Suicide - Postvention

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What is Postvention?

After a Suicide: A Toolkit for Schools, Second Edition 2018 (69 page PDF)
A Manager’s Guide to Suicide Postvention in the Workplace: 10 Action Steps for Dealing with the Aftermath of Suicide
Best practices in postvention
Comprehensive Appraoch to Suicide Prevention
Glossary
Postvention: A Guide for Response to Suicide on College Campuses Toolkit (28 page PDF) 
Postvention as Prevention
Postvention - Wikipedia
Provide for Immediate and Long-Term Postvention - SPRC
Resources for Suicide Postvention Planning
Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines

Postvention - Wikipedia


A postvention is an intervention conducted after a suicide, largely taking the form of support for the bereaved (family, friends, professionals and peers). Family and friends of the suicide victim may be at increased risk of suicide themselves. Postvention is a term that was first coined by Shneidman (1972), which he used to describe "appropriate and helpful acts that come after a dire event." In Schneidman's view, "the largest public health problem is neither the prevention of suicide nor the management of suicide attempts, but the alleviation of the effects of stress in the survivors whose lives are forever altered."[1] Postvention is a process that has the objective of alleviating the effects of this stress and helping survivors to cope with the loss they have just experienced.

The aim is to support and debrief those affected; and reduce the possibility of copycat suicide. Interventions recognize that those bereaved by suicide may be vulnerable to suicidal behaviour themselves and may develop complicated grief reactions.

Postvention includes procedures to alleviate the distress of suicidally bereaved individuals, reduce the risk of imitative suicidal behavior, and promote the healthy recovery of the affected community. Postvention can also take many forms depending on the situation in which the suicide takes place. Schools and colleges may include postvention strategies in overall crisis plans. These strategies are designed to prevent suicide clusters and to help students cope with the emotions of loss that follow the suicide of a friend.[2] Individual and group counseling may be offered for survivors (people affected by the suicide of an individual).

Organizations

The Suicide Aftercare Association [1], a 501(c)(3) public charity, was formed to reduce the possibility of suicide contagion and secondary suicides by performing biohazardous cleaning of suicide attempt and completion scenes so families are relieved of this burden.

Programs

Responding to Loss (RTL) is one of the crisis response programs that has been used to deal with postvention at high schools. This program is part of the Community Action for Youth Survival (CAYS), which is a three-year adolescent suicide prevention project serving three counties in the Chicago area. The objective of RTL is to provide strategies that will help high school crisis teams develop a structured response to the suicide of any student or member of the staff.[3] There are three components to this program. The first is Preparing for Crisis Training, the second is Peer Witness Intervention, and the third is Crisis Consultation. This program proved to be quite successful during its trial and the participants of the program were generally satisfied with the training that they received. As a result of this program, several schools have developed or revised their crisis team in response to a suicide. They have done this by following the Preparing for Crisis training aspect of the program and also through consulting with the CAYS program.[4]

The LOSS Program includes a first-response team with the objectives of delivering immediate services to the survivors of a suicide at the time of the death. This team is made up of para-professional survivor volunteers and staff members of the Baton Rouge Crisis Intervention Center, located in Baton Rouge, Louisiana. The LOSS Program is different from other postvention programs in several ways. First, the LOSS team physically goes to the scenes of the suicides to begin helping the survivors to cope with their loss as close to the event of death as possible. Members of this team can provide access to the needed resources and can begin the grieving process at the scene of the death. Second, since the LOSS team includes survivor volunteers at the scene, an immediate and meaningful bond is established between the newly bereaved individuals and the para-professional surveyor team members. This bond allows for the start of a conversation between the bereaved and the crisis team members about grief and the potential for hope after suicide. Third, the LOSS team has a strong relationship with other first responders, such as law enforcement, emergency services, fire departments, funeral home representatives, and more. This relationship allows the newly bereaved to have a larger variety of choices in regards to coping with a suicide compared to other survivors who might not have access to this program. This model of postvention provides referrals for additional support to all survivors and individuals at the scene of the suicide [5] The model of the LOSS Program has changed the scene of the suicide to a more "concerned and caring environment" for all individuals and survivors.[6]

References

  • Shneidman E. Deaths of man New York: Quadrangle Books, 1973.
  • Poland S. Suicide intervention in the schools New York: Guilford, 1989.
  • Underwood M & Dunne-Maxim K. Managing sudden violent loss in the schools New Jersey State Department of Education and State Department of Human Services; and University of Medicine and Dentistry at New Jersey, Community Mental Health Center at Piscataway, 1993.
  • Grossman, J., Hirsch, J., Goldenberg, D., Libby, S., Fendrich, M., Mackesy-Amiti, M., ... Chance, G. (1995). 'Strategies for school-based response to loss: Proactive training and postvention consultation. Crisis, 16(1), 18-26.
  • Campbell, F. R., Cataldie, L., McIntosh, J., & Millet, K. (2004). An active postvention program. Crisis, 25(1), 30-32.
  • Campbell FR. Suicide: An American form of abuse. New Global Development (XVI), 2000

Source: en.wikipedia.org/wiki/Postvention

What is Postvention?


