Support After Suicide is a Victorian-based bereavement support program provided through the Jesuits Social Services that aims to provide a range of services to assist individuals, couples and families of all ages who have had a friend or family member die by suicide. Established in 2004 from funding by the National Suicide Prevention Strategy (NSPS), the project runs one-on-one counselling, group counselling and education and training sessions with the overarching intention of increasing the accessibility and availability of support for people bereaved by suicide. Throughout 2008 and 2009 Support After Suicide counselled over 300 people in personal and group sessions and provided education to over 700 training participants.
'We know that people bereaved by suicide often want assistance but find it very hard to reach out for it,' says Project Coordinator Louise Flynn. 'There is still work to be done in terms of raising awareness around suicide and the needs of people bereaved by suicide. One of our main challenges is making sure people know we are here.'
Recently Support After Suicide has reached out to young bereaved people through a new outdoors-based initiative ran in conjunction with another Jesuit Social Services program called The Outdoor Experience. The initiative consists of two adventure camps held each year for young people between the ages of 11 and 15 who have had a parent or sibling die by suicide. The first camp was held in September 2008 and the three camps run so far have focused on kayaking, rock climbing and beach activities. Eight participants attend along with three leaders: a counsellor, a social worker and an outdoor activity coordinator.
Camp activities are designed to provide a context for conversations about the participants' experiences and impact of their suicide bereavement. For example, during one camp participants were assigned the task of writing a song, which created an opportunity for them to discuss issues about themselves and their bereavement. During the November 2009 camp they made a video clip, which also provided opportunity for discussion.
'There is no pressure to speak about what has happened but we do like to create opportunities for people to speak about the impact,' says Flynn. 'A few of the young people would have actually found their parent or sibling who died. We have had young people on the camps speak about it for the first time.'
Support After Suicide's headquarters are situated in Richmond, Victoria, but the organisation also provides counselling in other areas of the state such as Lalor, Dandenong and Melbourne CBD. The eight week adult support group program provides opportunity for bereaved people to spend time speaking to each other about their experiences. Sessions focus on themes such as understanding bereavement, exploring the changes that suicide brings and self-care during suicide bereavement.
'People feel very isolated and sometimes also stigmatised by a suicide death, so they feel a great sense of relief at being understood by others and being able to say things in a comfortable environment,' she says.
'We know that bereaved people can feel very isolated and alone and we also know that social support is an important part of people making their way through it. So we are also trying to connect with the wider social network and to increase their capacity to deal with their own bereavement while at the same time encouraging them to support each other.'
Support After Suicide's plans for the future include developing its website, improving its capacity to engage with young people and focusing more on rural and regional Victoria in terms of education and awareness training.
People bereaved by suicide often experience a very complicated form of bereavement, partly due to the combination of the sudden shock, the unanswered questions of ‘Why?’ and ‘What could I have done?’ a sense of rejection, and possibly the trauma of discovering the person who has taken their own life. They may experience a range of emotions including shock, alarm, disbelief, denial, regret, anger, shame, sadness, rejection, yearning, despair, blaming, detachment, loss of confidence and guilt. This range of reactions emphasises the dramatic personal effect that a suicide can have and the important but sometimes difficult task of helping someone bereaved by suicide.
By LIFE Communications
The StandBy Response Service is a community-based postvention program that provides a 24-hour coordinated crisis response to assist families, friends and associates who have been bereaved by suicide. The service operates in seven locations across Australia: the Sunshine and Cooloola Coasts, QLD; North Brisbane, QLD; Canberra Region, ACT; the Pilbara region, WA; the Kimberley region, WA; Southern Tasmania; and North/North Western Tasmania.
The StandBy program is managed by United Synergies Ltd, a not-for-profit organisation and is auspiced by a number of other organisations across Australia. United Synergies have been operating the StandBy Response Service on the Sunshine Coast in Queensland since 2002. In 2006, with the assistance of the Australian Government Department of Health and Ageing, a trial project was commenced to replicate the program in three additional communities – Cairns, Canberra and North Brisbane. In 2009 further expansion of the program occurred, with the establishment of services in Western Australia and Tasmania.
