and risks than non-healthcare workers, though the risk varies by role⁵. Of note, a systematic review found 12-53% of mental health professionals report significant trauma symptoms after a patient suicide⁶, and a qualitative study from a South African general hospital found that nurses described shock, blame, inadequacy, and fear of reprisal, while being expected to write incident statements about patient suicides⁷.

These statistics echo one core theme: healthcare workers are not invulnerable observers. They are humans operating in high-pressure environments, absorbing acute trauma while navigating systemic understaffing, moral injury, and administrative overload. The era of asking clinicians to practice individual resilience within systems that remain inattentive to their reality must end. These systems must evolve to respond to the needs of their workforce.

Healthcare systems are known for structured auditing procedures, but saying little when the subject of supporting the people who carried out those procedures is broached. When a critical event or suicide occurs within a healthcare setting, the institutional machinery immediately springs into action. Risk and quality management teams assemble, charts are locked, and root-cause analyses are scheduled. Timelines are reconstructed to the minute: Was the screening protocol followed? Were the charting compliance boxes checked? Was the risk assessment documented correctly?

What is often missing from this machinery is structured postvention - the psychological care, and active support provided to care teams following a suicide event or acute trauma. In the absence of immediate, human-centered postvention, clinicians sometimes get met with administrative silence, or at best, a generic reminder about an Employee Assistance Program hotline if one exists. This understandably is not good enough; health workers deserve better.

To break this cycle, systems must evolve from simply auditing tragedy to actively hearing the witnesses left in its wake. This requires an institutional shift in how healthcare leadership views their workforce. Clinical teams are frontline experts who see precisely where operational gaps, administrative overburdens, and psychological hazards threaten lives. By transitioning healthcare workers from silent witnesses into active co-designers of safe environments, systems and patients will ultimately benefit.

This transition can be driven by the implementation of three key pillars:

1. Institutionalized, Protected Postvention: Postvention cannot remain absent or ad-hoc. Healthcare organizations must embed structured, accessible, non-punitive peer support circles and clinical postvention protocols directly after traumatic loss events.

2.  Stigma-Free, Confidential Support Systems: A primary barrier keeping clinicians silent is the fear of professional penalty and the perception that seeking therapy or support may be a licensing liability. Care teams require confidential, shielded mental health support access that operates without threat to their medical licenses or clinical privileges.

3. Participatory Safety Leadership: Healthcare workers need secured representation on operational safety boards, policy committees, and scheduling task forces. When frontline staff co-design shift limits, nurse-to-patient ratios, and administrative workflows, systemic risk stands to decline.

Whether in a well-resourced hospital or one where an Employee Assistance Programme does not yet exist, the need is the same: to be heard. Systems that hear turn silent witnesses into partners in safety. That shift protects clinicians, strengthens care, and helps prevent the next loss.

References

1. Matandela M, Matlakala MC. Nurses' experiences of inpatients suicide in a general hospital. Health SA Gesondheid. 2016;21(1):54-59. doi:10.1016/j.hsag.2015.10.001
2. Walby FA, Myhre MØ, Kildahl AT. Contact with mental health services prior to suicide: a systematic review and meta-analysis. Psychiatr Serv. 2018;69(7):751-759. doi:10.1176/appi.ps.201700475
3. Laanani M, Imbaud C, Tuppin P, Poulalhon C, Jollant F, Coste J, Rey G. Contacts with health services during the year prior to suicide death and prevalent conditions: a nationwide study. J Affect Disord. 2020;274:174-182. doi:10.1016/j.jad.2020.05.071
4. Schrader J, Sharma S, Azer A, Large MM. Suicides in general hospitals: meta-analysis of incidence and trends. Aust N Z J Psychiatry. 2026;60(7):687-698. doi:10.1177/00048674261441088
5. Schrader J, Sharma S, Azer A, Large MM. Suicides in general hospitals: meta-analysis of incidence and trends. Aust N Z J Psychiatry. 2026;60(7):687-698. doi:10.1177/00048674261441088
6. Walsh G, Sara G, Ryan CJ, Large M. Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatr Scand. 2015;131(3):174-184. doi:10.1111/acps.12383
7. Olfson M, Cosgrove CM, Wall MM, Blanco C. Suicide risks of health care workers in the US. JAMA. 2023;330(12):1161-1166. doi:10.1001/jama.2023.15787
8. Sandford DM, Kirtley OJ, Thwaites R, O'Connor RC. The impact on mental health practitioners of the death of a patient by suicide: a systematic review. Clin Psychol Psychother. 2021;28(2):261-294. doi:10.1002/cpp.2515

About the Author

Nana is a Psychiatrist and Global Health Physician at Pantang Hospital, under Ghana’s Mental Health Authority. Her work focuses on health systems strengthening, clinician wellbeing, and suicide prevention; notably contributing evidence synthesis to the WHO Ghana 2026 Suicide Situational Analysis. A Chevening alumna, she earned an MSc with Distinction in Global Health Management from Imperial College London and is a recipient of the U.S. Department of State’s International Visitor Leadership Program (IVLP) Impact Award.