Postvention involves activities related to the help and support of people exposed to suicide. This may include community members, acquaintances, colleagues and family members. Research suggests approximately 135 people are exposed to each suicide death(1-3).

In the community, there are a large number of people who are exposed to a suicide death. Many who are exposed to suicide go on to be affected by the death. A smaller number may be bereaved, mourning the loss of the relationship.

It is an essential component of support and is fundamentally based on a relationship between people and their community.

It is imperative that postvention takes account of the broad continuum of people who have a relationship or identify with someone who dies by suicide(1). This is particularly important for ‘high-risk’ and marginalised communities.

“Postvention is therefore a significant form of suicide prevention”.

Australian Institute for Suicide Research and Prevention & Postvention Australia (2017) Postvention Australia Guidelines: A resource for organisations and individuals providing services to people bereaved by suicide.

Different grief reactions are experienced throughout every course of bereavement. Although bereavement experiences are individual, they share similar features and reactions. People bereaved by suicide, akin to people bereaved by other types of death, experience general grief reactions such as shock, denial, sadness, confusion and anger.

Research has shown that in addition to these feelings, people bereaved by suicide may show higher levels of shame, responsibility, guilt, rejection, blame (self and/or others), personal and public stigma and trauma(1-7).

Assistance after a suicide death can have an influence on long-term outcomes of bereavement(2,4). This can be either clinical (professional services) or non-clinical (support and information from front-line workers such as police, staff from the coroner’s office, or a funeral director).

References available at Postvention Australia Guidelines

In this section

Postvention Australia Guidelines

Postvention Australia Guidelines, a resource for organisations and individuals providing services to people bereaved by suicide
Source: lifeinmind.org.au/about-suicide/postvention

Postvention Australia Guidelines


Postvention Australia Guidelines: A resource for organisations and individuals providing services to people bereaved by suicide (24 page PDF)

The resource, ‘Postvention Australia Guidelines: A resource for organisations and individuals providing services to people bereaved by suicide’ provides a framework for mitigating the negative impacts of exposure to suicide. The Postvention Australia Guidelines provide support to organisations who may provide postvention services, but also groups or individuals in contact with the bereaved such as front-line workers, health care professionals, social workers, funeral directors, and volunteers.

The Guidelines provide this support by describing:

  • the roles of managers, ensuring accessible and understood protocols are available for front-line staff;
  • the importance of all staff understanding the ethical issues involved and having up-to-date knowledge of available and accessible services.

Furthermore, the guidelines provide tools to build the capacity of organisations, individuals, families and communities to respond to suicide for specific population groups and settings.

Postvention service provision should include the following(9)

Responding to the needs of suicide bereaved:

  • Understand the diverse needs of people impacted by suicide and their changing needs over time (including emotional and practical needs)
  • Consider a ‘No wrong door’ approach in facilitating referrals to other ore appropriate services, ensuring that the bereaved are supported in finding the right services
  • Offer a flexible approach that considers both passive and proactive services
  • Explore tailoring services by age, culture and kinship
  • Engage lived experience, including people bereaved by suicide in service development

Provision of culturally sensitive and appropriate services:

  • Work respectfully and inclusively paying attention to cultural diversity
  • Encourage appropriate use of language to avoid stigmatising service users

Provision of appropriate and accurate information and resources:

  • Ensure that the suicide bereaved receive appropriate and essential information in a timely manner
  • Have information available and accessible in different formats (such as hard copies, Internet, mobile phone apps) and ensure they reach the target audience

The Postvention Guidelines succeed in incorporating the work of a number of organisations in the postvention sector in Australia and internationally. However, given the document is a general guide for postvention services for people bereaved by suicide, it is important to remember that every community is unique and like any intervention, postvention strategies need to consider the characteristics and context of the specific community in question.

This page was developed in collaboration with Australian Institute for Suicide Research and Prevention.

Postvention support services

There are a range of services available in Australia to support people who are bereaved by suicide. These include programs to provide direct support (telephone, in person or online counselling), presentations, webinars, training and workshops and research based activities.

National crisis support

Access national 24/7 crisis support numbers and helplines.

Organisations

Suicide prevention organisations, programs and services currently operating in Australia.

Community support and resources

Tools and resources to guide communities on responding and communicating about suicide and its potential impacts.