StandBy maintains a strong emphasis on community-based initiatives and works in close partnership with local groups and services such as police, ambulance, funeral & coronial, Indigenous, health, education and cultural and bereavement support groups. The project aims to reduce potential adverse health outcomes with the ultimate intention of preventing suicidal behaviour. It operates in response to immediate local suicide loss, suicides that have occurred elsewhere but have affected local people, and when previous suicides continue to affect individuals or groups within the StandBy response area.
In November 2009 the new East Kimberley service was launched in Kununurra which marked the extension of the project’s response service area from east and west Kimberley to the north and south of Tasmania. The Pilbara StandBy program operates from Karratha and covers the whole Pilbara region, which spans an enormous expanse of land - an area not much smaller than Europe.
‘The service in Kununurra is now operational and the community are aware of its presence,’ says National Coordinator Jill Fisher. ‘Trained professional crisis teams are in place to provide the response and the services there utilise local people. In remote areas, largely because of distance, local people and local communities become part of the crisis response team.’
The StandBy Response Service differs from many other existing postvention services in a number of ways. Because the program is community-based, it harnesses and develops the skills, experiences, resources and knowledge that already exists within a community. This means the program is both cost-effective and reduces the duplication of effort that so often occurs within community sectors in Australia. It also creates a strong sense of ownership of the program within the community, creating feelings of empowerment and cooperation amongst local people.
StandBy has formal agreements with police and ambulance in all areas, including legal agreements that allow for sharing of information. One of the roles of StandBy is not just to support bereaved people but to offer support to police and ambulance and other responders, so that they are able to continue working diligently and access whatever support is necessary. Although StandBy frequently responds to crisis situations, Fisher says the majority of their services are requested after considerable time and deliberation from those affected by a suicide loss. She also believes there is a mythology out there that people want and need support immediately.
‘While StandBy has the ability to deliver rapid on the ground responses when requested, our experience has been that when people feel they have some control and power in determining what will best meet their needs, they make more empowered choices,’ Fisher says. ‘These choices might be made for support the next day, a week later or after the funeral. People really appreciate regaining a sense of control in their lives by being able to personally make that request for support at the right time and in the right place.’
StandBy differs from some other crisis support programs in that it will not attend an event or community without being invited by bereaved people.
‘We believe very strongly that when people have the ability to make the choice they act in ways that really help them into the beginning of that grief journey,’ Fisher says.
‘Quite often the confusion is so great for them they can lose that sense of safety and control over their own wellbeing. So many other people necessarily enter their lives at that time – including police and ambulance – so we try to make sure StandBy is more about supporting and enabling people at their identified point of need.’
In coming months StandBy will continue building its critical postvention response strategy, an eight week program being developed in response to communities that experience a sudden cluster or contagion. It has been trialled and evaluated and, according to Fisher, ‘has demonstrated some wonderful outcomes and strong feedback from agencies and from people on the ground.’
‘Again it is about utilising local services,’ she says, ‘but utilising them strategically and in a structured way to ensure ongoing community-based support and restore community safety and wellbeing.’
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“The best thing about the suicide bereavement support group was being in a safe, non-judgmental environment – and the encouragement that facilitators provided. Simply being among others and sharing the same loss and seeing we can go on...”
Lifeline and collaborating partners have produced Towards Good Practice: Standards & Guidelines for Suicide Bereavement Support Groups to assist and guide individuals, communities and service providers to provide the very best group based support for people bereaved by suicide. These standards and guidelines provide a voluntary Code of Conduct to assist in the development and review of quality, safety and effectiveness for anyone running a suicide bereavement support group (SBSG). Though support groups may not be appropriate or desirable for all people bereaved by suicide, when they are provided, members deserve the reassurance that the support provided is safe and guided by best practice.
A unique feature of the project was the combination of locally developed practice wisdom from Lifeline Centres, other currently operating SBSGs and suicide bereavement service providers from across Australia. This was supplemented by research and evidence knowledge to create a rich and practical best practice approach to SBSGs. This project has demonstrated the value of building on local service initiatives, and the insights of community carers in suicide prevention, while also introducing the rigour of evidence based service development. This ensures the creation of a national model for SBSGs that will support improved outcomes for people bereaved by suicide by providing a standardized best practice benchmark against which groups can be developed, examined, improved and validated.
