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 15^th, 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

GUEST BLOG: Human Resources in the Pressure Hangover

Kate Burke and I met in cyberspace when she reached out to me to interview me for a class project on social entrepreneurship and suicide prevention. Six months later, she is interning for the Carson J Spencer Foundation remotely from Washington, D.C. and helping us build our Working Minds Program. Her blog speaks to the challenges HR professionals face when trying to promote mental health in the workplace.

Unless you’re a park ranger, this image is in stark contrast to the realities most of us face when we head into our days, in particular our workdays.  Instead of calming colors and soothing sounds, the concrete jungle and an impression that challenges loom as large as the buildings can surround us.  On such a day, I came across the following quote by Victor Frankl:

When we are no longer able to change a situation,

we are challenged to change ourselves.

This quote struck a cord with me.  There were quite a few things outside my control, which were consuming my energy and hopes.  I was a manager of 20 administrative staff, which included extensive performance management and employee relations duties, in one of the largest professional services firm in the US and globally.  The economic downturn had required a number of tough staff decisions as well as a restructuring of my team.  These stressors mirror situations faced by many Human Resources professionals noted in an HRCrossing article titled WorkplaceStress and the Human Resources Professional.  One of which is…

Dual allegiance: Trying to be of service both to the managers and blue-collar employees can put enormous stress on the consciences of human resources professionals. If, by chance, adversarial relationships exist between the two groups, then the human resources professionals may get scorned by both sides and viewed as inefficient meddlers.

I felt I was between this proverbial rock and a hard place. The National Institute for Occupational Safety and Health (NIOSH) has also noted in their report Stress at Work that “extensive literature links job characteristics (e.g., low levels of control and work overload) to job stress and stress-mediated health outcomes such as cardiovascular disease and psychological disorders”.  Their diagram included here shows how a mixture of work stress and factors from outside work can work for or against people with possible negative outcomes for health.  This stress trap was also termed a “pressure hangover” in an article titled “Creativity Under the Gun” in the Harvard Business Review.  The article notes that working under pressure situations can require a few days for recovery.  This idea supports further the idea that chronic stressful conditions increase risk of illness, by not allowing recuperation time between pressure intensive projects.

For me, the work stresses in addition to other life stressors were making it more difficult to keep my emotions in check.  The phrase “Let it go” was oft repeated by friends and colleagues, with an occasional “You care too much”.  So how does one manage if you want to care about life but have no framework on just how is it you, “Let it go”?  Even while “being proactive” is a catch phrase in corporate America, there is a gap in proactive work being done to create Healthy Workplaces as it relates specifically to mental health.  Seemingly ever-increasing stress levels in the workplace are compounded by evidence I observed that organizational leaders are not fully prepared to handle employees who are facing severe stress, depression or other mental illnesses, and even less those that are contemplating suicide.  I would say this is mostly due to lack of knowledge versus lack of caring.

As is mentioned later in the HRCrossing article, I followed the path of many HR professionals, and took my own advice in making a change.  I resigned after 10 years in an intense corporate environment to pursue a master’s degree in Social Enterprise at American University with the intention to find structural solutions for healthier workplaces and work lives.  This program is allowing me to bring together my experience from business, entrepreneurial practices for new business structures – whether for profit or non-profit – and a commitment to live and encourage more balanced living of integrity.  In the course of my studies, I researched whether there were people applying the methods and ideals of Social Entrepreneurship to the field of mental health in the workplace and came across the Carson J Spencer Foundation (CJSF).  In particular CJSF’s program, Working Minds, is an answer to what I had observed during my time in Human Resources and Management and was encouraged by how they are bringing the entrepreneurial spirit to this conundrum creating healthy workplaces nationally and internationally. 

