Bereavement by Suicide – Learning Points

LEARNING POINTS

Episode One

Section 1: Breathe

Don’t underestimate how very difficult it is to break the news. Make sure you do the training!
The bereaved will remember every word you say, forever, so it is vital to get it right.
You will need to be in as calm a place as you can be yourself, in order to be open to the reality of the bereaved person, rather than projecting your own anxious or fearful thoughts and feelings onto them.
Breathing doesn’t just mean taking a deep breath or two. It means breathing until you become calm enough to become aware of what and where your tensions are – and to listen to these tensions, and deal with them. Mindfulness techniques are worth learning and practicing.
While you are waiting at the door, you may be asked by a neighbour what you are there for. You should not tell them: you must tell the family first.
Make sure you don’t speak to the wrong family. Check you have the right address – preferably before the door is answered.
You should make sure you speak to an appropriate person in that family. If a child answers, make sure they fetch an adult. And even if it is an adult who answers, check the name of the person before you break the news. You could be talking to a visiting neighbour or the plumber who happens to have answered the door.
Identify yourself and your role immediately, especially as you will be asking them to let you enter their house.
Switch off your mobile phone – and your radio, if you have one.
Avoid talking outdoors: you may be overheard by neighbours or passers-by. You should try to protect the privacy of the bereaved. If you are waiting for the door to be answered, do not discuss with neighbours why you are there.
When you are indoors, if possible, it is best to break the news when the bereaved person is seated, in case they feel faint.
Be sensitive to family members having favourite chairs that ‘belong’ to them. It may be best to wait for the bereaved to point out where you should sit down
Don’t forget to express condolences. That may seem too obvious to be worth saying, but simple and natural kindnesses can be forgotten, especially if you are trying hard – too hard – to ‘be professional’
Check if there is anyone else present in the house. For example, there could be a supportive adult who can join in the conversation – or a child who might accidentally be overhearing the news.
But be sensitive to how you ask: the bereaved person might feel vulnerable being asked by a stranger if they are home alone.
Break the news succinctly, unambiguously and immediately. It may seem harsh to express it so baldly, but ambiguous explanations can leave the bereaved quite in the dark about what happened. People have sometimes been left without any idea that their loved one has died.
Until the police have completed their investigation the death and the coroner has made a decision, about the cause of death, you should not make a definitive statement about it. You can only say that it is ‘a possibility’ that it was suicide.
Making a hot drink for the bereaved person in shock can be a good idea. But they may offer to make it themselves, out of automatic politeness, and you may find yourself accepting, also out of automatic politeness. You don’t want to intrude! But for safety’s sake, it should be you that handles boiling water.
And don’t add sugar automatically even if ‘hot, sweet tea for shock’ is a recipe that has been drummed into you. If the bereaved person has a metabolic illness like diabetes or cancer, they’ll need to avoid sugar.

Section 2: Listen

Listen! It’s the single most important thing you can do. Though you’re much more likely to be able to listen if you’ve taken care of your own needs, so breathing will help you do it.
Why is listening so important? At the most basic level, someone who has been bereaved may simply need to pour out highly charged thoughts and feelings in the presence of another human being, barely aware of how the listener is reacting.
But at a deeper level, you are not just listening but hearing. The bereaved person needs their unique point of view, their unique reality, to be heard. It validates them, at a time when their normal life has split into smithereens.
Never assume you can predict how they feel. However many times you have encountered people who have been bereaved, each person’s experience will be unique and specific to them.
Their perception of reality may well not correspond to yours. Yet they need the chance to express their reality and be heard.
People who are bereaved by suicide may have to endure an onslaught of responses from other people. Many may be judgmental and disrespectful, lacking in insight and compassion, both towards them and towards the person who has died. It is vital that others offer a more respectful, validating response – and the first person with the opportunity to offer that will be you.
If the bereaved person’s first experience of a response is validating and positive, it can provide them with a stronger foundation for coping with less positive responses from others.
You will need to accept and sit with the feeling of helplessness without rushing to fix the problem. The pain of loss through suicide is a problem you can’t fix.
It will be especially hard for you because all your ideals, values, and the rest of your training as a public servant will point you in the direction of making things better the for people you encounter.
Being professional vs being human in a natural, spontaneous way – it’s a tough choice sometimes. Is clasping Mrs Jones’s hand pro-actively going too far? Something to discuss with your bereavement trainer or manager.
Is shedding a discreet tear alright? Some bereaved people have said that they found it a sign of genuine feeling. Others find tears ‘unprofessional’ and prefer greater detachment.
Yes, it is ok to say you don’t know.
Sometimes an incomplete suicide can be a rehearsal – and a warning sign to be followed up.
Hanging is now the commonest way for people to kill themselves. A possibility to bear in mind: people may unintentionally hang themselves during an auto-erotic act.
It’s a myth that there is always a suicide note. If there is a note, the bereaved can ask the police to return it to them. NB: The bereaved may assume is that such a note will be a comfort to read. They may hope it holds a clue as to why their loved one made their decision. But in fact a note can sometimes cause added distress, as it may have been written in a moment of extreme hurt or anger.
It is usually ok to tell the truth in answer to an objective But do not contradict the subjective reality of the bereaved person about how they are feeling. As above: you cannot know how they feel, because every person is unique You have to listen and learn from them.
A bereaved person may be consumed with guilt, believing that they were fundamentally responsible for their loved one’s death.
The bereaved may also feel guilty about ‘wasting [police] time’. But it is vital to give a lot of empathic support in the immediate aftermath of such a trauma.

