CONTENTS

About This Course

Table of Contents

1. The Nature and Scope of Suicide
2. Recognizing the Progressive Development of Suicide
3. Substance Abuse as a Major Contributor to Suicide
4. Suicide Across the Life Span
5. Special Populations and Suicide Risk
6. Prevention and Early Intervention for Suicide and Substance Abuse Problems

Supplements
References
Resources

Holding the Lifeline
A Guide to Suicide Prevention

Sources of Help for the Bereaved

Self-help support groups for survivors of suicide have an important role to play in identifying and encouraging members to make full use of assistance and supports available to them.

While grief is a "normal" process for individuals to work their way through, the death of a loved one by suicide is generally not experienced as "normal" although suicide is a commonly recognized cause of death. The needs of people bereaved by suicide are many and can be quite complex. Assistance and support can be forthcoming from a variety of sources. Each source or contact can play an important role in helping the individual experience the normal process of grieving. Seeking help should be seen by the bereaved as a strength not a weakness, and as a vital step to the integration of the deceased person into their resumption of a full life. A range or variety of supports and assistance will offer choices to the individual, taking into account individual preferences. If a range of supports are utilized by individuals, this will enable them to express different levels of feeling.

Families are the major source of support and assistance. Families that are able to share their grief have found this to be a major factor in coming to terms with the loss. The sharing of grief will also serve to strengthen the family unit. Factors that may assist families in achieving this are the family's openness to expressing grief, the absence of secrecy surrounding the death, and the understanding of family members' right to grieve in their own way.

Problems that may inhibit families from grieving together are:

• destructive coping strategies;
• hiding the pain;
• denying the feelings that death has brought;
• avoiding, by pushing the death out of consciousness;
• secrecy and hiding the means of death
• fleeing Ð escaping from contacts and the environment that are associated with the
• person who has taken his or her life;
• working, as a coping strategy, and keeping extremely busy;
• developing addictive behaviors, e.g. eating disorders, abuse of alcohol or drugs;
• blaming family members for the death

Self-help support groups can assist group members by sharing situations and discussing problem-solving strategies as they arise in the family setting.

Friends and colleagues have a vital role to play in assisting the bereaved. The reactions of those in close contact with the bereaved are important, as their support, care, and understanding can provide the opportunity for a safe haven and relief. On the other hand, negative or judgmental reactions may increase the distress and isolation of the survivors.

Avoidance behavior is common amongst friends and colleagues and can also occur within the families of the bereaved. Such behavior may indicate ignorance of the facts relating to suicide or an inability to cope with the feelings that the suicide has raised for that person.

Common fears which can inhibit communication and lead to avoidance behavior may include:

• "I don't know what to say."
• "I don't want to make it worse for them."
• "They have lots of family/friends around, they don't need me."
• "They need the help of a professional, there is nothing I can do."
• "This is a personal family matter they don't need outsiders."
• "What if I say the wrong thing."

The self-help support group can provide the bereaved with an understanding of the reasons for behavior relating to avoidance or negativity, thus opening the door to discussion and understanding.

Friends have a vital role to play in assisting the bereaved. Some of their functions may relate to:

• Listening and hearing, and responding with empathy;
• Knowing when the person needs to talk to his or her loss and serving as a sounding board for emotional relief;
• Providing the safety-valve for the relief and ventilation of true feelings. Family members will often hide their pain from other family members to protect them;
• Assisting in clarifying concerns relating to other family members;
• Assisting in practical ways with formalities that need to be completed after a death or assistance in maintaining the family home;
• Suggesting professional help when appropriate.

Suicide, like homicide and "accidental" death, is generally perceived as an unnatural death that can be horrific. As suicides occur frequently in the home setting, the survivor may also have found the loved one. The mental anguish and torment, flashbacks and visualizations, as a result of the method chosen to take the person's life, will often stay with the bereaved for extended periods. Professional help is often necessary. Consulting the doctor of the bereaved can be the first step, as referrals can then be made.

Professional assistance can provide the opportunity for objective support. One of the benefits of professional support is that the bereaved will not feel that they have "burdened" the individual. This is a real fear in contacts with family and friends.

Health professionals of different types can provide assistance in a variety of ways. If physical health problems are experienced as a result of the bereavement, the local doctor can provide the care needed. Advice on general health care and symptoms that may be of concern to the bereaved, either in themselves or in family members, can be discussed and addressed.

If there are mental health or other stressful issues relating to the death, professional counselors may provide relief by helping survivors in integrating the reality of the deceased and seeking meaningful solutions. A counselor who specializes in or who has an understanding of grief issues can help the bereaved by providing them with an understanding of the grief process itself, thereby "normalizing" the feelings they are experiencing and reducing the sense of isolation.

Psychologists can work with the bereaved in resolving specific problems that may have arisen since the death, e.g. anxiety or panic attacks.

Psychiatrists can also play a vital role, particularly if the bereaved are experiencing prolonged depression in which they feel trapped. If they express the thought that they are "losing their mind," the support of a psychiatrist and medication may be needed for a period. "Normalizing" the use of specialist services is of vital importance.

Social workers can help the bereaved in integrating the social relationshihp impact of cultural taboos, social supports, professional resources, and their personal responses in going through the grieving process.

Reprinted from World Health Organization, Department of Mental Health, Mental and Behavioural Disorders. (2000). Preventing suicide: How to start a survivors' group. Retrieved October 25, 2005, from http://www.who.int/mental_health/media/en/61.pdf