Tuesday, March 6, 2012

Tensions in Postvention: An International Dialogue, Part II

By Sally Spencer-ThomasAAS Survivor Division Director

In the last issue of Newslink, I shared the first part of a historical discussion that took place at the International Association of Suicide Prevention’s World Congress in Beijing, China on September 15th, 2011. In this issue I continue to share a summary of that dialogue among some of the world’s leading postvention experts:

·     Karl Andriessen, M.Suicidology, (BELGIUM), Coordinator of the Suicide Prevention Program of the Flemish Mental Health Centres, and Co-Chair of the IASP Taskforce on Suicide Bereavement and Postvention is a tireless advocate for the needs of people bereaved by suicide.

·     Prof. Onja Grad, PhD, (SLOVENIA), clinical psychologist who has worked with survivors on a daily basis for the past 22 years — with individuals, families, groups. She is also a teacher at the University of Ljubljana School of Medicine.

·     Tony Gee

·     Jill Fisher M.Suicidology, M. Health Studies (Loss and Grief) (AUSTRALIA), National Coordinator for the StandBy Response Service and was the recipient of the 2011 International Association for Suicide Prevention Norman Farberow Award.

·      Myfanwy Maple, PhD, BSW (Honours Degree), (AUSTRALIA). Senior Lecturer, Social Work Course Coordinator, School of Health, is a social work academic and researcher in suicide bereavement over the past decade, particularly examining the loss experiences of individual family members.

·     Sandra Palmer, Ph.D. (NEW ZEALAND), a registered psychologist and Clinical Manager Community Postvention Response Service, provides support to communities experiencing suicide clusters or contagion. She continually faces the challenge of balancing the need for communities and families to honor the loss of loved ones with safe postvention practices to manage contagion to prevent further losses in the community.

·      John Peters, M.Suicidology (UNITED KINGDOM), lost his son to suicide 19 years ago and has for many years been a volunteer with Survivors of Bereavement by Suicide including staffing their Helpline each week and running peer-led support groups and an annual support day.

·     Diana Sands, PhD, (AUSTRALIA),Director, Bereaved by Suicide Service has worked with families bereaved by suicide for over twenty years, produced a film and written a book for children bereaved by suicide will speak to the complex and sensitive issues in how to talk with children bereaved by suicide.

In the first article I reviewed the group’s responses to the first two questions:

1)      How can we balance the need to prevent contagion with the need to honor loss?

2)      How do we balance getting a familiar sense of normalcy with the acknowledgement of significance to a community that has been deeply affected by a suicide loss?

In this article I summarize the themes of the second set of questions:

3)      Do we tell children about suicide or not? When do we tell them? How much information?

4)      What services do we provide – lay led, professionally facilitated or some combination? Knowing that the research indicates the benefits of peer led efforts, how do we manage quality control and sustainability?

5)      How do we safely involve survivors of suicide loss and attempts in research? What are the best protocols for this?

Part II of the Dailogue on Tenstions in Postvention

Do we tell children about suicide or not? When do we tell them? How much information?

Another engaged conversation ensued around this anxiety provoking topic. As the mother of three young children and knowing that survivors of suicide loss are at higher risk for suicide, I noted, “We don’t have the evidence-based long-term answer on how to do this right [explain suicide to children], and the stakes are high.”

Nevertheless, several excellent suggestions came forward from the group. Some offered that we inoculate children before crisis occurs by letting kids know that when things go wrong there are resources to help them.

When a suicide tragedy strikes, we need to be honest in a way they understand. Parents often think the kids don’t know but they do. Sometimes we have to help the parents work through this more than the kids.

Diane Sands, author of a book about supporting children bereaved by suicide said, “It is important to support our children even in the awfulness. A lot of parents want to protect children from this tragic knowledge. We need to let parents know there are people who can help them navigate these decisions. Parents worry that they will have to explain everything; rather it is a process of coming to terms with this knowledge. Children are extraordinary in picking up on nonverbal.”

When children are lied to, the resulting complications can make things much worse. Children know when there is fabrication even if they don’t know what is made up. It can cause great anxiety in children when what they are told doesn’t match what they intuit. Lying closes down the conversation of the loss, and opportunities for supportive relationships and constructive processing don’t happen. When there are lies, there are trust issues. When children find out the truth, they often become angry that they have been lied to and find they have to grieve the loss all over again.

Several participants noted that children are resilient and can handle age-appropriate information. Just tell the children information related to the exact question they’ve asked and try understand the reasoning behind the question, so you can appreciate the need behind it.

Diane explained, when the person who has died by suicide isn’t talked about, problems emerge because at the center of the process is a secret. When the family doesn’t know how to talk about a person, the story of their life starts to disappear and mystery of their death causes problems as people are not sure what they can and cannot say. Diane explained that the multiple conversations caring adults have with children helps them process this experience over time and assimilate the experience into their lives in a healthy way.

What services do we provide – lay led, professionally facilitated, or some combination? Knowing that the research indicates the benefits of peer led efforts, how do we manage quality control and sustainability?

Myf Maple, a leader on suicide bereavement research commented that much of the research on support services for people bereaved by suicide are often done with people who have accessed peer led support services, so some of the outcomes might be biased because of this sampling.
John Peters responded by saying there are three types of survivors: those who want help and find it, those who want help and can’t find it, and those who don’t want help. It is reasonable to ask those who found help if it achieved a positive outcome.
Tony Gee, a mental health professional who is bereaved by suicide noted that peer support is sometimes undervalued by professionals, but can be very cost effective and accessible.
Jill Fisher observed that peer led groups sometimes are affected by challenges in succession planning. Bereaved people who start support groups and find they are ready to move on struggle with how they can leave the group without feeling like they are dishonoring the reason for their involvement or the people they have supported.
Many agreed that we need more research on a variety of support options for the bereaved as well as guidelines on how to sustain the work of the helpers so they don’t burn out or get compassion fatigue.
How do we safely involve survivors or suicide loss and attempts in research? What are the best protocols for this?

Finally, our time together was running out, but we briefly explored the topic of research with survivors and several commented that we need more research on long-term effects of support services and survivor-researcher partnerships.
Some of the frustrated researchers in the room shared their experiences of ethical review boards that made faulty assumptions about the implications of asking people about suicidal behavior. A research project might have all the safety protocols in place and still get rejected because the review committee did not understand that asking about suicide doesn’t put the idea in someone’s head.

John Peters closed our time together by sharing a quote from AAS President Michelle Linn-Gust, “Fear continues to guide research – this fear is no different than the stigma that surrounds suicide and keeps us from getting the answers we need.”

 Sally Spencer-Thomas, Ph.D., is CEO and co-founder of the Carson J Spencer Foundation, founded after the suicide of her brother. The foundation is known for preventing suicide in the workplace, coaching youth social entrepreneurs to be the next generation of suicide prevention advocates, and supporting the bereaved.

Reposted here with permission from The American Association for Suicidology

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