For more information

POSTVENTION AUSTRALIA GUIDELINES (24 page PDF)

References

1) Maple, M, Sanford, R. (2019). Suicide exposure and impact within a non-representative Australian community sample, Death Studies, Jan,2019

2) Cerel J, Brown MM, Maple M, Singleton M, van de Venne J, Moore M, Flaherty C, 2018. How many people are exposed to suicide? Not six. Suicide & Life-threatening Behavior

3) Cerel J, McIntosh JL, Neimeyer RA, Maple M, Marshall D, 2014. The continuum of "survivorship": definitional issues in the aftermath of suicide. Suicide & Life-threatening Behavior. 44, 591-600.

4) Andriessen K, Krysinska K. (2012). Essential questions on suicide bereavement and postvention. International Journal of Environmental Research and Public Health, 9, 24-32.

5) Kõlves K, De Leo D. (2014). Is suicide grief different? Empirical evidence. In: De Leo D, Cimitan A, Dyregrov K, Grad O, Andriessen K. (Eds), Bereavement after traumatic death: Helping the survivors. Hogrefe, Göttingen, pp. 161-173.

6) Pitman A, Osborn D, King M, Erlangsen A. (2014). Effects of suicide bereavement on mental health and suicide risk. Lancet Psychiatry, 1, 86-94.

7) Jordan JR, McIntosh JL. (2011). Is suicide bereavement different? A framework for rethinking the question. In: Jordan JR, McIntosh JL. (Eds), Grief after suicide: Understanding the consequences and caring for the survivors. Routledge Taylor & Francis Group, New York, London, pp. 19-41.

8) Neimeyer RA, Sands DC. (2015). Containing violent death. In R. A. Neimeyer (Ed), Techniques of grief therapy: Assessment and interventions. Routledge, New York, pp. 306-311. Survivors of Suicide Loss Task Force (2015). Responding to grief, trauma and distress after suicide: U.S. National Guideline

9) Australian Institute for Suicide Research and Prevention & Postvention Australia (2017) Postvention Australia Guidelines: A resource for organisations and individuals providing services to people bereaved by suicide. Brisbane: Australian Institute for Suicide Research and Prevention. www.griffith.edu.au/__data/assets/pdf_file/0038/359696/Postvention_WEB.pdf

Source: lifeinmind.org.au/about-suicide/postvention/postvention-australia-guidelines

Provide for Immediate and Long-Term Postvention


When a person dies by suicide, many others are deeply affected:

  • One study estimated that 115 people are exposed to each suicide, with 1 in 5 reporting that this experience had a devastating impact or caused a major life disruption.[1]
  • Everyone grieves differently. Some people may experience short-term reactions, while others may have long-term responses.
  • Exposure to suicide can lead to an array of negative outcomes, including mental health issues, social isolation, and an increased risk of suicide [1]

What is Postvention?

Postvention is a term often used in the suicide prevention field. The definition below is from the U.S. national guidelines developed by the Survivors of Suicide Loss Task Force.[1]

[Postvention is] an organized response in the aftermath of a suicide to accomplish any one or more of the following:

  • To facilitate the healing of individuals from the grief and distress of suicide loss
  • To mitigate other negative effects of exposure to suicide
  • To prevent suicide among people who are at high risk after exposure to suicide (p. 5)

A Shared Vision: U.S. National Guidelines

In 2015, the Survivors of Suicide Loss Task Force of the National Action Alliance for Suicide Prevention released its report Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines. In preparing this report, the task force was inspired by the following vision: “a world where communities and organizations provide everyone who is exposed to a suicide access to effective services and support immediately—and for as long as necessary—to decrease their risk of suicide, to strengthen their mental health, and to help them cope with grief.”[1]

Key principles for creating a comprehesive postvention effort include:

  • Planning ahead to address individual and community needs
  • Providing immediate and long-term support
  • Tailoring responses and services to the unique needs of suicide loss survivors
  • Involving survivors of suicide loss in planning and implementing postvention efforts
All settings should incorporate postvention as a component
of a comprehensive approach to suicide prevention.

Take Action

All settings should incorporate postvention as a component of a comprehensive approach to suicide prevention. All communities and organizations should be prepared to respond to a suicide death, including tribes, towns, senior living facilities, workplaces, and health care providers.

Plan ahead:

  • Develop a plan and protocols in advance to enable your institution or community to respond quickly and compassionately in the crisis period after a suicide death.
  • Be prepared to respond to the immediate emotional needs of people affected by the crisis as well as to the long-term effects and risks that may be associated with exposure.
  • Educate and build relationships among those who will interact with bereaved people to enable a coordinated community response rather than fragmented services. Involve law enforcement, emergency medical services, community mental health, social service agencies, and other institutions.
  • Consider adopting the Active Postvention Model, in which trained volunteer teams reach out to provide support and resources to survivors as soon after a suicide death as possible. It differs from the traditional (passive) model of postvention where survivors only get help if they seek it themselves. The Survivor Outreach Team Training Manual will help you set up and train a survivor outreach team.