Working Minds showcase workplaces that practice innovative and effective approaches in promoting mental health at work through contests.  They also open dialogue about mental health in the workplace by providing education and training in suicide prevention.  This approach not only works to help the individuals facing challenges, it also contributes to the organizations through a double bottom line of social/health benefit and financial benefit.  Instead of the costs associated with absenteeism and turnover, Working Minds equips leaders to create a working environment where staff can get assistance and continue to contribute to the organization.  The training normalizes the discussion of mental health, and provides intervention skills when needed.  There is also focus on re-integration after crisis situations, all of which helps create an environment where people can reach out for help as well as continue to contribute.

I am excited about what Carson J Spencer Foundation (CJSF) and Working Minds is accomplishing and being a part of expanding their work.  I encourage you to join in the effort by being a changemaker in your organization.  Open the dialogue with your leaders about creating a healthier workplace.  If you or any colleague you work with is at a crisis point, reach out for help through the National Suicide Prevention Lifeline.  This link can also provide more information about warning signs.  Become informed and ask for training from Working Minds.  

ABOUT THE AUTHOR: Kate Burke is a consultant with over 15 years of experience in business in the private and non-profit sectors.  Ms. Burke's most recent experience is in operational management and human resources with the professional services firm PricewaterhouseCoopers.  She focused on performance management, process improvement and change management projects in San Francisco Bay Area and Washington Metro Area.  Ms. Burke has also worked with a locally based management company, a national non-profit higher education association and national life insurance company.
Ms. Burke holds a B.A. from Westmont College in International Studies with an emphasis in Latin America, including studies in Costa Rica.  She is a Masters candidate in Social Enterprise with the School of International Service at American University in Washington, DC.

Take the Stairs: How Self-Discipline and Goal Setting Improve Our Mental Health

An Interview with Rory Vaden

The Carson J Spencer Foundation excited for Rory Vaden and the Take the Stairs tour to come to town on March 4^th (Littleton) and 6^th (Denver)! We are so honored that he is donating the proceeds for this event to help us expand our youth entrepreneurship program to the state of Colorado and to support our partners at the University of Colorado Depression Center.

Rory is a professional speaker and author who promotes self-discipline, and we believe his message ties in well with our mission to help leaders and communities “sustain a passion for life.” I met Rory last fall at the Colorado’s chapter meeting of the National Speakers Association where he was the featured speaker. I was immediately drawn to his “true grit” approach to reaching challenging goals and felt his practical advice on making dreams become reality was spot on for our youth who are now transitioning from business plan creation to implementation.

I also know how goal-setting and persistence affect mental health. The Depression-Bipolar Support Alliance suggests that creating the life you want is an excellent way to build resilience against the on-set of depression.

That said, we also know that goal setting when one is depressed is hard,, and sometimes the smallest steps seem huge. For these reasons the University of Michigan Depression Center created a goal-setting toolkit.

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Dr. Michael Allen, Director of Research at the Depression Center noted that, “Flexibility in goal-setting often leads to success. We must learn to adapt to what's available even though it's not a perfect match with our interests or goals. A problem in depression is rigidity and perseveration.” 

The types of goals we set also influence our well-being.  For example, people who value relationship goals above achievement oriented goals have been found to have a greater sense of wellbeing than people who place achievement goals above relationship goals.  Our perceived lack of progress towards our goals affects our mood, especially when there are large discrepancies between where we are and where we think we should be. Finally, our self-talk around goal failure can influence our mood, do we say, “Bummer! I learned some lessons here and can grow from this experience,” or do we say, “I am a failure. I am always failing. The world is against me.”

For these reasons, I interviewed Rory about his philosophy, book and what we should expect from his presentations on March 4^th and 6^th.

SALLY: What is Take the Stairs all about?

RORY: The last time you had the option of heading up the escalator or taking the stairs, did you take the stairs? If you're like most people then probably not.  Unfortunately most people have an "escalator" mentality in all areas of their life. They are looking for the shortcut, the easy way, and the overnight success. Yet even in this instant age, success in anything simply comes down to discipline; the discipline to do things you don't want to do.  The book is about the psychology of overcoming procrastination, how to simplify the process of improving our self-discipline, and how to get ourselves to do the things we know we should do when we don't feel like doing them.