These standards are an international first; no other country has undertaken the development of national Standards & Guidelines for SBSGs. And no other country has undertaken the rigorous steps involved with the development of nationally accredited competency based training for SBSG facilitators, including the development of the very competencies that the training is mapped against. This innovative approach is being closely watched by many of our international colleagues who work in the postvention field and we are proud of what has been achieved by this collaborative effort in the field of suicide postvention for Australia.
Lifeline’s Commonwealth funded SBSG Standards & Practice Project was completed in May 2009 and brought together collaborative partners including: Australian Psychological Society; Jesuit Social Services (Support After Suicide program); United Synergies’ StandBy Response Service; NSW Dept of Forensic Medicine and The Compassionate Friends (Victoria). This team developed pilot resources to train and guide SBSG facilitators who then piloted 8 separate SBSGs across Australia. By building capacity in the workforce of those who support the suicide bereaved, the project aimed to improve the quality of care provided to those who attend SBSGs.
Another useful resource developed is Practice Handbook - Suicide Bereavement Support Group Facilitation which aims to provide guidance and assistance for those developing and operating SBSGs, as well as a framework for reviewing and evaluating current practices. The Handbook aims to be a comprehensive resource but not a prescriptive guide; it is also not a substitute for training and supervision but a complement to it.
The resources produced have been disseminated to those currently operating SBSGs throughout Australia (currently 10 Lifeline Centres operate SBSGs) and available as PDFs on Lifeline’s suicide bereavement and postvention webpage. Lifeline is currently looking for ways to continue to expand this valuable work in the New Year to support the network of SBSG facilitators across Australia. This includes expanding on the pilot nationally accredited competency based SBSG facilitator training so that it is available to train new facilitators.
Everyone affected by suicide needs to be reassured that they are not alone. The following suggestions may assist in providing understanding and support:
- Be respectful of people who are bereaved and the experience they are going through. Grieving is a normal human reaction, and someone lost to suicide creates a distinctly different and often more intense sense of grief.
- Understand the different type of grief associated with suicide where emotions can fluctuate from feelings of loss and confusion, through guilt and anger, to deep sadness and depression.
- Allow the person to grieve without feeling guilt. The role of the helper is to support, not to cure.
- Give people bereaved by suicide time to begin their healing process. Don’t expect that they will be ‘over it’ in a few weeks or months. It can take many months or years to come to terms with suicide and to find a way to live with the loss.
- Try to remember birthdays and other special days. Be aware that these may be particularly difficult times.
- Concentrate on doing no harm including: don’t ask for details about the suicide; don’t blame or give reasons for the suicide; don’t avoid talking about the person who has died because it may seem that you are denying they ever existed, which can be very upsetting for people left behind; don’t use clichés that make judgements or assumptions about the person who died, such as ‘They’ve gone to a better place’ or ‘It was the best thing for them’; and don’t use clichés when talking to the person who is bereaved, such as ‘You must be strong’ and ‘Life goes on’.
For more information read LIFE Fact Sheet 19: Someone I know is bereaved by suicide.
By SANE Mental Illness and Bereavement Project
 Above: SANE Mental Illness and Bereavement Project Coordinator Stephanie Wilks |
SANE Australia’s Mental Illness and Bereavement Project has moved into its third phase, extending the training and distribution of resources beyond traditional mental health services whilst also focussing on sustainability for the future. The project also welcomes a new Coordinator, Stephanie Wilks, who joins SANE with many years experience in the suicide prevention sector and is passionate about expanding the scope of the project.
Established in 2007, the Mental Illness and Bereavement Project aims to raise awareness and improve the quality of support and services for those bereaved when someone with a mental illness dies by suicide, or has gone missing for a long time.
Since its inception, SANE has consulted with peak organisations working in the area, as well as bereaved family and friends. A key issue that emerged is the need for services to provide better information and communication to the bereaved.