Respond effectively:

  • Immediately following a suicide, work with the news media to encourage safe reporting.
  • Work with those affected by the suicide death to aid mourning in ways that avoid increasing the risk of contagion.
  • Build capacity for ongoing support and treatment, including professional and peer-support options, for those who need it.
  • Provide support and guidance for friends and family members of the bereaved to help them provide effective ongoing support.

For more action steps, see the U.S. National Guidelines. Appendix B provides recommendations specific to national organizations; state and tribal governments; communities and local officials; schools, universities, businesses, and workplaces; mental health and public health agencies; professional organizations and accrediting bodies; faith communities and leaders; funeral professionals; first responders; social media and online communities; media; loss and attempt survivors; and researchers.

The resources on this page will help you respond appropriately to a suicide death and to support those touched by suicide.

Reference

Survivors of Suicide Loss Task Force. (2015, April). Responding to grief, trauma, and distress after a suicide: U.S. National Guidelines (p. 1). Washington, DC: National Action Alliance for Suicide Prevention. Retrieved from www.sprc.org/resources-programs/responding-grief-trauma-and-distress-after-suicide-us-national-guidelines
Source: /www.sprc.org/comprehensive-approach/postvention  

Comprehensive Appraoch to Suicide Prevention
Strategies, Programs, and Practices to Consider

Effective suicide prevention is comprehensive: it requires a combination of efforts that work together to address different aspects of the problem.

The model above shows nine strategies that form a comprehensive approach to suicide prevention and mental health promotion. Each strategy is a broad goal that can be advanced through an array of possible activities (i.e., programs, policies, practices, and services). This model of a comprehensive approach was adapted from a model developed for campuses by SPRC and the Jed Foundation, drawing on the U.S. Air Force Suicide Prevention Program.

Identify and Assist Persons at Risk

Many people in distress don’t seek help or support on their own. Identifying people at risk for suicide can help you reach those in the greatest need and connect them to care and support. Examples of activities in this strategy include gatekeeper training, suicide screening, and teaching warning signs.

Increase Help-Seeking

By teaching people to recognize when they need support—and helping them to find it—you can enable them to reduce their suicide risk. Self-help tools and outreach campaigns are examples of ways to lower an individual’s barriers to obtaining help, such as not knowing what services exist or believing that help won’t be effective. Other interventions might address the social and structural environment by, for example, fostering peer norms that support help-seeking or making services more convenient and culturally appropriate.

Ensure Access to Effective Mental Health and Suicide Care and Treatment

A key element of suicide prevention is ensuring that individuals with suicide risk have timely access to evidence-based treatments, suicide prevention interventions, and coordinated systems of care. Suicide prevention interventions such as safety planning and evidence-based treatments and therapies delivered by trained providers can lead to significant improvement and recovery. SPRC encourages health and behavioral health care systems to adopt the Zero Suicide framework for integrating these approaches into their systems. Reducing financial, cultural, and logistical barriers to care is another important strategy for ensuring access to effective mental health and suicide care treatment.

Support Safe Care Transitions and Create Organizational Linkages

You can reduce patients’ suicide risk by ensuring that they have an uninterrupted transition of care and by facilitating the exchange of information among the various individuals and organizations that contribute to their care. Individuals at risk for suicide and their support networks (e.g., families) must also be part of the communication process. Tools and practices that support continuity of care include formal referral protocols, interagency agreements, cross-training, follow-up contacts, rapid referrals, and patient and family education.

Respond Effectively to Individuals in Crisis

Individuals in your school, organization, or community who are experiencing severe emotional distress may need a range of services. A full continuum of care includes not only hotlines and helplines but also mobile crisis teams, walk-in crisis clinics, hospital-based psychiatric emergency services, and peer-support programs. Crisis services directly address suicide risk by providing evaluation, stabilization, and referrals to ongoing care.

Provide for Immediate and Long-Term Postvention

A postvention plan is a set of protocols to help your organization or community respond effectively and compassionately to a suicide death. Immediate responses focus on supporting those affected by the suicide death and reducing risk to other vulnerable individuals. Postvention efforts should also include intermediate and long-term supports for people bereaved by suicide.

Reduce Access to Means of Suicide

One important way to reduce the risk of death by suicide is to prevent individuals in suicidal crisis from obtaining and using lethal methods of self-harm. Examples of actions to reduce access to lethal means include educating the families of those in crisis about safely storing medications and firearms, distributing gun safety locks, changing medication packaging, and installing barriers on bridges.

Enhance Life Skills and Resilience

By helping people build life skills, such as critical thinking, stress management, and coping, you can prepare them to safely address challenges such as economic stress, divorce, physical illness, and aging. Resilience—the ability to cope with adversity and adapt to change—is a protective factor against suicide risk. While it has some overlap with life skills, resilience also encompasses other attributes such as optimism, positive self-concept, and the ability to remain hopeful. Skills training, mobile apps, and self-help materials are examples of ways to increase life skills and build resilience.

