The short video Firefighters Coping with the Aftermath of Suicide takes an intimate look at how suicide affects firefighters, both because they respond to suicide attempts and fatalities and because suicide strikes among their own ranks.

Please share the video with your local fire department (here's the short URL: youtu.be/QSH5EbNhJBA) and encourage firefighters to watch it (it's 11 minutes long).

In the video, Gretta Flatt, a firefighter with South Metro Fire Rescue near Denver, Colo., tells the story of a horrific suicide she and fellow firefighters responded to that triggered distress in her from a long career responding to traumatic incidents:

This is a prime example where I was not aware of how that would affect me personally. This particular call ... is really a hotbed .. I am at the latter part of my career, so it's like things are showing up out of the blue, and I have read about that, but it can really happen.

Self-compassion can be a potentially valuable skill for bereaved people to consider, and I believe I've found a simple exercise that I hope -- if it appeals to you -- will open the door to practicing self-compassion in a way that contributes to your healing.

The exercise -- the "Self-Compassion Break" -- can be found on Kristin Neff's website both as a written instruction and in an audio version. Clear, brief, step-by-step guidance is given on the website, which outlines three basic steps to pausing in the midst of a painful experience to invite self-compassion into the situation:

1. Be still for a moment and observe that you are suffering.
2. Recognize that your suffering is painful -- and also is part of being human.
3. Declare that being kind to yourself is your intention.

Why do I think this self-compassion exercise might be helpful to people who are grieving? Because there are times when the pain of loss touches us so deeply that it is not possible -- at least for a time -- to squelch our pain or to escape from it. And I hope that, if we are able to bear the pain and at the same time to be actively compassionate toward ourselves, we may begin to experience something meaningful beneath the pain -- or beyond it.

Please try the "Self-Compassion Break" -- perhaps beginning not with the most troublesome pain you feel but instead practicing with any kinds of difficult or stressful situations -- to see if it might hold value for you.

If self-compassion is an concept that resonates with you, here are some additional resources from Neff:

• "Self-Compassion Guided Meditations and Exercises"
• "The Three Components of Self-Compassion," a 6-minute video presentation (from which the illustration above is taken)
• "Self-Compassion: The Proven Power of Being Kind to Yourself," a 50-minute video interview with CJ Liu, about Neff's book on self-compassion
• "Why Self-Compassion Trumps Self-Esteem," an article from Greater Good: The Science of a Meaningful Life
• Self-Compassion on Facebook

I hardly know where to begin in heartily recommending the "Silent Suffering" series published today by the Columbus Dispatch. Each of its half dozen in-depth feature stories and handful of engaging videos is in itself worth experiencing. Taken all together, the series offers an extraordinary opportunity to see suicide from the perspectives of those who struggle with thoughts of killing themselves, of caregivers who are devoted to preventing suicide, of family members who are left behind to ask "Why?" and truly of everyone in a community who is affected by suicide.

Click on the picture above to go to a video that sets the scene for the entire series (the video features several moving stories from people's personal experience). My introduction to the series came when a colleague sent me the article "Some Survivors Cope with Loss by Helping Others Affected by Suicide," which tells the stories of people bereaved by suicide who now volunteer in a variety of ways that change -- and literally save -- the lives of others struggling with suicide and its aftermath.

I hope the following quote from the "Helping Others" story persuades folks to explore whatever might interest them in this superb series. These are the words of Mary Ann Ward of Columbus, Ohio, who lost her son Murray to suicide in 2009 -- and who now facilitates a support group for people bereaved by suicide.

“All we can do is accept this loss without ever understanding it, and lean on one another to move forward ... I can give hope to those who are newer than I. From the pain, we can grow in knowledge and wisdom, and experience joy again.”

I recently sent an essay to TAPS Magazine, which is going to be published in its upcoming edition; and I decided to recognize National Survivors of Suicide Day by sharing an excerpt from the essay here on the Grief after Suicide Blog. In the excerpt (you may download it here), I begin with this statement:

I believe the love we feel for a person who has died and the pain of grief we feel are directly and profoundly connected: When people die, our immense love for them is, in a way, the source of our pain.

Then I say that realizing the "pain following the loss of a loved one is a natural phenomenon ... can empower you to give yourself permission to express your pain." I call expressing your pain "a healthy response to the death of a beloved person," implying that such expressions are connected to the loving relationship between you and the now-deceased person. In fact, I declare, "the pain of grief can provide the 'fuel' for profoundly heartfelt discoveries ... [about] the meaning in your loss." I close the excerpt with a list of questions that I hope might help people cope with their pain, followed by this conclusion:

The pain of grief can be terrible, and there is often no sure way to stop pain from unfolding in real time. But finding safe ways to process your pain can help you see beyond it even as it has you in its grip. And reflecting on the connection between your pain and your love for the person who died can help you uncover meaning in your life that comes directly from the relationship you had -- and still have -- with your loved one.

By Franklin Cook

The special report "Systems Must Include Three Levels of Care for Aftermath of Suicide" (available to read or download below) is essential reading for anyone involved in developing, implementing, or assessing services designed to help people who have been affected by a suicide fatality, such as first responders, mental health practitioners, and the suicide bereaved.