SALLY: In your experience, how does goal setting and goal achievement affect self-perception and mood?

RORY: The most disciplined people in the world have determined that the best strategy is to put your self-esteem into your work habits and not your outcomes. In other words they focus only on what they can control and let the rest of life happen as it may. This is important because it means we can have confidence in ourselves that is unconditional and not affected by the positive or negative circumstances we may be facing in life as long as we are working as hard as possible on the things that we have in our power. I’d encourage people to focus on the next step in their path. What is the best thing is that they can do to influence that step? I tell people not put so much pressure on themselves about whether or not their goal may come to fruition exactly as hoped.

SALLY: What can people expect when they come to the event?  Who should come?

RORY: Everyone!  From high school students and their parents to professionals in the community, everyone can benefit from improved self-discipline.  I’ll be teaching the 7 strategies of simplifying self-discipline that are in the book.  Plus, by being there you’re supporting the Carson J Spencer Foundation’s Fire Within Program.  I look forward to being there!

This event is for people who want a more fulfilling lifestyle—those who are looking to take a different approach in 2012. My goal with this event will be to change the way audience members look at their path to success—each dream is achievable, but short cuts are not an option. We’re going to talk about why taking the stairs is the only route to the top.

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Join Us! You can register for FREE but seating is limited.

 To learn more about Rory, please visit www.roryvaden.com.  

TO REGISTER:

March 4^th at Columbine High School www.takethestairslittleton.com

March 6^th at the Colorado Depression Center www.takethestairsdenver.com

GUEST BLOG: Wishing You Peace, Love, and Soul

Contributors:

• (LEFT) Phoenix K. Jackson - Board Member of Carson J Spencer Foundation, Author of Compassion to Clarity and Back Again
• (RIGHT) Jess Stohlmann - FIRE Program Director at the Carson J Spencer Foundation

In the wake of tragedies, it is easy to feel lost, confused, shocked, and even angry. All of these emotions are common reactions to the loss of a loved one, community member, or icon. The loss of Don Cornelius leaves many of us overwhelmed by emotions because we never would have imagined losing a man who had changed history for African Americans in the United States in this manner. As the first person to put positive images of African Americans on TV on a consistent basis, Don Cornelius made a direct impact on millions of lives while Soul Train was on the air, and far more with the legacy of his work. In the midst of tragedy, we should seize the opportunity examine the issue of suicide in the African American community. As a part of our efforts to honor of the great accomplishments of Don Cornelius, we should venerate the ways that the community has protected itself against suicide, and we should look into the steps that can be taken to prevent future tragedies.

Often, the first question we want to ask is “Why?” It is natural to want to understand something as complex as suicide. It is also normal to try and find one, simple reason. The truth about suicide is that the answer to that burning question is far too complicated to boil down to one simple answer. Suicidal people experience multiple, varied situations and struggles that eventually lead them to feel like suicide is the only remaining option. If we can find a way to intervene when we see the warning signs, suicides can be prevented. But no one can be expected to intervene when they don’t know what the warning signs are. Below is a list of some of the warning signs we can look for as communities, and a link to a helpful resource. Educating ourselves about these warning signs is a great way to work toward preventing future tragedies. We know that prevention works, and most people who attempt suicide once, will never consider it again. If we can connect people to the right resources, we can prevent those attempts from ever happening. If you or someone you know is in distress, call the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) to get help.

