Sir: Yousaf et al (Psychiatric Bulletin, February 2002, 26, 53-55), have added important findings to the work that Courtenay and Stephens (Psychiatric Bulletin, February 2001, 25, 51-52) carried out among trainees in South Thames. In our paper 54% of respondents had experience of patient suicide compared to 43% in Yousaf's sample and 47% found by Dewar et al (Psychiatric Bulletin, January 2000, 24, 20-23). These findings suggest that patient suicide is a relatively common occurrence during the training years of psychiatrists.

An interesting element of Yousaf's survey is the use of the Impact Events Scale (Reference Chemtob, Hamada and BauerChemtob et al, 1988) to measure the personal impact of patient suicide events on trainees and on their professional practice. Certain themes are shared by the findings in the papers. Many trainees related that in the aftermath of the suicide their practice was affected to the extent that they were more meticulous in assessing the level of risk that patients were presenting. In some cases patient suicide had a beneficial effect on the doctor's training and that consultant support was important in coming to terms with the event. In a positive way patient suicide can be a formative experience and potentially adaptive for the trainee.

Having experienced the suicide of patients since the paper was published has afforded me the experience to learn that patient suicide does not necessarily become easier for the doctor to bear. The reaction is largely dependent on the level of clinical interaction that the clinician had with the person. Even with help from senior mental health staff the impact on the trainee can be aggravated by the attitude of the organisation to patient suicide and to his/her employees' response to the event. Training programme directors have much to offer in shaping the expectations of trainees following the death of a patient through suicide and the responsibilities of hospital trusts towards their staff.