Based on recently released national guidelines,* the report delineates three levels of care:
   • Immediate response: crisis assistance, triage and referral, follow-up
   • Support: assistance with grief and loss, self-help
   • Treatment: interventions for potentially debilitating conditions

Quoting Goal 6 of the guidelines -- which is to "ensure that people exposed to a suicide receive essential and appropriate information" -- the report explains that providing such information is a goal that applies across all three levels of care. It also features an addendum, "Information for People Exposed to a Suicide" that outlines the kinds of information that are valuable to people exposed to a suicide and points to the online resource directory available at bit.ly/afterasuicide.

By Franklin Cook

A recent blog post on Grief After Suicide argues (convincingly, I hope) that suicide bereavement is unique because suicide itself is a unique way to die. Yet, at the same time, an abundance of research -- not to mention the universality of the human experience of grief -- points to a paradox, namely, that all bereavement over the death of a loved one shares a great deal in common. In other words, grief after suicide is, simultaneously, both different than and similar to bereavement following other means of death.

Understanding and accounting for this paradox is important because, as is stated in recently released national guidelines on responding to suicide, created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention:*

Suicide grief support is an emerging field of practice poised to gain strength from newer understandings of bereavement adaptation in thanatology [the study of death and bereavement].

This emerging field would benefit tremendously from looking more closely at -- and acting more collaboratively with -- the field of grief counseling (as well as other fields, such as traumatology, mental health crisis response, and disaster response). Doing so would enrich and strengthen suicide grief support through the application of evidence-based and promising practices that are already proving to be effective with a variety of bereaved people. Taking this multi-disciplinary approach would prevent responses to suicide grief from evolving based on narrow or monolithic ideas centered primarily around what is unique about suicide bereavement.

By Franklin Cook

The report "Helping All Who Are Exposed: A New View of Suicide Loss"* (available to read or download, below) describes a framework that considers the needs of everyone who might experience negative effects after someone dies by suicide. The framework organizes people that a suicide could have an impact on into four categories:

   • Suicide Exposed: Everyone who has any connection to the deceased or to the death itself, including witnesses
   • Suicide Affected: Those for whom the exposure causes a reaction, which may be mild, moderate or severe, self-limiting or ongoing
   • Suicide Bereaved Short-Term: People who have an attachment bond with the deceased and gradually adapt to the loss over time
   • Suicide Bereaved Long-Term: Those for whom grieving becomes a protracted struggle that includes diminished functioning in important aspects of their life

The graphic above gives a multitude of examples of people who might experience fallout from a suicide, including many whose needs are not accounted for in current outreach efforts. As the report states,

"Determining how a particular individual might be categorized would not be linked to the person's designation, role, or relationship in reference to the deceased. Rather, each person's reaction to the death would determine the category into which he or she would be classified."

By Franklin Cook

A recent summary report,* "Impact of Suicide on People Exposed to a Fatality," raises an alarm about negative effects some people bereaved by suicide suffer from their loss that go beyond their experience of grief. The report is available, below, to read or download. It delineates research evidence that substantiates two troubling facts:

First, that the bereaved are at a higher risk for suicide:

"Clear and overwhelming evidence [shows] that exposure to the suicide of another person, particularly of a close intimate, elevates the risk of ... death by suicide in the population of people exposed."

Second, that the suicide bereaved are at a higher risk for other negative outcomes:

"The elevated risk for suicidality is not the only adverse effect of exposure to suicide. Many studies have also found elevated rates of psychiatric disorders (particularly depression), social difficulties, and continuing grief reactions in the suicide bereaved when compared with other types of loss survivors or population-level norms."

Even though research on the effects of suicide loss is sparse (which will be the subject of a post later in this series), the report concludes that the United States should "move ahead nationally to strengthen programs, services, resources, and systems to help suicide loss survivors and others affected by a fatality."

By Franklin Cook

Perhaps the word unique is too restrictive in a discussion of universal phenomena such as death or grief, but according to new national guidelines* for responding to suicide, considering such a perspective ...

... opens the door to asking not only "What makes grief after suicide different?" but also "How does the distinctive nature of suicide itself affect the bereavement experience of survivors?"

Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines suggests that death by suicide can raise questions about the deceased's volition and whether the death was preventable as well as about the role of stigma and of trauma in the death. The emotional reactions of loss survivors to a particular suicide, the argument goes, can be shaped by how each person experiences the death along the continua of it being willfull or not, preventable or not, stigmatized or not, and traumatic or not.

This idea is one of several fresh perspectives offered in the guidelines, which were created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention to advance a vision for reinventing postvention in America and creating ...

By Franklin Cook

In introducing "Suicide Loss First Aid: How Police Officers Can Assist Suicide Survivors" in The Police Chief magazine, Tony Salvatore of Montgomery County Emergency Service in Norristown, Penn., points out that more than three-fourths of suicides documented in a 2011 report "occurred in or near the victim's residence." He concludes:

This means that most suicide victims are found by family members or may have had family members who witnessed the death. Relating to those who were close to the victim of a suicide may be one of the most challenging duties that any officer faces, yet few officers receive any training for this task.

The article focuses on the knowledge and skills necessary for law enforcement officers to respond effectively to a scene, covering topics such as the immediate needs of suicide loss survivors, principles of basic suicide postvention (support in the aftermath of a suicide), and a number of other vital considerations.

Salvatore has been writing about the role of first responders in supporting the suicide bereaved for some time (see my 2010 blog post highlighting his work, bit.ly/suicideems), and I hope that the recent publication of national guidelines for effective response to a suicide fatality sparks interest in formal efforts to further develop protocols for first responders. Salvatore has documented the dire need for such protocols, and there are models available that may provide a starting place, such as a guide developed in Canada and guidelines from a police department in England.