Ed Shneidman, the father of modern suicidology, declared the following in his foreword to Albert Cain's 1972 book Survivors of Suicide:
A benign community ought routinely to provide postventive mental health care for the survivor-victims of suicidal deaths. Postvention is prevention for the next decade and for the next generation. Of the three possible temporal approaches to mental health crises -- prevention, intervention, and postvention -- in the case of suicide at least, postvention probably represents the largest problem and thus presents the greatest area for potential aid. [Cain, A. C. (Ed.). (1972). Survivors of suicide. Springfield, IL: Charles C. Thomas.]
Shneidman's declaration refers to postvention specifically focused on meeting the needs of the bereaved after a suicide fatality. He asserts that "postvention ... presents the greatest area for potential aid," and I believe the suicide prevention field has overlooked a practical approach centered around suicide grief support services that would exemplify "prevention for the next decade and for the next generation." Specifically, by a "practical approach," I do not mean a particular program or product: I mean the public health approach to prevention.
In a Jan. 15 blog post, Jerry Reed, Director of the Suicide Prevention Resource Center, says the suicide prevention field "must ... pursue upstream strategies and address environmental issues that may contribute to eventual suicidal behavior" and proposes
... that as a field, we resolve to be bold in 2012, test new hypotheses and evaluate promising programs that have the real potential to move the needle, and make significant progress to reduce suicide, and suicidal behavior in our nation.
I propose that one such bold move would be to heed Dr. Shneidman's advice by implementing effective grief support services for survivors of suicide loss as an "upstream strategy" to address one of the "environmental issues that may contribute to eventual suicidal behavior."
The hypothesis I am highlighting is that exposure to suicide is a risk factor for suicidal behavior and, furthermore, that a response focused on supporting the grief recovery of bereaved people is an effective intervention. Instituting such a process would be in keeping with the fundamental principles of a public health approach to suicide prevention, namely addressing a risk factor at its root in a large, identifiable population and expecting that doing so will substantially decrease the number of individuals who develop the malady in question.
Even as I suggest that survivors of suicide loss be considered a "high-risk population," I must also sound a strong warning against treating them as the field has treated other populations, by
On the contrary, I am proposing a public health response to suicide strictly focused on systematically delivering effective grief support to survivors after a fatality. In the parlance of public health,
Writing in a 1997 article in Suicide and Life-Threatening Behavior, Frank Campbell, now a past president of the American Association of Suicidology, said,
The hypothesis I am highlighting is that exposure to suicide is a risk factor for suicidal behavior and, furthermore, that a response focused on supporting the grief recovery of bereaved people is an effective intervention. Instituting such a process would be in keeping with the fundamental principles of a public health approach to suicide prevention, namely addressing a risk factor at its root in a large, identifiable population and expecting that doing so will substantially decrease the number of individuals who develop the malady in question.
Even as I suggest that survivors of suicide loss be considered a "high-risk population," I must also sound a strong warning against treating them as the field has treated other populations, by
- identifying a high-risk group and then
- implementing suicide awareness, screening, and early intervention programs targeted at that group.
On the contrary, I am proposing a public health response to suicide strictly focused on systematically delivering effective grief support to survivors after a fatality. In the parlance of public health,
- the noxious agent to be weakened is exposure to a fatality, and
- strengthening the host is accomplished through interventions that help survivors cope with grief and recover from traumatic loss.
Writing in a 1997 article in Suicide and Life-Threatening Behavior, Frank Campbell, now a past president of the American Association of Suicidology, said,
I hope that when the AAS has its 50th conference, in 20 years, that we will be able to look back with pride to the work that has been accomplished on behalf of survivors by developing, researching, and implementing effective models of postvention.
Shneidman wrote his argument on behalf of the paramount importance of postvention 40 years ago, and it was 15 yeas ago that Campbell expressed his hope about changing the legacy of suicide through effective grief support services. I believe that the time is now to strategically reframe the delivery of those services as an integral piece of the public health approach to suicide prevention. Doing so would be a crucial and unprecedented step forward in the movement toward every community providing effective "care for the survivor-victims of suicidal deaths," which promises to have a larger impact on suicide prevention overall than we can now imagine.
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