Section 3: Support

There are a multitude of symptoms of shock and grief. They include the inability to gauge the passing of time, confusion, forgetfulness, exhaustion, denial, blotting out pain through sleeping too much, working too hard, eating compulsively or drinking too much alcohol… And many more.
Pay particular attention to drinking, or taking drugs. These could be warning signs of another member of the family also at risk of self-harm.
Read Help is at Hand for guidance on what many bereaved families have felt – without imposing these thoughts, unchecked, on the bereaved person you meet. Their feelings and reactions may be different.
Encourage the bereaved person to call on practical and emotional support that can be given by family, friends, and neighbours.
Religious or community leaders and groups may also provide invaluable support. Offer to contact them yourself if necessary.
Be sensitive to religious or cultural taboos and other beliefs about suicide that may be held by the bereaved person or by their community.
The sense of the generational order being disrupted can be deeply unsettling to many people who have been bereaved.
It is important to be aware of your own responses to the death of someone close to you, especially if that death had been traumatic in some way – e.g. an untimely death. It would be wise to share your experience with your manager, colleagues and/or trainer before making a first responder visit.

If your experience was also of a death by suicide, it is particularly important to share it. You will need to be well supported to reduce the risk of your being re-traumatised while acting as a first responder.
Managers of staff who may need to become first or early responders should help create a nurturing culture at work, so that staff know they can safely show their vulnerability without fear of being judged as weak or unable to do their jobs.
You should come prepared with tangible materials to leave behind, as the bereaved person will be in shock and may not be able to retain information you offer verbally. The material will come in useful later, when the first waves of shock have died down.
Leave-materials can also be a very useful source of information for relatives or friends supporting the bereaved family, providing insight into how they may be feeling or about what to expect next, and by providing contacts for suicide bereavement charities, the NHS, and other sources of support.
It will be necessary for the next of kin to identify the person who has died as soon as possible. They should be supported in this – e.g. the police may take them to the hospital mortuary by police car, as they may be too much in shock to drive safely. The accompanying police offer should be sympathetic and not be too withdrawn, either because of their own shock and distress or out of a mistaken idea about needing to be detached to appear ‘professional’.
Always refer to the person who has died by their name and/or by their relationship to the person you are speaking with: e.g. ‘your son’. NEVER refer to ‘the deceased’ or to ‘the body’ EVER in the presence of the bereaved. The person who died was someone they loved. And still love.
People who have been bereaved often say that ‘the worst thing that could happen has already happened’ – and they may see a bit of clumsiness under pressure as nothing more than an indication that the professional is only human too.
This is especially likely if the mistake is quickly acknowledged and sincerely apologised for. Covering up a mistake defensively, however, is likely to backfire and add to the upset.
You should leave your name and number in writing, somewhere easy for the bereaved person to find again, despite their shock.
Don’t promise to be available at all times: you can’t be. Make it clear when you are available, and how the bereaved can get in touch with you when you are not.
Make it clear that they will not have to repeat their story to everyone who answers the phone in your workplace. Telling the story is exhausting – and exposing: it can feel like an invasion of privacy to have to repeat it to strangers.
The bereaved family will have to repeat the story to many others: to friends and relatives, to officials in banks, insurance companies, and many others who need to be informed that their loved one has died. You can ask if there is a trusted friend or relative who could take on some of this task.
Beware of giving assurances to the bereaved person that you can keep what they say confidential. You will, for example, need to report the visit to your managers. Under certain circumstances – e.g. if the death had taken place at Mrs Jones’s home – the police officer would not be able to offer any assurances about confidentiality.
Your organization may suggest you let the bereaved know that you will call again at a later date – perhaps in a month’s time – to see how the family is getting on, without setting an expectation that they have to speak to you.
And they may also suggest you call again on the anniversary of their loved one’s death. Calls like this, which show genuine concern for the bereaved family, are often highly appreciated.
Accepting that you ‘can’t make it better’ for the bereaved is easily said but not easily done. The distress you have witnessed will affect you. Share your feelings with your manager, trainer and colleagues can help you accept your powerlessness, and make a striking difference to your own psychological wellbeing.
Accepting your responsibility ‘not to make it worse’ can be just as daunting. So if you have made some mistakes in the process of breaking the news, you may feel guilt and distress. You should take into account that being a first or early responder is a very hard thing to do – perhaps the hardest thing you have ever done. By speaking to your manager, trainer and colleagues about what you see as your errors, and sharing your feelings about these, you may be able to cope with greater self-compassion.

