Helping those bereaved by suicide: what we have learnt at Support After Suicide

Helping those bereaved by suicide:

what we have learnt at Support After

Suicide

Martin Ryan, Louise Flynn, Anne Giljohann, Sehar Warren, Colin Charles, Jackie Ballantyne

Counsellors

Support After Suicide, Melbourne, Australia Email: [email protected]

Paper presented at 3rd _{Australian Postvention}

Helping those bereaved by suicide: what we have learnt at Support After Suicide

Outline of presentation:

1) Suicide statistics in Australia and Victoria 2) Support After Suicide program

3) Suicide bereavement’s particular features 4) Applicable theoretical approaches

5) Key learnings from Support After Suicide 6) Conclusion

Suicide in Australia

2010 Australian Statistics

 2,361 deaths registered as suicide (1.6% of all deaths)

 1,816 men (77%)

 545 women (23%)

 highest rate males aged 40-44(27.7 per 100,000), followed

closely by males aged 35-39 (27.5 per 100,000)

 This represents many children losing a father to suicide

 for males aged 15-19 = lowest rate (11.4 per 100,000 ),

but 23% of male deaths in this age group

 Males nearly 4 times that of females

 Most frequent method was hanging (56%)

(most frequent method for both men & women)

In 2004 Support After Suicide was funded as the sole specialist suicide bereavement counselling

service in the Australian state of Victoria.

Population of Victoria (2010) = 5,679,337

Number of suicides in Victoria in 2010 was 531.

405 men (76%) and 126 women (24%)

(Causes of Death, Australia 2010. ABS, released March 2012)

Helping those bereaved by suicide: what we have learnt at Support After Suicide

Support After Suicide program



A program of Jesuit Social Services

(non-government welfare agency adhering to the traditions of St Ignatius Loyola, founder of Jesuits)



Main work is with disadvantaged young

people, particularly those involved in the

criminal justice system

Support After Suicide program

Funded by the Australian Commonwealth

government as part of its National Suicide

Prevention Strategy.

Enacting Shneidman’s (1972) dictum that

postvention is prevention for the next

Support After Suicide program

The goal of the program is to increase the

availability of

timely

appropriate

individuals & families

(especially those with young children) who are bereaved by suicide

Support After Suicide program

 Employs 3.8 EFTSU (6 counsellors /community

educators) + .5 admin person

 Central location plus access to 4 other sites

around Melbourne including a CBD office.

 Staff have variety of backgrounds including

psychology, social work, counselling and

psychotherapy, plus bereavement counselling experience. All work part-time, with

Support After Suicide program

Direct service

Counselling

 Individuals/Families/Couples

 Based in inner city Richmond, outreach in Dandenong, Lalor, Ferntree Gully and CBD Support groups

 Early bereavement closed group  Monthly “drop in” group

 Forums for siblings/ partners

 Writing/performance group – “ Nothing

prepared me for this” project

 Volunteer program – engaged in range

of activities from fundraising through to peer support (bereaved to bereaved) and co-facilitating support groups

Support After Suicide program

Capacity building:

 Education and Training

 Secondary Consultation to Professionals

Health, education, welfare, community sectors  Resources

 Information sheets

 Website: for bereaved people and professionals

 Facebook

 Online community

Support After Suicide program



The program believes that people need

access to highly skilled clinical support to

be provided immediately post-suicide



Support should continue long term due to

the enormous impact and disruption as a

consequence of suicide

Support After Suicide program



Service is free of charge



No maximum limit on client sessions

(mean number of sessions = 24)



We try to see people as soon as possible

Suicide bereavement’s unique and

complex features

involves trauma (sensory or informational)

impact of suicide on identity and sense of self experience of failure

impact of stigma

search for an explanation

young people and developmental issues

impact on social network and family relationships increased risk of suicide

Support After Suicide program

Applicable theoretical approaches:

 Dual Process Model (Stroebe & Schut, 2008)

 Disenfranchised grief (Doka, 2002)

 Grieving styles (Doka & Martin, 2010)

 Continuing Bonds (Klass, Silverman & Nickman, 1996)

 Narrative approach (Neimeyer, 2001; White, 2007)

 A broadly psychodynamic approach

Key learnings

1) the need to work with the grief, the trauma and that the death was self-inflicted;

2) persisting with people for the long haul (expert companioning, Jordan, 2009);

3) the need to be flexible and creative, particularly with young people;

4) the power of group work;

5) the need for factual information about suicide and processes surrounding it for clients; and

6) to be open to clients’ extraordinary

experiences and the use of psychics and mediums.

1) Need to work with the grief, the trauma and that the death was self-inflicted

 All three important and at some point may need to

engage with each of these

 ?when/how

 Dosing important (self) for both traumatic

images/memories and for grief (DPM) (Jordan, 2010)

 Follow clients lead on this, plus some control needs

to be exercised by counsellor

 Counsellors need skills and knowledge

to work with each of these three elements

2) Persisting with people for the long haul

(expert companioning, Jordan, 2009)

 Mean no. of counselling sessions is 24 (even at 1

a week = half a year)

 “Sticking with it” through ups and downs (with

the latter predominating)

 “Groundhog Day” at times, but look and listen

for small changes in story

 Looking for signs of improvement in progress  Not just companioning, it is expert

and all that this entails (with belief, optimism and caring)

3) Need to be flexible and creative,

particularly with young people

 Not necessarily traditional counselling or therapy  Not necessarily office-based

 Activity-based e.g. camps, circus arts, swimming,

playing football or cricket

 Discussion of tattoos

 Casework – not just for emotional engagement,

but practical assistance

 Running with hunches and intuition

4) Power of group work

 Can have a significant impact for people

 Group participants can be very helpful to each

other

 Support and information from others who have

been through the same experience, often more important than what counsellor can do

 People feel isolated, alone, ‘outsider’, freakish.

