Suicide Attempt Survivors: An analysis of aftercare.

Surviving Suicide

Content Warning: 

This blog post includes discussion of suicide and suicide attempts. If you are sensitive to this topic and feel you are not in the headspace to read about suicide, please do not read any further. If you are in need of immediate mental health support, please visit my homepage where you can find the numbers of supportive facilities.  If you or someone you know is currently grieving the loss of someone by suicide, this NHS guide provides some helpful advice on how to give support. 

Suicide is an uncomfortable topic for many people and is unfortunately an issue that is showing very little signs of improvement. Mental health charity Mind revealed in 2019 that suicide rates had increased for the first time since 2013 (MIND, 2020). Statistics from the World Health Organisation (2019) reveal that worldwide, one person dies from suicide every 40 seconds, with attempted suicides on top of that. Additionally, there are currently only 38 countries worldwide who have introduced suicide prevention strategies (WHO, 2019). These statistics are undoubtably alarming and are indeed a sign that changes need to be made. 

This blog post will explore the positives and negatives of care and practice in the aftermath of a suicide attempt and assessing what needs to be adapted in order to prevent risk and further attempts. 

A study conducted by Florida State University explored the experiences of after-care in 96 individuals who consider them selves to be survivors of suicide, Each person took part in an unstructured interview where they gave a recollection of their experience with mental health care after their attempt. The interviews were conducted by the creator of Live Through This , a collection of real stories from suicide survivors. A common theme from the study is that connecting with others who have experienced similar can be beneficial, so if you have struggled yourself with suicide or want to understand more to support someone you love, I would really recommend reading some of these firsthand experiences. 

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The study revealed both positive and negative aspects within the care received after a suicide attempt. Positive experiences included having a strong therapeutic alliance where the staff members were empathic, trustworthy and appropriately challenging. Other positive factors were being prescribed the correct medication and receiving a psychiatric diagnosis - one participant said that getting their diagnosis helped them to understand more about why their brain had developed certain thought patterns and felt enabled to start changing said patterns. 

However, it should be noted here that there are conflicting views on the medical model surrounding diagnosis. Jo Watson, in the book 'Drop the Disorder!' (Watson, 2019), challenges the process of psychiatric diagnosis and proposes that diagnosis can be harmful. It instead proposes that professionals should assist people in truly understanding their distress, rather than labelling them (A Disorder For Everyone, 2020).

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In line with the self-determination theory which emphasises the importance of having involvement in your own care (such as being involved in the planning of treatment and decision-making), prior studies also support Florida State University's findings that involvement in one's own care is essential for recovery after a suicide attempt. The self-determination theory is known for it's emphasis on involving people in their own care and allowing them to have the freedom to make informed decisions. The theory explains that in working WITH the individual, rather than making all decisions for them, allows the person to feel more motivated in their own recovery and become more acquainted with themselves and their needs (Sheldon et al., 2004). 

(Image based on this image by University of Rochester Medical Centre)

Some participants said that having their close family members involved in their treatment was helpful, but others said that they faced stigma from family due to a lack of understanding. This suggests that involvement in treatment from family should not be essential to care in every case and that again, the individual should have a say in whether or not to involve them. Making familial involvement essential, it would put individuals at risk of being stigmatised and again, put them at a higher risk of suicide. 

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From this positive feedback from survivors themselves, we can gather that a multi-disciplinary approach is a strong approach to care, also drawing from several models of mental health such as the biopsychosocial model. A multi-disciplinary team is where professionals of different specialities come together to provide specific aspects of care (Physiopedia, 2020). In suicide attempt aftercare, this would include a doctor advising and providing medication, a counsellor and other roles such as social workers who can support with housing and other social issues. 

The multi-disciplinary approach is supportive of the biopsychosocial model which assists in the treatment of an individual by looking at multiple aspects of their life in order to better understand their condition and provide care (Borrel-Carrió, 2004). Biologically, this could mean looking at a person's physical health and genetic vulnerabilities. Socially, this would look at school, work, housing, and other sociological factors. Finally, the psychological part would observe personal beliefs, social skills and self-esteem among other aspects. 

(Image based on this image by Physiopedia)

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While it is encouraging to read that suicide attempt survivors report numerous positive outcomes from the care they received post-attempt, current studies do identify many gaps and ways that as professionals, we can do better. In the Florida State University study, 74.4% of participants reported having both positive AND negative experiences. So while there are good indicators that survivors are receiving some form of successful treatment, it is also evident that there are changes and improvements to be made to mental health services, particularly for suicide survivors. 

60.5% of suicide survivors reported experiencing stigma from emergency departments, which unfortunately can be linked to staff having a lack of understanding of suicide. A study in the Journal of Crisis Intervention and Suicide Prevention (Sheehan et al., 2017), suicide attempt survivors and their families state that health care professionals appear to be well intentioned but are lacking the essential training to understand suicide. Considering people with mental health problems are 3.2 times more likely to attend A&E (Dorning et al., 2014), it is clear that emergency service staff require better training. 

The FSU study also highlighted many other improvements to be made, such as improvements necessary to inpatient care, revealing that 44% of participants described their inpatient time as negative, whereas only 27% classified their experience as positive. Survivors had negative experiences surrounding feeling unsafe around patients with 'more severe' conditions such as schizophrenia. This in itself highlights a lack of mental health services and brings into question: should there be more specialised psychiatric services for different disorders? 

Another theme is that there was poor continuity of care after being released from the hospital or an inpatient facility. Systemic issues such as failure to check in with patients after they have been discharged was prevalent in the studies, along with releasing survivors from hospital before they have sufficiently stabilised. 

Recommendations based on the experiences of survivors would be to improve funding for mental health services. Two thirds of people who died by suicide were not receiving mental health support at the time of their death (PHE, 2018) - this could be for a number of reasons such as being afraid to reach out for help in fear of experiencing stigma, or they were unable to access help due to a lack of facilities. I myself am no stranger to the lengthy NHS waiting lists and know the feeling of being desperate for some support and being told you have to wait half a year for an appointment. There is evidence of some positive changes, such as the recent £25million funding given to the NHS in 2018 as part of a long-term goal to reduce suicide by 2021. 

In conclusion, there are clear positives within mental health care that contribute to suicide prevention such as including the individual in their own care and creating a space for them to communicate with people with similar experiences. However, there are also many areas for improvement, critical for preventing the rates of suicide rising further (Mind, 2020), such as having better care plans after discharge from inpatient facilities and providing staff with better suicide prevention training. 

I am not saying that if we make the changes identified in this post, everything will be perfect and suicide will cease to exist. I am saying that from the evidence, there is a whole lot more than we can be doing as a society and as professionals to prevent such high levels of suicide.

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"Love and compassion are necessities, not luxuries". - The Dalai Lama