Category: National Guidelines

WHEN SOMEONE DIES BY SUICIDE, ALL SYSTEMS MUST PROVIDE HELP

5/29/2015

Infographic: Levels of Care in Aftermath of Suicide

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.

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PARADOX REQUIRES CAREFUL SCRUTINY OF HELP FOR SUICIDE BEREAVED

5/18/2015

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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.

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FALLOUT FROM A SUICIDE CAN TOUCH EVERYONE WHO IS EXPOSED

5/12/2015

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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."

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THE VERDICT IS IN: SUICIDE CAUSES COLLATERAL DAMAGE

5/6/2015

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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."

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SUICIDE GRIEF IS UNIQUE BECAUSE DEATH BY SUICIDE IS UNIQUE

4/26/2015

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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 ...

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GROUNDBREAKING GUIDELINES ADDRESS GRIEF, TRAUMA, DISTRESS OF SUICIDE LOSS

4/20/2015

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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.

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WHEN SOMEONE DIES BY SUICIDE, ALL SYSTEMS MUST PROVIDE HELP

PARADOX REQUIRES CAREFUL SCRUTINY OF HELP FOR SUICIDE BEREAVED

FALLOUT FROM A SUICIDE CAN TOUCH EVERYONE WHO IS EXPOSED

THE VERDICT IS IN: SUICIDE CAUSES COLLATERAL DAMAGE

SUICIDE GRIEF IS UNIQUE BECAUSE DEATH BY SUICIDE IS UNIQUE

GROUNDBREAKING GUIDELINES ADDRESS GRIEF, TRAUMA, DISTRESS OF SUICIDE LOSS

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