SUICIDE WARNING SIGNS

(American Association of Suicidology)

·         I Ideation (Threatening to hurt or kill self, looking for ways to die)

·         S Substance Abuse (Increased or excessive substance -- alcohol or drug -- use)

·         P Purposelessness (No reason for living; no sense of purpose in life)

·         A Anxiety (Anxiety, agitation, unable to sleep or sleeping all the time)

·         T Trapped (Feeling trapped - like there's no way out; resistance to help)

·         H Hopelessness (Hopelessness about the future)

·         W Withdrawal (Withdrawing from friends, family and society)

·         A Anger (Rage, uncontrolled anger, seeking revenge)

·         R Recklessness (Acting reckless or engaging in risky activities, seemingly without thinking)

·         M Mood Changes (Dramatic mood changes)

For more information, click here: http://ow.ly/8ORGn

Part of what might make this loss so shocking is that suicide rates are low in the African American community, and especially among women. African American women have the lowest rates of suicide of any population in the U.S. For example, according the American Association for Suicidology in 2007, 1,958 African Americans completed suicide in the U.S. Of these, 1,606 (82%) were males (rate
of 8.4 per 100,000). The suicide rate for African American females was 1.7 per 100,000. The rate for Caucasion males in the same year was more than twice as high as African American males.

Slide from Center for Disease Control and Prevention

We want to highlight the things that have historically helped the African American community safeguard against suicide risk. Communities that have historically pulled together in times of need tend to have relatively low suicide rates. In the African American community, things that we know safeguard against suicide risk are: making individuals feel like they have an important, irreplaceable role in the community; empowering individuals and making sure they have a voice in their communities; and participating in faith communities that encourage feelings of belongingness and censure suicide as an option. All of these protective factors are also strong values in African American communities, so the rates for African American women are particularly low. Even with all of these protective factors, it is important that we as communities be willing to ask the right questions to make sure that we can intervene when people are in need. We should all be thinking about what we can do to stop the loss of life.

Belongingness protects against suicide. Photo by: vox_efx

Throughout the year, but especially as we celebrate BlackHistory Month, let’s join together to honor the incredible positive impact these values have had on African American individuals and communities, and work toward creating similar safeguarding values in other places. Focusing on the prevention work we can do in the future, protective factors we can work on increasing to reduce suicide risk, and honoring the life of those we have lost are the best ways to heal as a community.

As Don consistently wished us on his show, "… in parting, we wish you love, peace and soul!"

Resources

National Organization for People of Color Against Suicide

African American Suicide Fact Sheet

Trauma, Resilience, and Recovery in a High-Risk AfricanAmerican Population

The Strong Black Woman Vs. The Blessed Black Woman

For Suicide Prevention Training and Suicide Bereavement Support

Carson J Spencer Foundation

Five Things You Can Do with Social Media to Prevent Suicide and Promote Mental Health

Social media allows us to have timely and engaging communication, providing us – the citizen journalists -- an opportunity to shape the conversation around mental health and suicide. Usually when the terms “social media” and “suicide” are connected, the news is bad. Many examples of unsafe behavior exist, such as: a “how to” website, a suicide threat posted on Facebook, videotaped suicidal behavior uploaded to YouTube, a social network resulting in a suicide pact, a suicide note that goes viral and romanticizes a death, and so on.

While there are many safeguard procedures being developed that respond to cries for help and prevent these practices from reaching masses, it is nearly impossible to be proactive in addressing this problem. The suicide prevention and mental health promotion communities will always be in reactive mode. That said, there are many ways we can use social media for good, and here are my top five favorites:

                                 

1.       Post and pose: The beauty of social media is that is allows for interaction, and we can always find ways to get people talking by posing relevant questions. The goal is to tell people what you want them to remember and engage them in dialogue that moves to conversation forward. For example:

• Post a link to a helpful or innovative resource and ask if others have experience with it
• Post an article about a new discovery in the scientific literature and ask how people think this breakthrough will change things
• Post a news story about hope and recovery and ask if others have similar, relevant stories to tell
• Post a survey and ask people what they think the results mean

2.       Monitor and respond:  In the “After a Suicide Toolkit” [2011, Suicide Prevention Resource Center (SPRC) and American Foundation for Suicide Prevention(AFSP)], the authors suggest that we also help shape the conversation when others (traditional media and social media) share inaccurate or unsafe information. See Facebook safety mechanisms here. For example, the media often makes a big deal about suicide being a problem around the December holidays, when in reality, December is usually the month with the lowest rates of all. When people post inaccurate information like this, we can help correct the misperceptions with comments and links to credible data. When individuals post messages on Facebook or Twitter, we can respond by connecting them to resources like the National Suicide Prevention Lifeline.

