Rationale for Present Study

The studies and theories evaluated in this literature review highlight the lack of research on the psychosocial impact that a loved one’s suicidal behaviour has on family members. This is surprising given that over 6,122 suicides occurred throughout the UK in 2014 (Office for National Statistics, 2015), the devastating impact that suicidal behaviour has on families (Sugrue, Gilloway & Keegan, 2014) and the increased suicide risk that family members are at due to exposure to their loved one’s suicidal behaviour (Cerel, Roberts & Nilsen, 2005).

In agreement with Champlin (2009) and Nosek (2008), the researcher feels that as community care is becoming a more popular option for people with mental illness there is a stronger responsibility placed on family members to ensure that their loved one can live successfully in the community (Champlin, 2009). Robust evidence exists suggesting that a previous suicide attempt is the strongest predictor of a completed suicide (WHO, 2014). The implications of this are serious for familial caregivers who are frequently required to adopt a preventative and caring role in the aftermath of their loved one’s suicide attempt (McLaughlin et al., 2014). This experience is particularly challenging for family carers when one considers the vigilance required in recognising signs and preventing future suicide attempts (Nosek, 2008; Buus et al., 2014; McLaughlin et al., 2014) and the fact that carers are also juggling other demands of everyday life such as working and raising families (McLaughlin et al., 2014; Owens et al., 2011). Furthermore, an additional challenge to the role of caring and safeguarding the loved one is the risk that intervention can

39 pose to their relationship with their loved one (Owens et al., 2011). This was observed in Sun et al.’s (2008) study which showed the anger and resentment suicidal ex-patients felt toward their family carers due to their decision to hospitalise them.

All of the above studies and theoretical perspectives found that family members felt alone, isolated and were highly aware of the stigma associated with their family members’ suicidal behaviour. It is concerning that this was observed in Daly’s (2005) research ten years ago and is still felt, in the US and the British Isles in recent years (Champlin, 2009; McLaughlin et al. 2014). Despite the prevalence of attempted suicide in the British Isles, very few studies exist investigating the impact that a loved one’s suicide attempt has on family members. The results from the discussed studies inform the proposed study. However, it is worth noting that these studies were conducted in Taiwan, Denmark, Canada and the US where cultural or social norms and healthcare systems are structured very differently. For example, in Sun et al.’s (2008) study, carers engaged in folk therapies such as fortune tellers for support

with managing their loved one at home. This is unlikely to be observed in UK carers’

experiences as folk therapies are not a common part of UK culture. Therefore, Owens et al. (2011) and McLaughlin et al.’s (2014) studies may provide more culturally comparable results to the proposed study.

Subsequently, it is acknowledged that the few studies exploring family members’

experiences of caring for a suicidal loved one do not employ an IPA methodology.

Given the subjective nature of a family member’s relationship with their loved one and the unique causes of why someone attempts suicide, it is felt that an IPA study would allow the researcher to gain a rich and in-depth account of each individual’s idiographic experience of caring for a suicidal loved one. Additionally, Buus et al.

40 (2014) felt that in their study, loose ends were not explored and open-ended issues remained unexplored due to the focus group design. Semi-structured interviews proposed in this study would allow the researcher to follow up on these issues.

Furthermore, of the eleven studies reviewed above, only Sun et al. (2008), Sun et al.

(2009), Daly (2005), Nosek (2008) and Buus et al. (2014) explored the experiences of family members caring for a suicidal loved one with a non-bereaved sample. Very little research has been conducted to understand non-bereaved family members’

experiences of their loved one’s acute suicidal phase. The studies that do explore this have found that family members felt overlooked by healthcare professionals (McLaughlin et al., 2014), identified a great lack of support and isolation (Byrne et al., 2008) and felt no one could understand their struggle (Daly, 2005, and Buus et al., 2014). Furthermore, it appears that this group do not have the same range of supports available to them as family members who are bereaved by suicide. The proposed study aims to firstly to gain an understanding of loved ones’ experiences of living with a suicidal individual. Additionally, it aims to gain insight into their perceived support needs with a view to informing practitioners on appropriate supports for family members and carers.

Finally, although the above research can inform the present study, very few studies explored how loved ones cope with living with a suicidal individual and managing other competing pressures such as raising other children, functioning in work and maintaining relationships with other family members. This is surprising given the difficulties that participants in the above studies reported in these areas. It is surprising also that these areas have not been researched considering that unemployment, relationship breakdown and isolation are often cited as contributory factors for suicide in addition to exposure to a loved one’s suicidal behaviour. The

41 impact that a loved one’s suicidal behaviour has on the relationship between the suicidal person and their familial carer is also under researched despite the responsibility that is often placed on family members to care for and safeguard their loved one and Sun et al.’s (2008) findings that the quality of the relationship can impact the level of care provided. Given the range of emotions that family members experienced toward their suicidal loved ones in the above studies and how this can give rise to burnout (Grant Ballard, & Olsen-Madden, 2015), it is felt that exploring the relationships between the carer and the suicidal loved one, how this changes over time and what factors affect it, is worthy of investigation as it is currently poorly understood.