Episode Two

Section 1: Formalities

Make a follow up visit 1-2 weeks after the news has been broken.
What you can expect to achieve in this visit will depend on your usual professional role. You may be a senior psychiatric nurse with a great deal of therapeutic experience, specializing in suicide bereavement – but the chances are you are not. Tailor your expectations to your experience, and refer up as needed.
Always remember the key lesson of Episode One: Breathe – Listen – Support.

BREATHE: First take care of your own psychological needs so that you are in a better position to support others.
LISTEN: Really hear what is being said. Never assume you know what the bereaved person is feeling or thinking, however experienced you may be. Each person is unique.
SUPPORT SYSTEMS: Share the responsibility.

Never assume the bereaved person is ‘getting over it’. They will never get over it. Nor will they ever ‘come to terms with’ the loss they have suffered. Avoid such platitudes at all costs.
The initial shockwave may be subsiding, but there will still be considerable shock.
Bereaved family members are extremely vulnerable. When one family member dies by suicide, others become more vulnerable to following suit. Is anyone in the family you are visiting thinking suicidally (‘suicidal ideation’)? You may get a sense of where each family member stands on a spectrum of risk.
Remember to express condolences. This may seem too obvious to be worth saying, but it can be forgotten under pressure.
Such natural, human gestures can be forgotten especially if one is trying very hard to ‘be professional’. There is a fine line here. It is important to be professional in a way that does not suppress your naturally compassionate self.
The bereaved family may have formed a particular attachment to the first responder, in the heat of a shared crisis. Don’t take it personally if they don’t feel the same way about you.
You will need to check whether the bereaved have completed the initial legal requirements, e.g. identifying their loved one’s body, signing the death certificate.
You also need to see if they have some awareness of the legal processes to come. This will mean informing yourself, before your visit, about coroners, post-mortems and inquests (see Help Is At Hand for basics). But don’t worry: the coroner’s office will usually keep in close touch with the bereaved family and they will be able to answer more detailed questions.
A coroner is usually a lawyer, and the inquest is like a court. It is not always held in a courtroom, though. It may be held in any impersonal large room, like in a local hotel. However, there are circumstances that will require the inquest to be more formal, e.g. if the death had occurred in a prison, and such inquests will be held in a courtroom.
The bereaved family may believe that coroners intervene only in cases of unlawful death and this may make them anxious that suicide is still regarded as a criminal act. You will need to reassure them that a coroner is involved whenever a death is not from natural causes.
You can also let them know that if the post-mortem can explain the cause of death to the coroner’s satisfaction, an inquest may be considered unnecessary.
The family may ask why the public are allowed attend their inquest. An inquest is an official ‘public inquiry’. By definition, it will be open to the public.
The family may be concerned that shame and stigma will spread because of the inquest being open to the public. You can reassure them that the people who attend an inquest are almost always just close family members. You can also reassure them that they themselves are not legally obliged to attend if they choose not to.
The family may also have anxieties because the inquest is open to the media. They may feel it is an invasion of the family’s privacy, and fear the risk of sensationalism. You can reassure them that only a minority of inquests are reported. You should also update yourself on the latest media guidelines on reporting death by suicide to be able to reassure them about the actual practice of journalists in most cases.
The death by suicide in our video was not one that was considered suspicious. If it had been, the inquest would include a jury – and the family may want to have legal representation. [Trainers to add.]
Do establish if the bereaved family has seen their GP. The GP is likely to have phoned within the first day or two of the news of the death, and visited the family in person soon after that phone call. If the family has not seen their GP, you may want to gently suggest they do so.
Do establish if any sleeping pills have been given to the family by the GP or by anyone else: friends may well have offered their own sleeping pills, and the bereaved family may, these days, also have bought some online. Taking sleeping pills other than under the GP’s supervision is of course risky, especially for a vulnerable family.