Promote Social Connectedness and Support

Supportive relationships and community connectedness can help protect individuals against suicide despite the presence of risk factors in their lives. You can enhance connectedness through social programs for specific population groups (such as older adults or LGBT youth) and through other activities that reduce isolation, promote a sense of belonging, and foster emotionally supportive relationships.
Source:
www.sprc.org/effective-prevention/comprehensive-approach

Identify and Assist

Identifying persons who may be at risk for suicide is a key part of a comprehensive approach to suicide prevention. Family members, friends, teachers, coaches, coworkers, and others can play an important role in recognizing when someone is at risk or in crisis and then connecting that person with the most appropriate sources of care. But these individuals may need training on how to identify suicide risk and provide assistance.

Screening for Suicide Risk

Health care providers can help identify persons at risk by carrying out screening programs. However, when screening for suicide risk, it is important to have resources and systems in place to connect anyone identified as being at risk to appropriate follow-up care and assistance

Screening efforts should never be standalone programs. They are more effective when conducted as part of a comprehensive and strategic plan that begins with an assessment of the local context and the resources available to address the suicide problem.

When screening for suicide risk, it is important to have resources and systems in place to connect anyone identified as being at risk to appropriate follow-up care and assistance.

Providing Assistance

Programs that screen individuals for suicide risk are more effective when they:

  • Build in a mechanism for follow-up assessment that provides a more comprehensive evaluation of the person’s suicidal risk and needs and that serves as the basis for developing a care plan
  • Are prepared to share information about local resources, making sure the services listed are available and appropriate for the target population
  • Help build care transitions and linkages between individuals or institutions in the community and providers of clinical care and treatment
  • Share information about hotlines or other crisis response services

Take Action

  • Educate friends and family members about the risk factors and warning signs for suicide and how to respond appropriately.
  • Train gatekeepers (people who interact with individuals and groups who may be at risk for suicide) to recognize and respond to suicide risk.
  • Establish suicide screening and referral programs in settings such as schools, primary care offices, or programs serving high-risk populations.

Recommended Resources

Source: https://www.sprc.org/comprehensive-approach/identify-assist

Increase Help-Seeking

Increase Help-Seeking

 

PDF versionPDF version of this page

Seeking help for a mental health problem is not easy. Individuals who are struggling with thoughts of suicide or other mental health issues may face any number of barriers.

 

Barriers To Help-Seeking

Not recognizing that you need emotional support or professional help

Not knowing how to find help

Cultural traditions that value individual independence or frown on seeking help outside of the family

The mistaken belief that the problems you are facing cannot be resolved, even with assistance

Lack of access to care, either because of a lack of providers or due to financial issues

The Facts

Many individuals are affected by mental health problems.

Mental health issues are not signs of weakness or character flaws.

Many individuals need help and support to feel better.

There are many ways to get help and support, including telephone and online sources of assistance, mental health services, peer supports, and other options.

There are health care professionals who are specially trained to assess suicide risk and provide effective treatment for suicidal thoughts and behaviors.

There is hope. Individuals with mental health problems can get better, and many recover completely.

Individuals with mental health problems can get better, and many recover completely.

 

Take Action

Include people with lived experience on your suicide prevention planning team.

Identify local and national options for obtaining help, such as the National Suicide Prevention Lifeline, warmlines, online support communities, and mental health services, and promote them through outreach campaigns and other channels.

Identify and reduce structural and environmental barriers to seeking help. For example, make services more accessible, convenient, and culturally appropriate.

Educate the community about the warning signs for suicide and correct misinformation.

When training community gatekeepers to identify and assist people at risk, have course participants identify barriers to seeking help and make plans for how they personally would seek help if they needed it.

Reduce stereotypes, prejudice, and discrimination by sharing true stories of individuals who sought help and benefited from it.

Provide information on self-help tools and support options that people can access on their own.

Train peers to support help-seeking and provide information about available services and resources.

Engaging in strategic planning can help you learn about your community’s beliefs and behaviors about help-seeking as well as available resources, enabling you to focus and tailor your efforts. When promoting help-seeking, it is also essential to plan ahead to ensure that sufficient resources are available to meet an increased demand for services.

Source: www.sprc.org/comprehensive-approach/help-seeking

Effective Care/Treatment

Care Transitions/Linkages

Respond to Crisis

Postvention

Reduce Access to Means

Life Skills and Resilience

Connectedness

 

 

Best practices in postvention


Note: Research examining the effectiveness of postvention programs is limited and results of studies to-date are mixed. There is some evidence that some postvention strategies, including school-wide programs can be harmful.1 We need to continue to grow the evidence around postvention interventions by evaluating our work and sharing the lessons we’ve learned.

Interventions following the suicide or death of an individual should be based on four principles: Support, learn, counsel, educate.2

A whole-community approach is important in postvention strategies – following a suicide, all relevant community partners need to work together.

These postvention guidelines have been adapted from The Riverside Trauma Center Postvention

Guidelines.

