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

A historic document, Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines, was announced earlier this month at the Association for Death Education and Counseling conference in San Antonio and at the American Association of Suicidology conference in Atlanta. The Grief After Suicide blog -- in an upcoming series of posts -- will cover a number of ways that this groundbreaking document is paving the way for reinventing postvention in America. For instance, the guidelines:

• Summarize research evidence showing that exposure to suicide unquestionably increases the chances that those exposed -- perhaps especially the bereaved -- are at higher risk for suicide as well as for numerous, sometimes debilitating mental health conditions
• Highlight the effects of a fatality on people beyond family members of the deceased, including friends, first responders, clinicians, colleagues, and others (even entire communities) who may require support in the wake of a suicide
• Describe a new framework for classifying people who experience a suicide (Exposed, Affected, Short-Term Bereaved, and Long-Term Bereaved) that will help focus research and guide the development of programs and services to meet the unique needs of specific populations (see the graphic at bit.ly/continuummodel)
• Advocate for a systems approach, through organizing interventions into three separate, overlapping categories:
    • Immediate Response: Based on mental-health crisis and disaster response principles
    • Support: From the familial, peer, faith-based, and community resources that help the bereaved cope with a death
    • Treatment: By licensed clinicians for conditions such as PTSD, Depression, and Complicated Grief
• Argue that suicide bereavement is unique because death by suicide is unique (i.e., it involves questions about the deceased's volition, the effects of trauma, the degree that suicide is preventable, and the role of stigma in people's treatment of the deceased and the bereaved)
• Present an outline of the research needed to expand and enrich what is known about suicide bereavement and other effects of suicide (which will lead to the development of evidence-based practices in suicide postvention)
• Assert that suicide grief support efforts ought to be informed by research and clinical advances over the past 20 years in the fields of bereavement support, traumatology, and crisis and disaster preparedness
• Include an appendix outlining numerous, practical resources for the suicide bereaved and those who care for them (please link to the expanded, online version of the resource clearinghouse)

---

An excerpt of the guidelines (Table of Contents, Executive Summary, Acknowledgements, Preface) is available at bit.ly/excerptsosl, and the complete document is available at bit.ly/respondingsuicide. The guidelines were created by the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention.

A recent survey of men bereaved by suicide suggests that:

• Suicide bereavement is profound and sustained for the majority of men, with 30% reporting that grief remained a constant difficulty in their lives one to three years after their loss and another 30% saying that it was a constant difficulty for longer than three years.
• Men generally believe friends, family, and peers (others who have experienced a loss to suicide) are the most helpful.
• Peer assistance and one-on-one help are especially valued by men, who also say they rely on information from the Internet for assistance.
• Most men believe men and women grieve differently, and plenty of men fit the stereotypes commonly associated with men's handling of emotional matters.
• Many men, on the other hand, believe that stereotypes get in the way of healthy grieving and that societal influences hamper men's grieving.
• Many also see bereavement as very individualistic, reporting that they are as emotionally expressive about their grief as women are.
• Men are interested in being peer helpers for other bereaved men, especially if they are far enough along in their own grief and are trained and supported.

This last finding -- that many men are willing to help each other with grief after suicide -- is of utmost importance, for men themselves likely hold the keys to their own recovery.

Unified Community Solutions (my private consultancy) and the Carson J Spencer Foundation (Sally Spencer-Thomas's nonprofit organization) distributed the survey to help us explore developing more-effective programs and resources for suicide bereaved men. We are hopeful that by this summer, we'll have an idea about how we might begin making new inroads into supporting men bereaved by suicide.

Please see the copy of the slides from the presentation on the survey that Sally and I (and Rick Mogil, who directs suicide grief programs for the Didi Hirsch Community Mental Health Center) delivered at the American Association of Suicidology conference in Los Angeles last Saturday.

I know Barb Hildebrand both for her thoughtful posts on the American Association of Suicidology listserv (a members-only community) and for the abundant and helpful content on her "Suicide Shatters" Facebook page (which I invite everyone who might be interested to follow).

Describing her mission on Facebook, she writes:

I am a passionate advocate for suicide prevention and mental illness since losing my late husband, Rob, to suicide Dec. 2000. I've had a lot of time to learn, accept, forgive, heal and move forward and feel so strongly that this is my purpose, to take my own experience, share with others and help them on their journey of recovery.

I got to know Barb even better when I recently encountered her story in a post she wrote for the Grief Toolbox about her experience as a survivor, in which she gives us a dozen valuable insights about coping with grief and shares in a most helpful way how her healing unfolded over time.

She believes a key force in her recovery has been forgiveness, which she says has freed her from painful emotions that were "consuming me and destroying me":

Forgiveness is ... not necessarily done for someone else, it is done for you, so that you can begin to heal whatever is holding you back. I have ... learned that forgiveness for yourself is best done first ... I have since forgiven myself many times for things I have done that most definitely contributed to how my life turned out. Each time I do, more and more is released ... and I [recognize] my anger [has] slowly dwindled away.

During the 15 years I've been involved in suicide grief support and prevention, I've known many fellow survivors of suicide loss "from a distance" and then either met them face-to-face or, as was the case with Barb, "met them" more intimately online. These connections stand out to me as a precious reward for doing this work -- and more importantly, as a vital reminder that we are not alone.

I could begin everything I write about grief after suicide with this: "Everybody's journey is different. Each of us is trying to find our own way to carry our grief." (To carry our grief: I'm holding on to that idea.)

A post from Anne Thorn of Cornwall, England -- "Will I Ever Get Over the Guilt?" -- reminded me of the singular path that each of us follows, and I am thankful to her for describing a part of her journey. In brief, three things helped her reconcile her feelings of guilt after her son, Toby, died by suicide: (1) something the author of this little booklet wrote on the topic (see pp. 16-20), (2) this handout from LaRita Archibald, and (3) this advice from her physician:

When I went to my GP and I told him that I would have found it easier to cope with losing Toby if he had died of an illness ... he said to me "Your son did die of an illness, it was called depression."

Now, I might have thought (and you might think, as well), "if those three things helped her deal with her feelings of guilt, maybe they'll help me," which is an altogether reasonable -- and very hopeful -- assumption. In fact, for me, the awareness that my father died from the disease of depression was extraordinarily helpful in coping with my feelings of guilt.

However, when I go to the contents of the booklet and the handout, I find some ideas that do not line up -- for me -- with what is helpful regarding guilt. The booklet gives a prescription (tells me what to do, exactly) that I dont agree with, and the handout makes a bold statement about personal responsibility that I half agree with but half don't.

Even so, those items were obviously helpful to Anne (for she is recommending them to others). Would I recommend them to others? Absolutely, yes I would.

Why? Because if one survivor found them helpful, another might also find them helpful. The booklet was was written for the American Association of Suicidology by Jeffrey Jackson, who is a survivor of suicide loss, and the handout's author, LaRita Archibald, is a survivor and a leading expert in the field. Most of all, I would recommend them because, to come full circle, "Everybody's journey is different."

Nobody's way of grieving is right or wrong. Survivors who share what has been helpful to them, like Anne and Jeffrey and LaRita, are offering an invitation, as 12-Step groups say, to "take what you want and leave the rest." We are strengthened by our diversity -- by our sharing and our conversations about our differences -- as well as by our awareness of all that we have in common.