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For Those Left to Grieve
By Kelsey Munro June 12, 2009
From the Sydney Morning Herald

People left distraught by suicide have a higher risk of killing themselves, but there are new programs to help guide them through the darkness.

Losing a loved one to suicide is one of the hardest things anyone can go through. Getting help to people shattered by suicide is now being recognised as a crucial part of suicide prevention.

"Postvention", or intervening after the event to support people affected by a suicide, is considered prevention for the next generation since it has become clear that people left behind by suicide are at considerably higher risk of suicide themselves.

"It has been shown that people bereaved by suicide are more at risk for various reasons," says Dr Sheila Clark, a GP from Adelaide with a long-term academic interest in suicide issues

"One is [for immediate relatives in a suicide case] that depression is something that can run in families, and people with depression have a higher risk of suicide.

"Another reason is that there has been modelled behaviour in the family. For example, if a father takes his life, a child may think that's an acceptable way out when they encounter great difficulties in life - as we all encounter- particularly when they reach the age at which their father took his life.

"Finally there has been a gene identified that seems to carry a very slightly higher risk of suicidality, so suicide has been shown to run in families."

In Australia about 2000 people take their lives each year, which is about 500 more deaths than occurred in road vehicle accidents last year. About 80 per cent of suicides involve males.

Estimates of the number of people affected directly by a suicide vary between 10 and 100 people each death, so the group of bereaved may be quite large. "We are talking about family members, close friends, school friends, work colleagues, perhaps the carer of the person who took their life, and it can also affect people who witness a suicide," Clark says.

Professor Ian Webster, a Sydney physician with a long involvement in suicide prevention, says broader communities may also be adversely affected by a suicide.

Indigenous communities in particular suffer a higher rate of suicide than the general population.

"There are Aboriginal communities in particular which have reported clusters of suicides, especially in young males," he says. "It's as if the sorrow and the sadness and the impact of that goes like a tidal wave among those at risk in these communities."

This recognition of the increased risk to the bereaved has seen some researchers and clinicians devising programs specifically to assist them. A range of help comes under the umbrella of postvention.

There are support hotlines such as the Salvation Army's Hope for Life (1300 467 354), counselling on Lifeline (131 114), Mensline (1300 789 978) or the Kids Help Line (1800 551 800).

There are written resources online such as SANE Australia (www.sane.org) or the Living Is For Everyone website (www.livingisforeveryone.com.au).

There is also crisis response help available in some communities; and various forms of ongoing assistance including individual or family counselling and support groups.

Because the grieving process after a suicide may take years or decades, postvention has no expiry date.

Dr Edwin Shneidman, the American founder of suicidology, or the study of suicide, coined the term postvention in the 1960s. Shneidman died last month, aged 91, having lived just long enough to see postvention finally become a recognised field.

"We've always simply called it the aftermath, or said that people are bereaved, but within the last three years it's really made a huge jump," says the author Michelle Linn-Gust, the president-elect of the American Association of Suicidology. "It's always been the piece that's left behind."

When she was 21, Linn-Gust lost her sister, aged 17, to suicide. She went on to write a book for siblings bereaved by suicide, called Do They Have Bad Days In Heaven? Surviving The Suicide Loss Of A Sibling, and to become a spokeswoman for people who have lost someone close.

"After that person dies, the family is still affected by that loss," she says. "Sixteen years later my sister is still very much a part of our family. We're still connected to her even though she may not be here."

She says that grief is complex and multi-layered - one of the reasons postvention is so important. "It's hard to say, `My loved one killed him or herself,'"she says.

"People aren't really sure where to turn those feelings to. Guilt is a huge part of suicide."

With a suicide rate that is about average globally, Australia has recently been at the forefront of the recognition and study of postvention strategies. Specific funding for postvention programs has been included in the National Suicide Prevention Strategy in the past two years.

The second national Postvention Conference was held in Melbourne last month, for Australian and international experts as well as people bereaved by suicide.

"Clinicians can learn from the bereaved and vice versa," says Linn-Gust, who visited Australia to conduct workshops at the conference. "It's about connecting, just as preventing suicide is about connection."

So what might postvention mean in practice?

One innovative first response program which focuses on delivering help in the immediate aftermath was developed on Queensland's Sunshine Coast and has since rolled out to nine other areas including Cairns, Canberra, the Pilbara, the east and west Kimberley, North Brisbane and parts of Tasmania.

StandBy, a 24-hour crisis response program that is federally funded and run by a non-profit agency, United Synergies, joins community organisations to support the bereaved and trains professionals to deliver that support.

StandBy's national co-ordinator, Jill Fisher, who was also a founder of the organisation, says StandBy came together in the aftermath of several suicides which happened close together in a small Sunshine Coast community in 2002.

It was shown that the bereaved often did not know what assistance was available, and some had given in to despair without seeking help. A lack of services was not necessarily the problem (police, ambulance services, coroners, funeral directors, government representatives, counsellors and health providers were all in the frontline), but a lack of co-ordination between them was.

"The issue of postvention is very new, it's an emerging field that's only starting to get some traction," Fisher says. "We're at the end of a three-year trial and we have a very defined model that we think works."

StandBy works by providing tailored help to the bereaved, depending on their wishes and circumstances.

For example, the group helped a single mother with several children who had only recently moved to a community, fleeing an abusive partner, when her teenage child committed suicide. The police told the woman about StandBy and when she indicated she would like help, it immediately responded.

"The primary needs are obviously around addressing the grief and trauma, but many can't do that until the practical needs are addressed," Fisher says.

The group organised food assistance for the family, liaised with the local police domestic violence support agency, informed the children's school of the situation, assisted with funeral arrangements and helped look after another child who had special health needs.

"It's a first aid approach, not about solving all the big issues," Fisher says.

In all, 10 local services were co-ordinated in the support for this family.

Consistently, people supported have told StandBy that the biggest help was not having to continually repeat their story to each new community service provider.

"People have said to us, `Thank God I don't have to keep telling my story to get help,'" Fisher says. "With the permission of the bereaved we can pass on information in a safe way without them having to be re-traumatised by telling the story."

Since its inception StandBy has helped 780 people reeling from the suicide of a loved one, and Fisher says as far as it is possible to determine, not one person given support has taken their own life.

"We would love to see StandBy across Australia," Fisher says. "You think of Triple 0 for emergency or BeyondBlue for depression; we would love people to think of StandBy for those bereaved by suicide."

"We are very supportive and aware of other initiatives happening; there's a wonderful community of practice in Australia. We want every person impacted by suicide to be able to get support. That's our aim."

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