Verify death and cause+

  • No information should be released until circumstances of the death are confirmed by the appropriate authorities.
  • Families may want to keep the cause of death private. They may need support exploring the pros and cons of sharing the cause of death.

Coordinate resources+

  • Mobilize a crisis response team comprised of local resource partners and people who are close to and familiar with the youth. The crisis response team should try to gather for an initial meeting within hours of the death.
  • Some organizations (e.g. schools or workplaces) may be inclined to handle the crisis on their own, but outside partners can assist by providing consultation to those unaware of how to support individuals experiencing loss. Outside resources can also ensure that those who are directly responding to the crisis are themselves supported.

Tips:

  • Develop a strategy within your community to provide clarity about what to do, when to do it and who will do what. Ensure your strategy is supported by evidence so that you can learn from other people’s experiences. For information on developing a postvention strategy, check out the Policies and protocols section of this toolkit.
  • Be sure to evaluate what you’re doing so that you can build on what you know. For more information, check out the Evaluation section of this toolkit.
  • Work together. It shows solidarity as a community and can reduce frustration for those who are trying to help. For more information, check out the Come together section of this toolkit.

Disseminate information+

  • The most effective way to provide details is in a written statement that can be distributed.
  • The statement should include factual information about the death (including acknowledgement that it was a suicide), condolences to the family, plans to provide support, information about funeral plans and any changes in work or school schedules over the coming days.

Tips:

  • Don’t read an announcement over a public address system. Rather, have a conversation in smaller groups (e.g. homeroom, team meetings, etc.). This will give you a better chance to gauge reactions.
  • Provide everyone with the same information to prevent rumours.

Support those most impacted by the death+

  • There are many people who may be impacted by the death, including family, close friends, fellow team/club members, colleagues, neighbours, a romantic partner, school staff and staff from agencies who may have been in close contact with the individual. Those impacted should be supported.
  • Friends and family of the deceased will experience the most acute loss and will require ongoing support. They should be at the centre of your postvention efforts.
  • The emphasis should be on mourning the loss. This extends beyond support provided immediately following the death. Plan to care for vulnerable individuals at potentially sensitive milestones (e.g. birthdays or anniversaries).

Tips:

  • Many people will struggle to make sense of the why. This is an opportunity to remind people that suicide is never the result of a single factor, but rather is a convergence of many factors.
  • Those affected should be encouraged to get support from community mental health services or support groups.

Identify those at risk and prevent contagion+

  • Individuals deemed at risk need someone who knows them well to check on them and their family.
  • After a death by suicide, it’s important to identify whether close friends or others are at risk of suicide or other risky behaviours. Those at risk could include individuals who:
  • have a history of suicidal behaviour
  • experience depression
  • have a history of tragic loss or suicide in their family
  • identify with the deceased (regardless of whether they had a close relationship)
  • may have felt responsible for contributing to or who felt they could have prevented the suicide

Tip:

  • Those at risk may not need an immediate referral or evaluation, but they should be encouraged to ask for support and should be made aware of those who can be of most help to them.

Commemorate the deceased+

  • Commemoration activities should be the same for any death, regardless of the cause. Focus on the personal attributes that will be remembered, rather than the cause of death. Whole-community events during the school or work day with required participation are not ideal. Voluntary commemoration activities and funerals that are held after school or work hours are preferred.
  • Focus on facilitating healthy grieving as a necessary form of prevention (e.g. memorialize those lost to suicide by encouraging and supporting suicide prevention activities of local or national organizations, raising scholarship money through activities or becoming involved in helping other suicide survivors).

Provide psychoeducation on grieving, depression, post-traumatic stress disorder (PTSD) and suicide+

  • Help individuals understand the grieving process and educate them about the signs and symptoms of depression, PTSD and suicide.
  • It’s important to use an evidence-informed curriculum.

Tip:

  • For younger people who haven’t experienced a loss, it may be comforting to understand that their reactions are normal.

Provide services should additional suicides occur+

  • Don’t panic.
  • If necessary, seek assistance from experts.
  • Work together as a community in a coordinated fashion to establish or carry out prevention plans and to ensure protocols are in place for responding to future suicidal behaviours.

Tips:

  • The community should consider forming a community coordinating committee. This committee should:
  • include membership from schools, public safety, community leaders, local mental health agencies, local media, clergy and the regional coalition for suicide prevention.
  • work together with the community on suicide prevention at the community level by developing plans and protocols to respond to any future deaths or suicidal behaviour and to begin a plan for prevention in the community (if applicable).

Link to resources+

  • Link individuals and groups to resources for continued support as required.
  • Be sure to include contact information for emergency services.

Tip:

  • Think beyond traditional resources. Consider resources for basic needs, addictions, sexual health and crisis resources.

