We asked, ‘how is the impact of colleague suicide experienced by NHS staff and what helps and/or hinders affected colleagues in seeking support?’. Our findings demonstrated that the participants experienced diverse impacts and that their experiences of seeking support were hindered when they encountered a range of gaps in, and barriers to, provision.
When NHS staff are affected by the suicide of a colleague, they experience a complicated emotional response ranging from shock, despair and grief, to guilt, anger and fear. Their experiences and reactions give rise to a range of support needs. In seeking to have those needs met, they encounter diverse gaps and barriers to provision. Their subsequent actions and reactions take the form of filling in those gaps for themselves and their colleagues. Some colleagues fall through the gaps entirely. Workers’ experiences, needs, actions and reactions are informed by two contexts: workplace norms, narratives, and cultures, and individual and shared professional identities.
Throughout these experiences, staff employ emotional labour (in addition to that already employed in their work) to manage their complex responses which impact their emotional and psychological health. The efforts that they engage to overcome and fill the gaps in support lead to difficulties and disruptions in processing their feelings, perceptions of isolation, consequences for patient-facing work (particularly when working with patients who display suicidal behaviours), and occupational dropout.
Participants spoke of colleague relationships as reaching beyond the professional and becoming friendships. These relational aspects shaped responses to the suicide. Such stories of closeness align with those told by Colbert et al.,125 who evidenced a range of ‘functions’ within workplace relationships that include friendship and the opportunity to give to others. Indeed, perceptions of closeness88 are of greater relevance than familial relationships in informing the extent of impact following a suicide. Thus, it is likely that the suicide of a close colleague will leave co-workers in need of support, for which workplaces must be prepared.
The perception of being part of a workplace ‘family’ was a key factor in shaping the shared professional identities of study participants. Many used the collective ‘we’ when describing experiences, responses, or reactions following their colleague’s suicide, suggesting a strong sense of shared experience. Connection with colleagues and experiences of support from them and from leadership figures are protective factors for health workers.126 This phenomenon may not be exclusive to healthcare professionals; staff in UK universities found that perceptions of belongingness and community nurtured a sense of closeness to a student following their death by suicide.46 Belonging to a ‘workplace family’ and experiencing coworker support are associated with better worker health and less exhaustion31 and may serve as a protective factor against workplace stresses and challenges.127 So, it appears that the concept of ‘family’ in the workplace may serve to heighten responses to a colleague death, but also provide protective factors in managing personal responses. This sense of a shared experience contrasts with the reported experiences of healthcare professionals who perceived themselves as isolated following the death by suicide of a patient or client.47 This raises the question of whether it is the perception of losing a ‘family’ member, as opposed to a patient, that generates this difference.
There was a dominant narrative of professionalism across participant accounts. References to the ‘professional mask’ highlighted how participants put their emotions aside to manage the demands of their roles. Employees may suppress or regulate emotions following a stressful event to deliver an appropriate emotional presentation for the workplace.99 Emotional management of this kind has been conceptualised as emotional labour.95 This cognitive dissonance leads to stress, which can lead to burnout.101 Participants in this study employed the ‘professional mask’ as performativity associated with emotional labour.128 The suppression of felt emotions, while presenting the self in a ‘preferred’ or ‘approved of’ manner, may lead to emotional dissonance and internal tension,100 which they needed time and space to resolve.
Our findings suggest that participants needed safe, protected time and spaces to be together, talk, process, share memories and make plans for memorialising their colleague. These spaces were often not available. A lack of training and resources for supporting staff after a suicide was detrimental to people’s ability to cope, process and move forward. This aligns with the experiences of doctors and nurses following a patient death by suicide, who have reported a lack of postvention support.129 Creating safe, protected time and space for processing and healing may prevent mid- and long-term harm such as extended periods of sick leave or people choosing to change/leave profession.130 As such, our findings indicate that further research might explore whether such short-term investment could garner long-term economic and workforce benefits. The need for time and space challenged participants’ embedded perceptions of invulnerability within the context of organisational narratives about ‘carrying on’. They faced a duality of experience as their need to share and be together impinged on the work culture that prized invulnerability both organisationally and individually.131
Participants found themselves with nowhere to go in a culture that stigmatised and silenced the topic of suicide; they were left to take care of themselves and their colleagues by ‘filling in’ the gaps in support. Our findings evidence a lack of acknowledgement by senior leaders and organisations of a colleague suicide. Participant experiences of the ‘minimisation’ of their colleague’s suicide and their own responses left them bewildered and angry. When the life of someone who died by suicide goes unacknowledged, there is a sense that the individual becomes objectified by the means of their death.132 Such de-personalisation contributes to the perpetuation of stigmatised conceptions of suicide in the workplace.133
An absence of support, alongside the ‘carry on’ narrative and culture of silence, generates a sense of invisibility. Staff perceive this as a message that their organisation does not want to acknowledge their distress. This prompted us to query what impact this may have on perceptions of trust between staff and employers. Organisational failure to respond to staff suicide renders it a ‘non-event’; thus, it is invisible and staff needs are overlooked. Effective support might include compassionate, supportive leadership that normalises vulnerability, and access to therapeutic interventions.127
Our findings further evidence an absence of attention given to staff members who work with patients or clients who experience suicidality. Participants spoke of their distress at having to deal with suicidal patients in different settings around the time of their colleague’s suicide. None reported safe practice conversations with supervisors or assessments to ensure their fitness to practice following the suicide of their colleague. They spoke of feeling unsafe, and of their concerns for patient safety. This reported failure to recognise affected staff members’ needs may increase the likelihood of staff operating below their usual capacity, increase risk of professional errors, or lead to reduced patient safety.