Bereaved by suicide
When a person takes their own life the grief experienced by family and friends can be devastating - and those left behind may also have an increased risk of suicide.
When a person takes their own life the grief experienced by family and friends can be devastating - and those left behind may also have an increased risk of suicide
Some of the factors associated with an increased risk of suicide are well established. Men are known to be more vulnerable than women, especially those aged 45-59. People with mental health problems, particularly depression, are at greater risk than the general population, as are those who self-harm or misuse drugs or alcohol. Social isolation is another acknowledged risk factor.
But according to mental health nurse David Olphert, who has more than 30 years' professional experience, there is much less awareness about the increased risk in people who have been bereaved by suicide.
The evidence for this increased risk is not just anecdotal. A UK study of 3,432 young bereaved adults, published in BMJ Open in 2016, found that those bereaved by suicide were 65% more likely to attempt suicide than those whose loved one had died suddenly from other causes.
Over the past three years, Mr Olphert has developed the Bereaved by Suicide Service at the Northern Health and Social Care Trust in Northern Ireland. 'I came on board in 2013 when the service was remodelled,' he says. 'Two of us cover the whole trust, an area of 50-60 square miles. My colleague used to work in health promotion and I bring a clinical background. We publicised the service to GPs, community mental health teams, churches, youth services and voluntary organisations. In the first year our referrals went up by 75% and the following year by a further 5%.'
As well as offering individual counselling, Mr Olphert works closely with the police, statutory services and community organisations to provide a network of support.
The role involves reviewing sudden death notification forms from the police. 'On that form the police officer will ask the family if they want support. If they do, we allow two weeks for the funeral, then we send information, and two weeks after that we call and arrange to meet. We let them know the sessions that are available and they can take them up or not.'
He says the stigma around suicide is an enduring problem. 'Suicide is still a topic people choose not to talk about. We publicise our work but we don't sensationalise it.'
Part of his work is monitoring 'clusters' of suicide in social groups. 'There's always a risk that suicide can be contagious. If we find a lot of connectedness among deaths, we put more resources in. If a young person who died was involved in a youth club we make sure the other young people know there is someone they can talk to.'
People come to the service weeks, months or even longer after a death. 'You can't push or force individuals, you might do more damage,' he says. 'They see moving away from the grief as moving away from the person. We tell them that you never lose the person, but you do need to lose some of the grief and pain. You need to put it in a more healthy format.'
After an initial assessment, clients are offered four to six sessions of therapeutic support. They then have the option of a further six with an organisation called CareCall.
'In our first session we set goals,' he says. 'In the second, we discuss their well-being. Not coping becomes a habit: we all need routine, but grief can rob you of routine. Without intervention, people can stop leaving the house and they can have lots of mental health problems.'
Mr Olphert says people need reassurance that what they feel is normal. 'The nature of death by suicide is traumatic and you have the symptoms of grief that mimic depression: disturbed sleep and eating patterns, a lack of motivation. The trauma releases adrenaline that affects your ability to think, and people may not remember things. They might walk into a shop and think “why am I here?”. They need reassurance that they're not losing their mind.'
Guilt and anxiety
Grief after suicide can be complex and can affect family relationships. The pain of suicide can't be eased quickly, but Mr Olphert says some things can make a difference, such as staying connected to friends and family, honouring the deceased person by sharing memories, staying healthy, prioritising daily tasks, and seeking help.
'The aim is to help people to understand that although they will never be the same again, they can survive. Losing a child is particularly horrendous. There's the guilt, the “what could I have done differently?”. There is a hyper-vigilance for other family members, anxiety, their stomach in a knot. They often these come with physical symptoms.'
Mr Olphert tries to help people find positives. 'You always take that person with you, but you can't be stuck in grief because that will cause you to be angry and upset all the time. We try to focus on the fact that the person may have been a fantastic mother, father or son. It doesn't take away the pain but it helps to stop the anger.'
Bereavement counselling works for many, but not for all. 'The most satisfying part is seeing people who are really upset being able to breathe and live again,' he says. 'Some people are stuck and I can't get them unstuck and that is very frustrating. They can always ring us, we never close the door, we don't give up on them and they know that.'
A father's story: I lost one son, and then my other son took his own life
'When Owen's brother died, it was sudden and unexpected. Owen and I became even closer. He worked in a grocer's shop close to where I live. Every evening I would call him after he finished work. Then one evening, Owen was not in the shop.
'Two days later he came to see me, unshaven, unwashed and looking ill. The doctor said he had severe depression. He was put in hospital and they said he had become schizophrenic. When he came out I was told he would never recover but his illness could be managed.
'One bright September day, Owen left his flat, walked to the old bridge over the River Bann and jumped in the river. We didn't recover his body until the following Sunday.
'I felt shock, disbelief, I thought this can't be real. Then the flood of emotions: what had I done wrong? Could I have prevented this from happening? Was I to blame? I needed help. I could not go through this on my own.
'I put fear and pride aside and phoned a Bereaved by Suicide worker who got me a counsellor. She was of immense help. I also joined a group where I was able to explore my feelings. I didn't attempt to build my life around the pain. I let the pain flow out of me to create an inner void where peace could take root and grow.'
Suicide: the figures
- There were 6,188 deaths from suicide in the UK in 2015, equating to 10.9 deaths per 100,000 population, a slight increase on the previous year.
- The male suicide rate decreased, while the female suicide rate rose to its highest in a decade. However, the male rate was still three times higher than the female rate.
- England and Scotland saw decreases in the total number of suicides, while Wales and Northern Ireland saw increases.
- Northern Ireland had by far the highest suicide rate in the UK, at 19.3 deaths per 100,000 population, the highest on record. Scotland and Wales had rates of 13.9 and 13.0 per 100,000 respectively. England had the lowest rate at 10.1 deaths per 100,000.
- The most common method of suicide among both women and men was hanging.
Source: Office for National Statistics, Suicides in the UK: 2015 registrations.
Alison Whyte is a freelance health writer