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.”

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

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

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)

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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.

"FJC's Journal" is an occasional feature on the Grief after Suicide blog, in which publisher Franklin Cook shares observations about suicide bereavement based on his personal experience as a survivor of suicide loss.

I decided for World Suicide Prevention Day to write about how my father's death by suicide has protected me, personally, from dying by suicide. I believe I am among many survivors of suicide loss who would say -- without being one bit melodramatic -- that they might have died by suicide had they not experienced the suicide of a loved one.

My experience with suicidal thinking stems in part from the fact that I was a practicing addict from when I was 18 years old until I was 36. There are two incidents from that part of my life that illustrate the connection, for me, between addiction and suicide.

Sometime in early 1990 (just a few months before I got clean for good), I did something that I believe went beyond being "high-risk behavior." About three times within a couple of weeks, I got as drunk as I could get, then smoked one more joint, and drove down Highway 73 south of Martin, S.D. so fast that my car would barely stay on the road -- daring God to kill me the whole way. This would be at three or four in the morning, and I'd cover the 18 miles between Martin and Merriman, Neb. in a dozen minutes. Then I'd turn around in the parking lot of the Sand Bar and drive back north, following the speed limit (more or less), listening to rock-and-roll, and reflecting on the meaning of my life. That seems like a first cousin to suicidal behavior to me, although I didn't think of myself as wanting to die at the time.

A recent study published in the British Journal of Psychiatry on the views of people bereaved by suicide regarding news coverage of a suicide fatality found that currently available media guidelines for appropriate coverage of a suicide may not adequately take into account the needs of survivors of suicide loss.

[There is] a tension, and a difference of emphasis, between guidance for the press based on strategies to prevent copycat suicides (especially avoidance of certain details) and the perspectives of bereaved people (who feel they have a right to expect sympathetic and accurate reporting). There is a tension between a guideline that suggests that certain information should be withheld/not disclosed and a perspective that favours (in reports of an individual case) an accurate account, which may include such information (such as an image of the person who died).

At issue is the fact that ...

... systematic reviews of the literature have concluded that suicide rates may rise after media reports of suicide, especially if the dead person was a celebrity, if the report glamorises the suicide, if reporting is prominent, or if the method of suicide is discussed in detail.

Of course, those findings have influenced the media guidelines issued by suicide prevention proponents (see the U.S. guidelines), and the importance of preventing copycat suicide is paramount; but the bereaved's concerns about news reports of suicide also ought to be taken into account. The study of survivors showed that some want to share their story through news reports but others do not, so it would be helpful to have information and assistance readily available to the newly bereaved -- including how to take care of their own needs and what impact news coverage has on suicidal behavior -- so they can make make informed decisions about talking with the media.

I'd like to offer this video* of Good Charlotte's 2003 song "Hold On" to survivors of suicide loss everywhere as an example of how powerful our voices can be (as well as to anyone who might be thinking about suicide: I hope you can hold on to life, and I encourage you to call 1-800-273-TALK/8255, where someone is available 24/7 for a free, confidential discussion):

Find more videos like this on Good Charlotte

* The video is from an embedded link taken directly from the band's website.