Suicide & Grief
Content Warning:
This blog post includes discussion of suicide and suicide attempts. If you are sensitive to these topics and feel you are not in the right state of mind 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 various 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.
My last blog post on suicide covered the experiences of care in suicide attempt survivors. We were able to identify than an important part of treatment is involving the person in their own care, enabling them to feel more in control and have increased engagement in treatment. This relates to the self-determination theory which aims to enhance motivation in people, catering to three psychological needs: competence, autonomy and relatedness (Deci and Ryan, 2000). The blog also brought up several areas for improvement, based majorly on the lived experiences of suicide survivors themselves. Care staff involved in the treatment of patients after a suicide attempt were reported to be well intentioned but ill-equipped to understand and deal with suicide due to a lack of training (Sheehan et al., 2017).
Improvements to care after suicide are evidently necessary. More funding for mental health services in the NHS is essential for reducing the suicide rates - only two thirds of people who died by suicide were in contact with mental health teams before they died (PHE, 2018).
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What society often fails to realise is that the person who dies by suicide is not the only person impacted by their suicide/ suicide attempt and that there are others affected who need support. Losing to someone you love can be a highly traumatic experience and should be treated as one by healthcare professionals - this post advocates for more support for families impacted by suicide. This post will focus on the experiences of care by people who have lost someone to suicide (parents, siblings, close friend etc...). and identifiable improvements to these services.
A study published in the International Journal of Environmental Research and Public Health revealed that around 1 in 5 people lose someone to suicide before they reach adulthood (Andriessen, 2020). The same study also brought up three key factors: the death can be life-changing, the death makes you feel less connected to friends, and that the death can have a huge impact on the system of the family. These are all changes to life that can cause biological, social and psychological stress.
The biopsychosocial model looks at the different aspects of a person's life (biological, psychological and social) and can be used by professionals to identify stressors and risk factors that may be contributing to the person's ill mental health, with an aim of providing tailored support (Borrell-Carrió, 2004). 
The biopsychosocial approach looks at the person as a whole and considering all types of risk factors that can come from each area of an individuals life. For example, a person could be struggling to cope with being diagnosed with an illness (biological), facing unemployment (social) and having self-esteem issues). By looking at the person as a WHOLE rather than focusing on one specific area, like the medical model, a multidisciplinary team can be put into place for them, ensuring care is provided to suit all of the individuals needs (NHS, 2014). In this example, the individual could be provided with medication and other biological treatments for the physical illness, housing support for the social aspect and several forms of counselling could be effective to treat the psychological side - such as CBT, a successful form of counselling in self-esteem improvement (Morton et al., 2012)
Going back to the study by the International Journal of Environmental Research and Public Health, it mostly focuses on the experiences of adolescents who have lost a parent/close family member to suicide, including input from their parents/guardians.
Whilst, expectedly, the negatives of bereavement massively outweighed the positives, most of the participants and their parents said that they had become more empathic and compassionate towards others, developing stronger interpersonal relationships. However, some of the parents expressed worry that their child had become more empathic towards others but not to their self. Other studies reported that by experiencing the death of someone close to suicide can increase a person's likelihood to become depressed in the future and have a higher risk of suicide. Once again, these statistics highlight the importance of bereaved people having access to all types of care through a multidisciplinary team.
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We have established that losing a parent can be a life-changing experience, provoke feelings of isolation and loneliness and can have an impact on familial relationships (Andriessen, 2020), so let's take a look at how grief from suicide can impact adults when they have lost their child to suicide. A study from the academic journal: Health and Social Care in the Community compiled the experiences of people who have lost a child to suicide.
The study brought up common themes in how people experience the death of a loved one to suicide. One participant said that while they do want to talk about their experience, most people seem uncomfortable and unwilling to talk at depth. The study also revealed that having the opportunity to talk about their experiences and emotions was important for the participants to maintain a bond with their child, despite them not being here anymore.
A study from the International Journal of Environmental Research and Public Health explores in-depth the experiences of parents who have lost a child to suicide. The study revealed three key themes that are experienced by parents: trying to make sense of the event, finding purpose and meaning, and identifying coping strategies. Counselling can be an effective way of working through experiences, so it feels important that the bereaved parents receive adequate support in form of counselling after the experience. CBT in particular has been proven to be effective in helping people to find healthy coping mechanisms (Mind, 2017).
One father in the study said that his child had been receiving mental health care five days before the suicide and that he heavily puts blame on the medical system for providing inadequate care for his daughter. He admits that he often finds himself looking for people to put the blame on. Other participants reported avoiding talking about the topic and having to think about it and developing unhealthy coping mechanisms such as using cannabis and alcohol misuse as a distraction from the pain of losing their child.
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Some parents in the IJERPH study reported very personal things that helped them. One mother said that she found peace by setting up a standing order with a florist and taking flowers to her daughter's grave every Friday. While it is important to listen to each and every individual and understand their own personal emotions and feelings, it is also key to consider professional help and how that can assist in the care of parents after suicide.
A key theme from the studies surrounding group counselling/support groups was that it was a relief to be able to discuss the event with other individuals who have experienced the same. While most people found comfort in talking to friends and family, support groups brought in a new angle where everyone in the room was on the same page. One participant, when talking about individual therapy explained how she had questions about her grief and was able to discuss them with her therapist. While the therapist may not have answered these questions for her, it opened up a discussion and the mother was able to work through the grief without having to do it alone.
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Here in Leeds, we have some facilities whose aims are to support those bereaved by suicide. For example, Leeds Suicide Bereavement Service, a service funded by the Leeds City Council, provides 1-1 support, support groups, and family support. The service is open to anyone who has lost someone to suicide, whether the death occurred decades ago or days ago. Individuals who have used the service mainly reported positive experiences, such as a short wait time, getting them support as fast as possible. Others also said they appreciated the options available within the service, such as one to one counselling and support groups. Some service users said that they were uncomfortable being in a room full of people talking about suicide, but that it was a lot less daunting being able to talk to someone empathic, understanding and well-educated, one on one.
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From the evidence observed in this blog post, it is clear that having other people to relate to is an important aspect of coping with the loss of a family member. It can make people feel less alone in their experience. Having a choice between the type of support received after the death was also a key theme, so it appears vital that health care professionals are understanding of the self-determination theory which emphasises the importance of an individual having the power in determining in their own care. The SDT views a person as whole and that even though they're experiencing emotional distress, they should still have the right to make their values heard, feel better equipped to make decisions and be able to make attachments (URMC, 2020).
While it is encouraging to see that there are effective services available and that understanding of suicide is seemingly improving, more can be done about the rising numbers of suicide worldwide. Professionals should be provided with better, more in-depth training to avoid stigmatising intentionally or unintentionally and to be better equipped for supporting people through emotional crisis.
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I mentioned a website on my previous post called Live Through This, a site that contains recollections of people who have survived suicide attempts. I would like to take a moment to mention this site again. While it can be helpful for people who have lost someone to suicide to read and understand the experience from a first-hand point of view, I believe EVERYONE should make an attempt to understand what drives people to attempt suicide. This can help us be more mindful to those in our community who have either attempted suicide or has lost someone to suicide and also identify warning signs and risk factors.
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