According to Ms Wilks, more timely and integrated supports reduce the likelihood that the bereaved will experience the complex grief associated with increased health risks and suicidal behaviour.
‘When mental illness is involved, the bereaved often contend with a range of complex emotions, with research suggesting that friends and family who are bereaved in this way are more likely to die by suicide themselves,’ says Ms Wilks.
‘Bereavement caused by a missing person has the added trauma of ambiguous loss - not knowing what has happened to their loved one - and people may be less likely to access support such as grief counselling. Such support is crucial and can be a key element in aiding someone who is recovering from a loss.’
The findings have guided SANE in the development of resources including factsheets for the bereaved, guidelines for mental health services and a DVD examining the lived experiences of the bereaved. These resources were rolled out during the second phase of the project to staff at mental health, bereavement and helpline services. The ‘five step best practice model’ was also implemented via a ‘train the trainer’ format to improve the capacity of health services’ staff to help the bereaved.
To date, the unique postvention project has provided training to 250 staff from 50 services around Australia and has received a positive response from participants: over 90 per cent indicate that their understanding of the complex issues involved had improved and nearly all cited increased confidence due to the training. Eighty five per cent of participants felt the project was very important for their service’s capacity to fulfil its role.
The feedback from the workshops revealed the need for more information, training and support in this important area. SANE is now extending the training to private practitioners in the mental health sector, as well as Coronial Courts in all states and territories, the police, who are often a crucial first point of contact for the bereaved, and for Culturally and Linguistically Diverse (CALD) and indigenous communities.
‘Pilot workshops for the Victorian Coroner’s Court and Police Welfare Unit are currently underway, however many of these services have varied operations within each State and the challenge remains tailoring each session to best meet the needs nationally’, says Ms Wilks.
SANE also aims to provide ongoing support to groups that have received the training and expand the distribution of resources to enable professionals to support bereaved family and friends, and encourage networks between mental health, bereavement, helpline and coronial services.
‘The ongoing challenge for the Mental Illness and Bereavement Project is to ensure that participants understand the needs of people bereaved by suicide or missing persons and that this understanding becomes culturally embedded into organisations’ frameworks. SANE anticipates that ongoing partnerships with niche organisations already working within suicide and bereavement services will help to facilitate and sustain this for the future.’
By LIFE Communications
Read the Suicide Prevention Australia (SPA) suicide bereavement and postvention position statement here.
This reviews draws upon several studies and literature reviews on suicide and bereavement that have been published during the last two years and which have focussed on protective and risk factors following bereavement. These include a number of studies that compare those bereaved by suicide with those who have lost a significant other via other traumatic or sudden means.
The impact of a person’s bereavement can vary, depending on factors that may act as protective and risk factors for problematic outcomes following the loss (Brown, Sandler, Jenn-Yun, Xianchen & Haine, 2007). For example, according to a review of the literature regarding childhood bereavement of parental suicide (Hung & Rabin, 2009) the degree to which a family experiences instability before the death of a parent can influence how well the remaining family members cope with their loss.
A study (McMenamy, Jordan & Mitchell, 2008) that sought to explore the coping strategies of people bereaved by suicide found that there were four main important factors that influenced the degree to which people may be able to maintain their normal level of daily functioning post-loss (range in years since experiencing loss was two months to 34 years). These were broadly classified as (a) psychological issues, (b) social issues, (c) helpfulness of resources, and (d) barriers to accessing help. Barriers to accessing help included lack of information on where to find help, depression which resulted in lack of energy to seek help and unavailability of resources.
One of the observations that has been made within the literature is that there is more that is shared by all people bereaved by any cause of death for a significant other (i.e. immediate family or partner) than distinguishes those bereaved specifically by suicide (e.g. Andriessen, 2009; Brown et al., 2007; Feigelman, Gorman & Jordan, 2009; Sakinofsky, 2007). For instance, Feigelman and colleagues (2009) found that the type of death (suicide compared to natural causes) did not significantly predict the likelihood of depression or suicidal thoughts. Additionally, the degree of stigma experienced by those who had lost a child to suicide or traumatic death were similar whilst both were greater to that experienced by parents who had lost a child to natural causes. Some examples of the types of responses that survivors had found unhelpful and stigmatising included (a) avoidance by others experienced by the survivor, (b) unhelpful advice (e.g. “It’s time to move on”) and (c) absence of caring (e.g. “no one asked me how I was feeling afterwards”, Feigelman et al, p 602).