3.       Create a buzz with a button or a badge: According to the Center for Disease Control and Prevention’s “The Health Communications Social Media Toolkit,” buttons (designed for organizational use) and badges (designed for individual use)
can be a very effective way to spread a call to action. Both tactics involve a small, colorful graphic with a simple, catchy message that you can embed in your email signature, on your webpage or in your Facebook post. The graphic is then linked to a place where people can start taking that action. For example:

• To promote the message “Are You at Risk for Depression? Get screened today” on National Depression Screening Day, create a graphic and link it to a depression screening tool
• To promote the  message “Mental Health Matters – Let Your Voice be Heard”, create a graphic that links to an on-line petition for mental health legislation
•   “Today is World Suicide Prevention Day – Take 5 to Save a Life” is a great example of how to use a button. This graphic made quite a splash as suicide prevention advocates from all over the world posted it on Facebook on World Suicide Prevention Day.

4.       Share stories of success: Everyone loves a good story, and the world needs more models of what is working. By following safe media guidelines and strategies for compelling storytelling, we can really start to capture people’s attention.

·         YouTube: Videotape footage of communities pulling together like AFSP has done with their “Out of Darkness Walk.” These pieces demonstrate solidarity, perseverance, and commitment. What is your community doing that brings large numbers of people together for our cause? Capture this, share the spirit, then upload to YouTube.

·         Another excellent example of a community sharing hope is this “100 reasons to stay” video.

 

Video on reasons to live goes viral

·         Podcast:  Interview a therapist on what people should expect when they come to therapy. Interview a faith leader with an enlightened view on how spirituality and mental health are intertwined. Interview a community leader (e.g., elected official, first responder, local celebrity, business leader, etc.) who is a champion of the cause.

·         Blog: Write about your observations of a family that transcended their grief to make a difference. Or about how your favorite coping strategies have helped you. Or about a positive outcome that took place when you reached out to a friend or family member that was struggling.

5.       Promote art that is healing and hopeful:

·         Playlist: Create a playlist on iTunes that shares uplifting songs designed to pull people through dark times

·         Flickr: Pull together an on-line art show of images with narratives that depict recovery

·         E-Book: Publish a downloadable book of poems and short stories about positive transformation

How have you used social media to prevent suicide or promote mental health?

Tensions in Postvention: An International Dialogue Part I

Tensions in Postvention: An International Dialogue Part I

By Sally Spencer-Thomas

In the aftermath of a suicide, several needs are evident —psychological first aid for those most directly affected, help for communities as they return to a level of functioning, and  surveillance for vulnerable individuals who might be harmed by  contagion. The strategies to achieve meeting these needs sometimes come into conflict with one another and create tension in our postvention efforts. Well-meaning and well-informed people can find themselves firmly standing on one side or another of these points of potential disagreement, complicating an already difficult process.

In September this year, I had the honor of facilitating an international discussion on the “Tensions in Postvention” at the International Association of Suicide Prevention’s (IASP) World Congress in Beijing. About two dozen people gathered to join some of the top suicidologists from around the globe as we explored the challenges of supporting individuals, families and communities in the aftermath of a suicide. Among the invited participants were:

·     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. He 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.

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

·     Sandra Palmer, Ph.D. (NEW ZEALAND), a registered psychologist and Clinical Manager Community Postvention Response Service, and 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 wrote a book for children bereaved by suicide. She will speak to the complex and sensitive issues regarding how to talk with children bereaved by suicide.

During this session we discussed the following 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?

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 or suicide loss and attempts in research? What are the best protocols for this?

In this column, I will review the discussion of the first two questions, and in the next issue of Newslink I will review the discussion of the last three questions.

