The grieving practitioner

This article is aimed at mental health professionals who have experienced the death of a patient. Whether a sudden unexpected death of a patient you have worked closely with or a patient who has died due to a terminal illness, such losses need to be considered as an actual bereavement or trauma depending on the circumstances and your emotional responses. Just as we might grieve for the loss of a loved one when a family member dies, we may similarly grieve when a patient dies and it is important for you to take notice and attend to this experience.

Reflecting on the impact of grief

Finding space to reflect on the loss of your patient and what it raises for you is an important part of your grieving process. This may be as part of a team if the loss affects a team, or it may need to be on an individual basis, particularly if this loss brings up other personal losses for you. You may have experienced the loss of a loved one many years ago, and any unprocessed grief from this may be triggered by the recent loss of your patient. It is important to find a safe, contained space in order to reflect on this and highlight further support you might require from your employers. If you have a supportive manager, you may wish to discuss how your workload can be adjusted and whether a referral to your occupational health department may be helpful. If this significantly affects your mental health, for example, if you find yourself experiencing persistent symptoms of anxiety and depression, you may wish to see your GP for a referral for psychological therapies including Cognitive Behavioural Therapy (CBT).

Personal and professional boundaries

When a loved one dies, there are certain procedures and rituals which can make the act of grieving easier. For example, friends and family offering condolences, taking time off work, attending the funeral and taking part in religious ceremonies. Often prayers and ceremonies help you to remember the deceased and give you an opportunity to say goodbye. However, when a patient dies and you are left with a similar or same sense of loss, it may not necessarily be appropriate or even accepted as a professional for you to be part of these rituals.

Depending on the context of your work and the nature of the death, there can be a conflict between your wish to attend to your grief and your expectations to continue with your work demands. If you work in an organisation which is sensitive to these issues, you may request support from your manager to take reasonable time off from your usual workload to attend the funeral. It is vital however to negotiate this with the carers/relatives who would need to feel comfortable with your presence in the funeral. If there were strained relationships between services and families, your attendance may not be suitable despite your personal wishes. You may also need to negotiate how many professionals from your service will attend the funeral in order avoid overwhelming the carers/families. Despite your need to say goodbye and to be part of the grieving rituals, it is important for you to reflect on whose needs you will be serving by doing so. If your presence is supportive to the carers/relatives, this may be useful. However, if you are unable to contain your own grief enough to contain carers/relatives, your presence may not be helpful to others. 

Saying ‘goodbye’ through a therapeutic letter/picture

Given the issues identified in maintaining professional boundaries, saying goodbye becomes an even more important part of you processing your own loss. You may wish to spend time alone in a place of comfort (this may or may not be a place of worship). You may wish to offer your deceased patient a final message which you can write as a therapeutic letter (being mindful of confidentiality) or draw as an image. This act of symbolically saying goodbye is likely to help you process your grief and enable you to move on. 

If this loss affects your colleagues/team in a similar way, you may wish to do this together and mark this loss through a shared event. This may be a celebration of the patient’s life through a simple gesture of planting a tree in your service grounds or getting together for a meal to mark their life. Looking to colleagues for support is more appropriate than the temptation of seeking comfort from grieving carers/relatives who may share the same grief but need to be perceived in the context of your relationship with them as a professional.

Grief is not something that can be quantified and this article is not intended to provide the answers about how you should cope with your grief. Rather, it is hoped that any professional going through this grief can be given the ‘permission’ to feel the same emotions which may be experienced by the death of a loved one. Whether sadness, despair loneliness, guilt or anger, all these emotions are acceptable and there needs to be ways which you as an individual and as a professional receive support from your organisation as well as from your personal/social networks.