Increasingly, pills are formulated and packaged in ways that reduce risk: the pills are of lower strength, and new packaging is designed to slow down extracting the pills. But who knows what pills someone might get online? So it’s worth checking.
Remember to enquire about the situation of all the members of the family (or equivalent group) and not get caught up only with the person you meet.
Bring a note with you of local numbers that the family members can call if they need help, both in and out of normal clinic hours – especially for help if they have suicidal thoughts.
Ensure the family has at least one copy of Help Is At Hand somewhere easily accessible. Bring one with you in case they haven’t.
Bereaved family members can be agonized by guilt and shame – for a host of reasons, including some that are wholly unrealistic. Parents may, for example, torment themselves with the belief that they could have prevented their teenager’s death ‘because parents should always know how their children think and feel’.
It is unhelpful to be argumentative. It is probably best just to listen, in the first instance. Later, if an appropriate moment arises, you could gently remind the bereaved parents that teenagers notoriously prefer to keep their thoughts and feelings away from their parents as a normal part of their growing up process.
Guilt and shame are not synonymous. A person will feel guilt if they judge themselves to have done something wrong (or failed to have done something they should have done). But if they judge themselves to have a bad or inadequate character – to be bad in their ‘being’ rather than in their ‘doing’ – they will be feeling shame.

Section 2: Friends

Check if there are children or teenagers in the bereaved family. If so, do they feel able to go back to school/college, or are they too upset? If you are appropriately qualified, you could offer to talk with these children/young people yourself.
Check whether the staff at their schools/ colleges are aware of the situation – and not just their form teacher or tutor but also the principal. If the school/college has not been informed, you could suggest that the parent contacts the principal to clarify the family situation.
Bereavement training is now available for staff throughout a school, not just for those whose role is pastoral care.
Some schools and colleges now have specialist trained bereavement counsellors that the students can see.
There are also counsellors available through suicide bereavement charities (see Help Is At Hand) who are experienced in talking with children and young people.
If the children/young people are already receiving counselling, you can check how well the counselling is progressing, if you are appropriately qualified. NB Of course you will only hear an assessment from the parent’s point of view, not the children’s, unless you are also in conversation with the children.
Most children/young people need to feel they are part of a group of friends they have chosen. You can find out if this is the case here. Are their friends acting as a good support group?
Young people use social media and mobile phones relentlessly. This can be an asset: their way of giving vital support.
Parents need supporters too from their circle of friends, relatives and neighbours. But you may discover that the family has not shown their circle that they need help – perhaps out of a misplaced belief that they ‘should be able to cope’, or a fear of having their privacy invaded. If so, you can remind them of non-intrusive, practical supports that friends can provide, like walking the dog, doing the laundry or washing up, or preparing meals.
Friends, neighbours and relatives can also help by offering simple, brief, warm, human gifts – like bringing comfort food, offering hugs, or taking the family out with them to get exercise and fresh air.
Or by listening empathically – accepting the bereaved just as they are, rather than trying to change how they are feeling. This is a point that has been made before, but it worth repeating because offering acceptance is the single most important way of helping.
Offering unsolicited advice, by contrast, is an indication that you want the bereaved person to change. They will change when they are ready – in their own time, not in yours.
If it is not easy for a trained professional to behave ‘normally’ in such an abnormal situation, its easy to see how hard it can be for people in their immediate circle. And they will also have had long complex relationships with the family already, which can lead them to assume they know more than they can actually know. E.g. They may offer knowing explanations, like: ‘Your husband always did undermine him.’ Even where these judgements are unspoken, the unhappy family will feel their negativity.
But even where the parents’ support group is caring and positive, they may often try to inhibit or ‘fix’ the tumultuous feelings of the bereaved family as they wrestle with their pain – basically because they can’t face this depth of pain themselves. Friends and relatives may:

give unsolicited advice to try to ‘take the pain away’
avoid lighter, everyday, or humorous topics out of a misguided wish to ‘be sensitive’.

As a result, the family may, ironically, end up looking after people in their support group, instead of the other way round.

Section 3: Feelings

A family that has been bereaved can feel a strong need for the healing and closure that can come with a funeral. So it can be very hard for the family to have to wait for days or even weeks till the coroner notifies them that the post-mortem process is over and their loved one’s body can be released. Until this happens, the funeral cannot take place. The family cannot even set the date for the funeral.
What they can do, however, is to use this interval to make preparations for the funeral: to gather readings, music, photographs, to organize flowers and orders of service, and to invite people to take part in the ceremony. Some people find this quiet period of preparation a deeply comforting part of the grieving process.
Be sensitive to the fact that some men still believe that it is ‘weak’ to feel emotional – even after a trauma like this. Where possible, normalise signs of emotional distress: it can give ‘permission’ to bereaved men to express their grief.
Normalising expressions of feeling may also help people who have been bereaved to accept counselling as a place they can release feelings in a confidential, safe environment. There can be a fear that to express and accept feelings or thoughts they consider socially unacceptable means to condone acting them out. E.g. If they were to dare to say, honestly, ‘I am so angry with X, I feel like hitting him,’ they may imagine they are being encouraged to go and hit poor X. If anything, of course, the reverse is the case.
Blotting out feelings by working too hard is a frequent escape route. Other bereaved people may find it difficult to concentrate well enough to work – to the point of constantly falling asleep.
A grief-based inability to work, where compassionate leave is brief, can create employment problems. You can suggest that the family approaches the employer to explain the situation, perhaps with an accompanying note from the GP.
Eating or drinking too much after a bereavement is another way of blotting out painful feelings – and one that can create health problems.
It is particularly important to establish if bereaved family members are drinking too much, or taking drugs, as these can be indicators of heightened suicide risk.
It is important to check if the person who died had a partner or boyfriend/girlfriend, who may be feeling just as devastated as the family and need similar support, yet not be known to bereavement services. You can encourage the family to contact these friends/partners so they too can receive the professional support they need.
Some close friends or relatives might not have visited the bereaved family from fear of intruding on private grief, and this wish can be misinterpreted as a lack of concern. It is worth surfacing such issues so they can be re-framed.
Death by suicide is not just sad or shocking: its violence is frightening. Its reverberations can affect not only the bereaved family but their circle of friends, neighbours and relatives – and even the professionals supporting the family. You may be able to acknowledge these fears, when it seems appropriate.
It is extremely unhelpful to be judgmental about the person who has died by suicide – and especially to criticize them for ‘selfishly’ causing pain to those left behind. Although a professional is unlikely to be so insensitive, the bereaved family may well have experienced such accusations of selfishness, leaving them feeling confused and conflicted. Such accusations may tend to come from older relatives, brought up at a time when society viewed suicide judgmentally.
The bereaved family may also have been hurt by people who show less sympathy to a death they view as ‘chosen’ by the person who died than to a death they view as being beyond the person’s control – e.g. as a ‘victim’ of a car accident or of cancer.
Sometimes people say ‘at least it was chosen’. How can suicide lessen the loss? This kind of depreciation shows a lack of empathy and can feel deeply unkind to the bereaved family.
It is also disrespectful of the person who died, as the notion of ‘choice’ offers too simplistic and dismissive a view of their psychological state. The reasons leading to someone dying by their own hand are complex, and can probably never be fully known. It is more fitting to accept the mystery than to reach for easy answers.