Evaluate and review lessons learned+

  • Obtain ongoing feedback from everyone involved in postvention services, including youth.
  • Be sure to evaluate everything you do! This can help you enhance your strategies should postvention be required again in the future.

1.Teen Mental Health. (2010). The effectiveness and safety of suicide postvention programs. Research review and recommendations: A summary report. Retrieved from: http://teenmentalhealth.org/product/effectiveness-safety-suicide-postvention-programs/

2.Chehil, S. & Kutcher, S. (2012). Suicide risk management: A manual for health professionals. Oxford, UK: Wiley-Blackwell.
Source: www.togethertolive.ca/best-practices-postvention

Glossary


You’ve got an important job to do, so don’t let jargon get in the way. Here is a list of terms that you may come across.

To access the full reference for any of the terms, please click here.

Best practices

The provision of care utilizing evidence-based decision-making and continuous quality improvement regarding what is effective (Alberta Mental Health Board, 2005).

Burnout

Emotional exhaustion, depersonalization and a reduced feeling of personal accomplishment that develops as a result of prolonged stress or frustration typically associated with the workplace. Burnout occurs over a fairly long period of time and is cumulative, not the result of one bad day. (National Child Traumatic Stress Network, Secondary Traumatic Stress Committee, 2011; Best Start Resource Centre, 2012)

Capacity-building

How a community can build on its own existing strengths and abilities rather than being overwhelmed by problems or feelings of powerlessness (Austen, 2003).

Cisnormative

Cis-normativity is the assumption, sometimes unintentional, that everyone is cisgender (i.e. that everyone’s biological sex at birth corresponds with their gender identity and expression). As one example, separating boys and girls in gym class is a common cisnormative practice in schools.

Community

A group of people who share a concern, geographic area or population characteristics (Kim-Ju et al., 2008). Together to Live focuses on communities who share a concern for youth suicide.

Community capacity

The assets already existing within a community, including concrete resources needed to address particular issues and the wisdom, expertise and leadership to make things happen (Austen, 2003).

Community mobilization

Individuals taking action around specific community issues (Kim-Ju et al., 2008).

Compassion fatigue

A term used to describe secondary traumatic stress, which refers to the presence of post-traumatic stress disorder symptoms caused by at least one indirect exposure to traumatic material. Symptoms can include exhaustion, feeling overwhelmed, isolated and disconnected. (National Child Traumatic Stress Network, Secondary Traumatic Stress Committee, 2011; Best Start Resource Centre, 2012)

Contagion

A phenomenon whereby susceptible individuals are influenced towards suicidal behaviour through the knowledge of another person’s suicidal behaviour (US Department of Health and Human Services, Public Health Service, 2001).

Cyberbullying

The use of communication technology to facilitate deliberate, repeated and hostile behaviour towards an individual (Paglia-Boak, Adlaf & Mann, 2013).

Death by suicide

A purposeful self-inflicted act that is fatal and is associated with implicit or explicit intent to die (Chehil & Kutcher, 2012).

Developmental evaluation

An approach to evaluation inquiry for complex environments which focuses on collecting information as a project is unfolding. The information gathered is intended to be used to guide and inform the developing project (Gamble, 2008; Patton, 2011).

Flourish

To flourish is to be able to enjoy life, cope with life’s difficulties, believe in yourself and others, feel you belong somewhere in the world and believe that you have something you can give to others. (Source: http://www.handsonscotland.co.uk/flourishing_and_wellbeing_in_children_and_young_people/flourishing_topic_frameset.htm)

FNIM

Acronym that stands for First Nations, Inuit and Metis.

Gatekeeper

A community member who’s strategically positioned to recognize and refer someone at risk of suicide (e.g. neighbours, teachers, coaches, caseworkers, police officers; White, 2013).

Heteronormative

Hetero-normativity is the assumption, sometimes unintentional, that everyone is heterosexual. As one example, the underrepresentation of gay and lesbian couples in the media is a widespread heteronormative practice.

Implementation

Performing targeted evidence-informed interventions (including community interventions) to foster behaviour change.

Inconclusive evidence

When there is not enough research to justify drawing conclusions or the research points to mixed conclusions (Chehil & Kutcher, 2012).

LGBTQ

Acronym that stands for lesbian, gay, bisexual, transgender and queer (and/or questioning).

Life promotion

Life promotion is a holistic and strength-based approach to suicide prevention. It is based on the belief that preventing youth suicide involves helping young people find their own path to a healthy and meaningful life.

Likely beneficial

Implies that there is some evidence for a program’s effectiveness, however no research has comprehensively looked at the evidence (e.g. when there is no systematic review or meta-analysis of the literature).

Logic model

A visual representation of a program or initiative’s inputs (necessary resources), activities (actions, events), outputs (products), and resulting short-, mid-, and long-term outcomes.

Non-suicidal self-injury

A deliberate attempt to cause injury to one’s body without the conscious intent to die (School Mental Health Assist, n.d.).

