MENTAL HEALTH CRISIS RESPONSE PRINCIPLES APPLY TO AFTERMATH OF SUICIDE

Grief is the normal human reaction to loss -- it is not a mental illness -- yet helping people who have experienced a traumatic loss, such as when someone dies by suicide, can be informed by the principles that guide mental health practice. I believe an excellent set of guiding principles for responding to a suicide fatality, in fact, can be found in the booklet "Practice Guidelines: Core Elements for Responding to Mental Health Crises." The guidelines clearly apply to suicide loss, first of all, because they address

mental health crises [that] may include intense feelings of personal distress (anxiety, depression, anger, panic, or hopelessness), obvious changes in functioning ... or catastrophic life events.

Secondly, the guidelines -- though focused on mental health crises -- were developed to promote two goals that also are essential to responding to a suicide on behalf of those who might be affected by the death:

• Ensure that standards consistent with recovery and resilience guide ... crisis interventions.
• Replace today's largely reactive and cyclical approach to ... crises with one that works toward reducing the likelihood of future emergencies and that produces better outcomes.

The principles outlined in "Core Elements for Responding to Mental Health Crises" -- outlined below -- apply in direct ways to effectively responding to traumatic loss and to the shock and grief that follows in its wake. I believe they could be used as a framework for developing programs and services to help those affected in the first minutes, hours, days, and weeks after a suicide.

• Avoid harm. An appropriate response establishes physical safety, [and] it also establishes the individual's psychological safety ... An appropriate crisis response incorporates measures to minimize the duration and negative impact of interventions used.
• Intervene in person-centered ways. Appropriate interventions seek to understand the individual, his or her unique circumstances and how that individual's personal preferences and goals can be maximally incorporated in the crisis response.
• Share responsibility. An appropriate crisis response seeks to assist the individual in regaining control by considering the individual an active partner in -- rather than a passive recipient of -- services.
• Address trauma. Crises themselves are intrinsically traumatic, and certain crisis interventions may have the effect of imposing further trauma -- both physical and emotional ... It is essential that once physical safety has been established, harm resulting from the crisis or crisis response is evaluated and addressed without delay by individuals qualified to diagnose and initiate needed treatment.
• Establish feelings of personal safety. An individual may experience a ... crisis as a catastrophic event and, accordingly, may have an urgent need to feel safe. What is regarded as agitated behavior may reflect an individual's attempts at self-protection ... Assisting the individual in attaining the subjective goal of personal safety requires an understanding of what is needed for that person to experience a sense of security.
• Rely on strengths. Sharing responsibility for crisis resolution means understanding that an individual, even while in crisis, can marshall personal strengths and assist in the resolution of the emergency.
• Engage the whole person. An individual ... in crisis is a whole person ... [who] may have multiple needs, and an adequate understanding of the crisis means not being limited by services that are compartmentalized according to ... specialty.
• Treat the person as a credible source. An appropriate response to an individual in ... crisis is not dismissive of the person as a credible source of information -- factual or emotional -- that is important to understanding the person's strengths and needs.
• Include recovery, resilience, and natural supports. An appropriate crisis response contributes to the individual's larger journey toward recovery and resilience ... Interventions should preserve dignity, foster a sense of hope, and promote engagement with formal systems and informal resources.
• Focus on prevention. An adequate crisis response requires measures that address the person's unmet needs [including any risk of suicide].

The complete booklet is available as a free download.