Episode Three

Section 1: Counselling

In Episodes One and Two, the professional in the video was responding to the bereaved family’s immediate and short-term needs. In the third video, he signposts longer term coping strategies, like counselling and therapy.
Most people bereaved by suicide seem to benefit from a few sessions with a trained counsellor. Some people may need a longer course of sessions – and some may need to see a psychotherapist.
Counselling and psychotherapy are not the same, though there may be overlaps.

Counselling

In counselling, a person will generally work on a specific, current issue
The work tends to be done through dialogue, often focusing on a single method – e.g. CBT (Cognitive Behavioural Therapy)
A course of counselling tends to be completed in a small number of sessions, often half a dozen.

Psychotherapy

In therapy, a client will usually delve more deeply into a wider range of issues
The therapist and client may work together for many months, or even – intermittently – for years
They will typically address problems arising over a longer period of their lives, identifying recurring patterns
They may use a wide range of ‘talking therapies’ as well as body-based therapies – e.g. EMDR.

Elisabeth Kubler-Ross’s Stages of Grief can be a comforting book for some bereaved people. They find its framework of five stages – denial, anger, bargaining, depression, acceptance – useful as a tool for framing and identifying what they are feeling while they are learning to live with what they have lost.
Unfortunately the book can sometimes suggest that bereaved people will always travel in a linear sequence through these stages: e.g. starting with denial and completing this stage before moving onto anger… The reality is that the feelings experienced by bereaved people are unlikely to behave so neatly. They may return repeatedly to one or other point in the sequence, or experience them concurrently, or experience feelings that are not included here at all.
Families can sometimes feel that their lives too have come to a standstill, and that they will never recover and move on from this loss. It is important not to dismiss this feeling: it is real for now, and that makes it real enough. Your role is to recognize and accept what feelings there are, not to push them away or try to change them.
The professional should never claim to know what the bereaved family is going through. No-one who has not been bereaved by suicide themselves can begin to know this depth of grief, and it is insulting to the bereaved family to suggest you do.
And even if you have shared this experience, people are unique, so you cannot know exactly how someone else is feeling. We can, however, use our imagination as a way of getting a little closer to what the bereaved person is going through – which is why Grant says, ‘I can only imagine your distress.’
You should be prepared for the fact that a sudden or untimely death is likely to cause huge disruptions in families. As anger, fear and blame are released, it should not come as a surprise that old fault lines in family relationships are intensified – and even previously close and happy relationships can come under severe strain. The risk of serious marital problems and divorce rise.
You should also note that some family members may be attached to the belief that ‘families should come together’ in some wonderfully co-operative way after a bereavement, and may become doubly distressed by the family actually being at odds with one another. They may, in time, see that families are more likely to be riven by shockwaves after a violent death than to co-operate.
You will need to remember that people mourn in different ways – and model this idea for family members who may demand that everyone responds similarly. Some extraverts may believe, for example, that everyone in the family ‘should’ constantly display and share their distressed feelings with one another, and feel abandoned when others don’t meet this expectation. Conversely, introverted family members may feel battered by these unwelcome demands and feel silently accused of caring less about the person who died because their response is more inward.
Bereaved family members may berate themselves for helping to create the conditions for suicide, e.g. by saying or doing something wrong, or by having a poor relationship with the person who died. Just listen, or refer them to a counsellor or therapist.
It may strike you that the bereaved person you are seeing had been in a co-dependent relationship with the person who died. This is complicated: best referred to a therapist to deal with.
One way to reduce post-suicide tensions between family members may be to encourage an attitude of mindfulness, where they learn first to be kinder to themselves. As they become more mindful of their own needs and better able to take care of them, they might be able to be kinder to each other.