Group restores connection to society, restores a sense of belonging.

5) Need for factual information about suicide and processes surrounding it for clients

 Not mentioned in the literature but we have

found it to be very important

 Counsellors need to be prepared and able to do

this

 Information regarding suicide, especially

hanging (predominant method in Australia)

(Sauvagneau’s work e.g. 2007 & 2010 useful here)

 Coronial processes

 Assisting client to understand the

autopsy/toxicology and coronial reports

6) Open to clients’ extraordinary experiences and the use of psychics and mediums

 People will tell the counsellor about these

experiences if they trust them

 Can be comforting and helpful to them  May be disturbing

 Key question to ask: how did you feel? What do you

think it means?

 Going to psychics/mediums is not uncommon  Can be comforting, and/or provide

answers, but not always (LaGrand, 1999 and 2006; Sanger, 2009)

Conclusion

 In working with those bereaved by suicide, one size does not

fit all

 A variety of types of responses and supports, needed from

individual work, family work, group work, activity-based work to online responses

 that provide a range of supports (counselling, therapy,

practical information and assistance) for the long haul involved in having someone close to you suicide

 Working well involves: 1) clinical training; 2) working

effectively; and 3) working compassionately

An earlier version of this paper was

presented at the 9th International

Conference on Grief and Bereavement in

Contemporary Society & ADEC 33rd

Annual Conference, Miami, Florida, June

22 – 25, 2011 and also a version of this

paper is in press and will be published as

an article in the journal

Grief Matters

later

in 2012

Acknowledgements

I would like to acknowledge the contribution of

my counsellor colleagues at Support After

Suicide to the development of the ideas in this

paper, particularly Louise Flynn as Coordinator

of the program, and my current colleagues

Anne Giljohann, Sehar Warren, Colin Charles

and Jackie Ballantyne, as well as former

colleagues Barbara Friday, Brendan

Fitzgerald and Felicity Elkiana

References

Chandler, R. (2005). ‘Psychodynamic therapeutic approaches with people who are grieving.’ Grief Matters, 8(2), 30-34.

Doka, K. (2002). Disenfranchised Grief: New directions, challenges and

strategies for practice, Champaign IL: Research Press.

Doka, K. & Martin, T. (2010). Grieving Beyond Gender: Understanding

the Ways Men and Women Mourn. (Revised edition), New York NY:

Routledge.

Flynn, L. (2009). ‘Is suicide bereavement different? The experience of Support After Suicide.’ Grief Matters,12(1), 18-21.

Jordan, J. (2009). ‘After suicide: clinical work with survivors’ Grief

Matters, 12(1), 4-9.

Jordan, J. (2010) ‘Principles of Grief Counselling with Adult Survivors’ in Jordan, J. & McIntosh, J. (eds.) (2010) Grief After Suicide: Understanding

the Consequences and Caring for the Survivors, New York NY: Routledge,

179-223.

Klass, D., Silverman, P., & Nickman, S. (Eds.). (1996).

Continuing bonds: New understandings of grief.

References

LaGrand, L. (1999). Messages and miracles: Extraordinary experiences

of the bereaved, St. Paul, MN: Llewellyn Worldwide.

LaGrand, L. (2006). Love lives on: learning from the extraordinary

encounters of the bereaved, New York NY: Berkeley Books.

Neimeyer, R. (2001). Meaning Reconstruction and Experience of Loss,

Washington, DC: American Psychological Association.

Ryan, M., Merighi, J., Healy, B. & Renouf, N. (2004) ‘Belief, Optimism and Caring: Findings from a cross-national study of expertise in mental health social work.’ Qualitative Social Work, 3 (4), 411-29.

M. Ryan, C. Dowden, B. Healy & N. Renouf. (2005) ‘Watching the Experts: findings from an observational study of expert Australian mental health social worker. ‘ Journal of Social Work, 5(3), 279-298.

Sanger, M. (2009). ‘When clients sense the presence of loved ones who have died.’ Omega, 59 (1), 69-89.

References

Sauvagneau, A. & Racette, S. (2007). ‘Agonal sequences in a film suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging.’ Journal of Forensic Science, 52, 957-59.

Sauvagneau, A., LaHarpe, R., King, D., Dowling, G., Andrews, S., Kelly, S., Ambrosi, C., Guay, J., and Geberth, V., for the Working Group on Human Asphyxia (2010). ‘Agonal sequences in 14 film hangings with comments on the role of the type of suspension, ischaemic habituation and ethanol

intoxication on the timing of agonal responses’. American Journal of

Forensic Medicine And Pathology, (undergoing post author corrections,

29th _{of July 2010.)}

Shneidman, E. (1972). Foreword. In Cain, A. (Ed.) Survivors of Suicide,

Springfield, Ill: Charles C. Thomas, ix-xi.

Stroebe, M. & Schut, H. (2008). ‘The dual process model of coping with bereavement: overview and update.’

Grief Matters, 11(1), 4-10.

White, M. (2007). Maps of Narrative Practice, New York, NY: W.W. Norton.

Support After Suicide

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