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

As we opened the discussion many participants shared examples of how communities have navigated the balance between what family and close friends want and what is safe for the community. Sandra Palmer talked about how t-shirts printed with pictures of lost loved ones are commonly seen at funerals and memorialization events. She went on to describe how families when told about the potential risk will also print a hotline number or other resource on the t-shirt. I talked about how candle lighting ceremonies are common and how we can help communities make these events safer by coaching the event planners on safe messaging and surrounding the attendees with helpful resources. Jill Fisher of Australia talked about framing a memorial event as a remembrance event celebrating life rather than over-emphasizing the circumstances of a death.

Sandra Palmer: “What we are getting to is about balance.”

Jill Fisher: “We try to do a number of activities to meet a number of needs of the bereaved.”

Onja Grad: “[The response] has to be right away.”

Diane Sands: “Schools are much more careful. Families are more thoughtful and respectful to the community. We can rely on folk to be more thoughtful.”

As in many provocative discussions attendees raised additional questions:

·     How can we be proactive in our efforts with families and communities so they understand the risks?

·     Knowing that it is never anyone’s intention to cause additional harm, how do we explain to families that there is a risk in doing things the way they planned?

·     Many families, including my own, have a huge desire to do prevention work right away, and yet without proper time to grieve and heal sometimes these efforts crash and burn, causing additional hardship. How can we counsel people to heal first and engage in prevention activities later?

·     How do we support people in bereavement when we are not of the grieving family’s culture?

·     How do we promote young people’s safety while giving them the space to grieve in their own way, which often includes very public expressions through social media? For instance, youth sometimes post on their deceased friend’s Facebook page. Sometimes the outpouring reflects their grief at the loss like a public shrine of flowers and stuffed animials might. Others post comments like “you are now in a better place,” thereby romanticizing the death and minimizing the tragedy.

The general consensus of the group was that both honoring loss and preventing contagion are possible. With outreach to new survivors and supportive instruction about preventing contagion, we can allow a safe space for the bereaved to mourn and direct the grief energy so that risk factors for contagion are minimized.

[To watch this Part I of the discussion: http://www.youtube.com/watch?v=0kIoXoCvrz4 ]

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?

This question revolves around a community response to suicide. We noted that returning to a previous routine can be grounding for many after a trauma; it offers structure and a sense of familiarity. Nevertheless, moving too quickly or too completely to “business as usual” can make those closest to the loss feel discounted.

We also acknowledged that in larger systems and communities there will often be many people who are not affected at all by the death, and if we go in “all guns blazing” we can do harm.

Many cited George Bonanno’s work (Bonanno, 2004) on resiliency after trauma and emphasized the potential strength of the human spirit and the power of communities pulling together after a loss like suicide. The key to finding the right balance revolved around framing the interventions as choices with the understanding that different survivors need different things at different points in their grief journey. Jill Fisher called her approach an invitation of the “lightest touch” so that what we offer won’t interfere with the natural resilience that exists.

As Jill noted, “After a suicide you find police, criminal investigators, medical rescue professionals, coroners — up to 10 people in your home — that you have no right to say ‘no’ to. You are invaded. We want to make sure that the bereavement support is a choice you’ve made.”

The group also explored the reality that not all suicide deaths impact communities in the same way. For instance a school that has been rocked by multiple deaths usually experiences heightened anxiety and fear as rumors escalate. For these communities, “returning to normal” might require more conversations of assurance.

One participant described this particular tension in postvention: “Grief is a natural process, and when you put shutters around it, damage can be done. The bereaved will let you know what they need; our role is to support them.”

While the cultures and languages of this diverse group of experts varied, the themes of the challenges were similar. By sharing lessons learned and stories of success, we forged a solidarity in our efforts to support people bereaved by suicide.

Reference:

Bonanno, G. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20-28.

 Sally Spencer-Thomas is CEO and co-founder, 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. She is AAS Survivor Division Chair.

"Reposted with permission from the American Association for Suicidology" follow this link to see the article in Newslink.