Outcome (summative) evaluations

A type of evaluation that focuses on the overall success of a program to determine whether a program should be continued (Wholey, Hatry, & Newcomer, 2010).

Papageno effect

the protective effect that responsible media can have on individuals (e.g. increased awareness about the signs of suicide among those exposed to the media reporting).

Post-traumatic stress disorder

Emotional duress that results when an individual is exposed to one or more traumatic events (National Child Traumatic Stress Network, Secondary Traumatic Stress Committee, 2011).

Postvention

An intervention strategy aimed at attending to the needs of those who require assistance after a suicide.

Postvention program

Postvention programs aid those in the grieving process in addition to reducing the incidence of suicide contagion through bereavement counseling and education (Szumilas & Kutcher, 2010).

Prevention

Systematic efforts to reduce the risk of suicidal thoughts or behaviours, and ultimately death by suicide (School Mental Health Assist, n.d.).

Primary prevention

Similar to universal prevention where population-based strategies are used to prevent a problem from occurring altogether (Heller, Wyman & Allen, 2000).

Process (formative) evaluation

A type of evaluation that focuses on the improvement and development of an ongoing program (Wholey, Hatry, & Newcomer, 2010).

Program evaluation

The application of systematic methods to address questions about program operations and results, including ongoing monitoring of a program, one time studies of program processes or program impact (Wholey, Hatry, & Newcomer, 2010). The approaches used are based on social science research methodologies and professional standards (Wholey, Hatry, & Newcomer, 2010).

Protective factors

Factors and experiences believed to promote resilience and better mental well-being that may buffer against the negative effects of risk factors and stressors (Kutcher & Chehil, 2007). Examples of protective factors for youth suicide are coping skills and social support.

Risk assessment

Procedure that aims to weigh out risk and protective factors to determine the level of suicide risk for an individual or a community.

Risk factors

Factors or experiences associated with an increased probability of a particular event occurring. Examples of major risk factors for youth suicide include a previous attempt, a psychiatric diagnosis (e.g. mood disorders, substance abuse) and access to lethal means (Gutierrez et al., 2008; Doan et al., 2012).

Risk management

Practices involved in recognizing and responding to a person with suicidal ideation or behavior.

Secondary prevention

A prevention strategy that aims to reduce the chances of a potential problem happening, at the earliest possible moment. It usually targets at-risk groups that have yet to show definite symptoms of the problem (e.g. reducing modifiable risk factors of youth suicide; Heller et al., 2000).

Self-harm

A very broad range of self-inflicted behaviours causing tissue damage or injury, which may or may not be associated with an intent to die. Also includes behaviours that don’t involve tissue damage or that result in a degree of injury that is vague or unclear (Klonsky, 2011).

Stigma

Stigma can be broken down into three components: (1) people or groups of people are marked (e.g., people marked mental illness), (2) negative labels are associated with people who are marked, and (3) people who recognize the mark buy into the label.

Strategic action planning

An approach that can help you understand the issue of suicide in your community, set realistic goals, identify activities that will help you reach your goals, and implement evaluate and improve these activities over time.

Suicidal ideation

Thoughts, images, or fantasies of harming or killing oneself (Chehil & Kutcher, 2012).

Suicidality/Suicide behaviours

Any purposeful self-inflicted acts, including suicide attempts, self-harm and self-injury, that may lead to death regardless of the intent of those behaviours and actions (Chehil & Kutcher, 2012).

Suicide

Intentional, self-inflicted death (White, 2013).

Suicide attempt

A purposeful self-inflicted act with implicit or explicit intent to die, which does not result in death (Chehil & Kutcher, 2012).

Suicide intent

The conscious decision to take one’s life (Chehil & Kutcher, 2012).

Systems map

A visual tool that will map out your project.

Targeted prevention

Efforts that target a group we know for whatever reason is at higher risk (e.g., targeting those with a previous attempt, those with mental illness for early identification and intervention; School Mental Health ASSIST, n.d; Chehil & Kutcher, 2012).

Tertiary prevention

A prevention strategy that resembles a treatment strategy, where the goal is to reduce any further negative effects of an established problem (e.g. relapse prevention; Heller et al., 2000).

Universal programs

Prevention efforts that target everyone regardless of their level of risk (e.g. whole school approaches; School Mental Health ASSIST, n.d; Chehil & Kutcher, 2012).

Vicarious trauma

A permanent cognitive change in the service provider that typically develops over time as a result of empathic engagement with another person’s trauma that can lead to pervasive disturbances in all areas of the professional’s life (National Child Traumatic Stress Network, Secondary Traumatic Stress Committee, 2011; Best Start Resource Centre, 2012).

Wherther effect

negative effects that irresponsible media reporting can have on individuals (i.e. a spike in deaths by suicide after a widely publicized suicide)
Source: http://www.togethertolive.ca/glossary-glossaire#Postvention

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