Causes

As mentioned before, the causes of a death by suicide are complex and unique because human beings are complex and unique. One person may fear a painful terminal illness, while another may fear great loneliness. One may feel a burden to their family or to society, while another may feel overwhelmed by the suffering around them – and, believing it is their responsibility to heal it, conclude that they don’t deserve to live since they have failed. Various people may suffer from a range of mental illnesses leading to self-inflicted death. Or it may come about as a result of pursuing a fascinated curiosity about the mystery of death. It can even be a powerful form of social or political protest, as many acts of public self-immolation have been across many centuries.
Often professionals, or even friends and relatives, may describe the cause of death simply as caused by ‘a psychotic episode’. Although this may comfort some bereaved families, it can feel insultingly dismissive to others – a failure of the imagination and heart. As bereaved families rarely know for certain why someone they loved took their own life, they often search agonizingly for a greater meaning than this. They may try following the loved one’s footsteps – walking into the depths of their pain – in an attempt to understand empathically what they had been experiencing before their decision to end their life.
It is common to experience nightmares and flashbacks after a trauma. People who have been bereaved can often suffer from a degree of PTSD (Post-traumatic stress disorder).
So can the professionals who respond to death by suicide. The statistics tell a grim story of professional first or early responders being at considerably heightened risk of PTSD and suicide themselves.
The good news here is that these risks are not inevitable. There is encouraging counter-evidence too: that where managers have successfully created a culture where vulnerability is acceptable and where a responder is encouraged to share upsetting experiences with the managers and with colleagues, the incidence of PTSD plummets.
The bereaved family may harbour fears that they are ‘going mad’ – perhaps especially if the death of their loved one was diagnosed as being caused by a mental illness. They may well only be suffering symptoms of acute stress – naturally enough, after such a trauma – and it may be important to reassure them that this is all it is.
However, given the heightened risk to family members, it may be worth checking their psychiatric history with their GP, if you are in a role that enables you to do this. But even so you may not find this action plain sailing. Many medical staff feel ‘patient confidentiality’ takes priority over sharing information that could lead to support for other family members at risk.
One of the important actions that many people take if they know that a loved one is dying is ‘tying up loose ends’: things that have needed to be said, sometimes for years, are finally said. But when someone dies suddenly by suicide, the bereaved family is robbed of this opportunity. Unfinished business can cause profound and painful regret.
Sometimes therapists are able to use techniques like guided visualization or role-play to enable bereaved family members to feel a degree of closure over things left unsaid or undone.
A critical moment of closure comes for a family when they are able to say goodbye to a loved one when they are dying. But again, someone bereaved by suicide is often robbed of this precious chance. It is important to offer the bereaved family the opportunity to say goodbye to their loved one even after death, without over-protectively shielding them from what will be a painful moment – painful but vital nonetheless.

Childhood

The loss of a loved one can bring up pain from the past. If you note the presence of a past trauma that might be adding a further layer of distress to a bereaved family member, you may suggest a referral to a therapist.
Old traumas may well not have been explored, since only a tiny minority of people were supported by therapy in the past. Unprocessed grief and loss were unfortunately the norm for most people.
Unprocessed grief in one family member can also deleteriously affect others, who may sense the pain of a lingering wound and be troubled by it, with no knowledge of how to deal with it.
One of the strongest needs most children have is to belong to a wider group of friends. If this need is thwarted by rejection from their favoured group, it can cause deep-seated pain.
Even though death by suicide is no longer a crime, it can still attract stigma and shame. Friends or relatives can sometimes act as if it is something to be hidden away rather than celebrated. But a funeral is an important rite of passage for the bereaved family – a vital act of closure – and nothing needs to stop the funeral of someone who has died by suicide being a genuine and whole-hearted celebration of their life.

Epilogue

Suicide is not something that health professionals or most police officers have to confront very often. Many of you will never come across it at all. The result is that, more often than not, no time has been allowed for training you in suicide bereavement. But if and when you find yourself in this position, you will need to know how to cope – and it will be one of the hardest things you will ever have to do. So we hope you will take the time to go through this training.
One of the reasons why responding to death by suicide is so distressing, so traumatic, for us is that we are public servants – people who have committed our lives to actively making people’s lives better. Yet in the case of suicide, we can’t do this. We can’t do anything for the person who has died.
And we can do so little too for the bereaved families left behind. Often all we can do is to listen, to be there – which can feel frustratingly passive. The desire to provide active help, to offer answers, provide remedies, will be great. But this habit of being pro-active, which we have developed over years for all sorts of good reasons, is exactly what we now need to inhibit.
This is a time when the only thing we can fix is ourselves: we have to calm our own turbulence so that we can really listen – and be guided by what we hear. Because this is a wound we can’t heal. We can’t make it better. All we can do is not make it worse.

Anuradha Vittachi, Hedgerley Wood Trust, 7 November 2016