On the other hand, some research suggests there may be responses that are specific following loss arising from suicide. One appears to be the case in people’s emotional responses following the loss. For instance there may be complications arising from the combination of guilt and anger experienced by peers in a school environment towards both the person who has completed suicide and others that were involved in their life (e.g. Streufert, 2004 as cited in Levine, 2008). Another study, cited by Brown and colleagues (2007; Cerel, Fristad, Weller & Weller, 1999, 2000), compared the grief-related emotions of children and young people (age range 5-17 years) who had lost a parent to suicide with those children who had lost parents to another cause. The researchers found that the suicidally bereaved participants were more likely to experience anger and shame whilst finding it considerably harder to accept the death at the six and 12 month period following the death; however there was equal likelihood that the children and young people non-suicide bereaved for experiencing sadness, jealousy and suicidality. One study reported that there was an increased risk for those bereaved by peer suicide when compared with those who had lost a peer via other means (Bridge, Day, Day, Richardson, Birhamer & Harrison, 2003; as cited in Andriessen, 2009), whilst a further study of parents of children who had completed suicide were found to be at equal risk to those who had lost a child via other means (Murphy, Johnson & Lohan, 2003; as cited in Sakinofsky, 2009).
Taken together the above results indicate that people who are bereaved by suicide do not respond in the same way. Variables such as existing coping mechanisms and experiences that precipitate the suicide event appear to be influential, as does the responses received once the person has lost a loved one to suicide (e.g. Feigelman, Gorman & Jordan, 2009).
Regarding the efficacy of interventions, there has been little systematic research into what specific types of therapeutic interventions may serve to decrease risk and increase protective mechanisms in relation to healthy grieving (Andriessen, 2009; McMenamy, Jordan & Mitchell, 2008; Sakinofsky, 2009). Anecdotally it would however seem important to ensure that people bereaved by suicide are aware of the support resources available (McMenamy, Jordan & Mitchell, 2008).
In summary the research on the impact of suicide on those who are left behind is growing, however future research needs to consolidate around matters such as different populations (e.g. parents, children, peers, and siblings).
References
- Andriessen, K (2009). Can postvention be prevention? Crisis: The Journal of Crisis Intervention and Suicide Prevention 30, 43-47.
- Brown AC, Sandler IN, Jenn-Yun T, Xianchen L, Haine RA (2007). Implications of parental suicide and violent death for promotion of resilience of parentally-bereaved children. Death Studies 31, 301-335.
- Feigelman W, Gorman BS, Jordan JR (2009). Stigmatization and suicide bereavement. Death Studies 33, 591-608.
- Hung NC, Rabin LA (2009). Comprehending childhood bereavement by parental suicide: A critical review of research on outcomes, grief processes, and interventions. Death Studies 33, 781-814.
- Levine H (2008). Suicide and its impact on campus. New Directions for Student Services 121, 63-76.
- McMenamy JM, Jordan JR, Mitchell AM (2008). What do suicide survivors tell us they need? Results of a pilot study. Suicide & Life-Threatening Behavior 38, 375-389.
- Sakinofsky I (2009). The aftermath of suicide: Managing survivors’ bereavement. Canadian Journal of Psychiatry 52, 129-136 (Supplement).
Dates for the LIFE Professional Development evaluation workshops, which will arrive in March and April in every Australian capital city, have been finalised (see below). These free day-long workshops will introduce and explain the key concepts of evaluating suicide prevention projects and leave participants with a take-home plan. Spaces are limited and registration is now open. Visit the evaluations workshop page for more information, including a registration form.
Dates and locations for LIFE's Professional Development evaluation workshops:
- Melbourne - 9 March;
- Hobart - 17 March;
- Adelaide - 23 March;
- Sydney - 30 March;
- Canberra - 31 March;
- Darwin - 13 April;
- Brisbane - 20 April; and
- Perth - 27 April.