NUBE 2025

This presentation walks participants through an understanding of the biggest contributors to their areas of stress in a healthcare workplace environment in the context of critical incident and disaster response and recovery, and what can be done to effectively and reasonably reduce symptoms and increase active coping. We will cover examples of cognitive, behavioral, and emotional challenges while discussing practical and accessible strategies for recognizing and managing through burnout, compassion fatigue and moral injury experiences in healthcare. Participants will also come away with a better understanding of the most effective and efficient ways to helpfully engage patients and colleagues who may be experiencing crisis, or who are just in need of support while also developing insight into their own resilience and coping tactics and styles.  

Learning Objectives:

Recognize common experiences and behavioral indicators of burnout, compassion fatigue and moral injury.

Develop and understanding of elements needed for an effective coping plan.

Assess personal, active coping strategies and effective crisis deescalation strategies.

Our work is rewarding, yet stressful and not without risk.  Despite our best efforts at providing optimal care and managing risk, adverse events, although infrequent, can have profound impacts on individuals who care for patients, on institutions, patients and families.  Unanticipated deaths or injuries and other adverse events occurring within our facilities or following discharge from emergency departments, or who are cared for by mental health clinicians can represent personal and professional crises for practitioners. Existing literature on adverse outcomes in health care tends to focus on medical errors such as missed diagnoses or procedural errors.  Physicians caring for such patients can be considered “second victims” due to the emotional impacts following such events and some health systems have peer support programs in place to assist such providers.   There is less data on adverse outcomes in behavioral health not involving medical errors, such as patient suicides shortly or immediately after discharge, overdose deaths or harms inflicted on others by a patient; and on the impacts on clinicians who care for such patients.  

Emergency behavioral health providers are faced with the task of conducting risk assessments and determining level of care such as hospitalization vs. discharge. As such they may be subject to perceived accountability of patient behaviors following discharge from emergency departments. At the same time, community resources and options for containing risk, including inpatient bed availability may be limited, necessitating outpatient disposition. Suicide deaths involving patients currently in treatment or shortly after discharge can be particularly emotionally impactful on clinicians due to the nature of the therapeutic relationship as well as institutional responses which may view all suicide deaths as “adverse events”. Indeed, many institutions have “zero suicide” initiatives with the admirable, but unachievable goal of eliminating suicide deaths among behavioral health patients. If an organizational assumption is that all suicide deaths are preventable, caregivers who learn of the death of a patient by suicide may experience feelings of failure, fear of reprisal or even post-traumatic symptoms.

Hospital Adverse Event or Sentinel Event review committees are often tasked with the important work of conducting root cause analyses, morbidity and mortality reviews, institutional risk management or minimizing liability. Such committees may or may not have a goal of providing support to members of the care team. Within behavioral health, given the importance of supporting clinicians who have cared for patients involved in adverse events, while lessons learned for system improvement, specific behavioral health Adverse Event Committees can be uniquely suited to accomplish both tasks simultaneously. Providing immediate emotional support and reassurance to providers, allowing sufficient time between psychological first aid efforts and detailed case reviews; and prioritizing suggestions for systems improvements over individual responsibility are important functions of such committees.

This presentation will provide an overview of the topic of adverse events in behavioral health, and impacts on clinicians. We will then provide case examples to illustrate how a behavioral health Adverse Event Committee can help support providers and identify areas of potential system improvements.

Learning Objectives:

To provide an overview of behavioral health adverse events and impacts on clinicians.

To learn how to better support clinicians following behavioral health adverse events such as patient suicides.

To highlight the unique roles of a behavioral health Adverse Event Review Committee.