The historic response by organizations after a suicide was to sweep it under the rug or ignore the elephant in the room. There are many reasons for this, some of which result from the stigma and discomfort surrounding suicide. This is no surprise. Suicide is complex and misunderstood, and only in recent years has suicide research received appropriate funding to increase understanding. However, suicide is a leading cause of death and we must have the courage to be prepared to assist loved ones left behind while ensuring we communicate helpfully.
When done well, postvention becomes suicide prevention. It is the goal of suicide postvention to facilitate the healing of people impacted by the loss while preventing suicide among those at increased risk after exposure to suicide.
Postvention should consist of a multipronged approach that begins with providing active support and education for the leadership of an organization before a suicide occurs so they can effectively support their employees. Additionally, postvention should help those impacted express and share their grief while ensuring that the death becomes an opportunity to educate those affected about the causes of suicide and the resources available.
CRITICAL COMPONENTS OF POSTVENTION
Verification of the death
It is important to verify the death from a trusted source. Recognize that information travels fast, especially in digital spaces. Organizations must work to dispel rumors and ensure the correct information is shared by verifying the details of the death. If the death occurred on department property, it’s important that you contact law enforcement, limit scene access, and send appropriate representatives to assist in notifying the family.
Providing information
Agency leadership must work to disseminate appropriate information early so that misinformation is not shared. When transmitting information, follow existing death notification procedures. Avoid discussion on the method used and provide a written statement. The written statement should include factual information about the death and language that acknowledges it was a death by suicide. Express condolences to family and friends, detail plans to provide support, provide information about funeral arrangements, and share contact information for a media spokesperson. Avoid using stigmatizing language such as “committed suicide.”
Use caution when talking with the media. Free guidance on crafting a press release is offered by the Johns Hopkins Bloomberg School of Public Health on Responsible Reporting on Suicide for Journalists. It is well known that sensationalized or romanticized descriptions of suicide deaths can contribute to suicide contagion, a phenomenon where one suicide leads to another. After a suicide, vulnerable people can be influenced based on how the initial suicide was treated. This is why resource sharing and normalizing a path from struggle to hope are important after a suicide. If the media shares any information, it should overemphasize available resources.
One challenge for agency leadership is when the decedent’s loved one asks that the death not be disclosed as a suicide. This common request stems from fear of the historical stigmatization of suicide. If, however, informal channels have already disclosed this information, failure to acknowledge the suicide can have a negative impact. According to the Action Alliance for Suicide Prevention and the American Association of Suicidology, if the information has already spread through informal communications, leadership runs the risk of appearing disingenuous, out of touch, and untrustworthy if there is no acknowledgment of the manner of death. Also, in many states, the manner of death, even when it is worded as, “the cause of death is being withheld by family,” is public information, as it may appear on the death certificate as such.
Additional guidance from human resources, if available, will help managers handle this sensitive topic with the family. We must keep in mind that if a department experiences a suicide, leadership silence can have a negative impact, with the potential for inadvertently discouraging other struggling members from seeking help.
Coordination of the resources
Long before a suicide or any other death, agency leadership should ensure resources are available to support the department’s members and the deceased’s family. Helpful resources include chaplains and clergy, peer support teams from neighboring departments, local mental health resources, grief groups and clinicians, the human resources department, and employee assistance programs.
Identifying and supporting those impacted
Following a suicide in your department, you must avoid sharing specific details to prevent imitation. Additionally, avoid sharing personal details. When we share details such as “because of post-traumatic stress disorder,” “divorce,” “the stress of a public safety career,” or “they suffered from depression,” we can inadvertently signal to vulnerable individuals going through similar situations that suicide is their only option.
Historically, suicide loss survivors have felt they were being avoided and reported that their phone books shrunk after the loss. When we treat suicide like any other death, it helps to reduce shame, blame, and stigma. Ensure you assign a family liaison to work with the family and meet their needs. If you are unsure, just ask them what support is needed and useful. There are several available support groups and resources for families impacted by suicide.
The American Foundation for Suicide Prevention has a resource guide for the United States and Canada. And, United Suicide Survivors International is a global organization that cultivates the lived expertise of suicide into action through leadership, collaboration, and advocacy.
Memorializing the deceased
Ensure the deceased is memorialized as you would for other causes of death. Make sure that the focus is on the firefighter’s life, not their death. While memorialization after death is a universal practice, it is far more difficult after a suicide because of stigmatization and the complicated grief experienced by those closest to the loss. Although research has found that suicide is not selfish, many left behind have inherited some of the deceased’s pain. It is difficult for them not to feel anger, and it’s more difficult in the first year after a suicide to understand that the true causes are far more complex than the person “taking the easy way out.”
Suicide survivors are left wondering, “Why did they do this? Whose fault is it? How could they do this to us? What did we miss?” The most important task for survivors is to find ways to remember and honor the deceased’s life while putting the suicide in context. In the years after a death by suicide, anniversaries are difficult. Keep a record of the deceased’s birthday and the anniversary of death so the department can reach out to families and loved ones during those difficult days.
A few years ago, a North Carolina Peer Support team member, Marty Mitchell, lost his brother to suicide. He shared the following about his experience:
“The most difficult thing about losing my brother is not being able to prevent it and trying to understand why this happened. My close friends were the most helpful in getting me through his loss. We all have friends, but, as you know, only a select few will always pick up the phone anytime you call. Holidays and birthdays seem different and difficult.
For my family, being willing to talk about it when the subject comes up and being honest about our feelings seemed to help. I keep reminding myself and others of the good times we shared. Dying by or being affected by suicide doesn’t define who they were. The hardest questions my family was forced to endure included, ‘Who caused this or who made him do this?’ These aren’t questions that can be answered and they serve no constructive purpose. When supporting somebody after a loss, there is no need to investigate. Just be willing to be there and honor the person for their life and the good they did while with us.”
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DO’S AND DON’TS FOR HELPING SUICIDE LOSS SURVIVORS
DON’T
- Tell people it is God’s plan, or that everything happens for a reason.
- Try to assign blame.
- Spread rumors.
- Let politics influence the services. These conflicts only hurt those who are grieving.
- Forget all those impacted.
- Expect people to grieve like you do. Everyone experiences grief differently.
DO
- Be careful assigning a friend as the family liaison. They might volunteer to help, but are also grieving and need care.
- Stop rumors as you hear them.
- Get comfortable just sitting and being with people. You don’t always have to do something or talk. Sometimes we just need to know there is someone there.
- Just show up. Some of the best helpers are the people who just show up. They didn’t ask. They just came by. They were not pushy but did not let me push them off with saying, “I am OK,” when I was not OK.
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Endnotes
Lawrence Berkowitz, James McCauley, Donna L. Schuurman, and John R. Jordan, Organizational Postvention After Suicide Death: Grief After Suicide: Understanding the Consequences and Caring for the Survivors (Routledge, 2011), 157–178.
“Workplace Suicide Prevention and Postvention,” National Action Alliance for Suicide Prevention, https://theactionalliance.org/communities/workplace/.
“Words matter: How to Safely Communicate About Suicide.” webinar, Lexipol,
November 21, 2019, https://info.lexipol.com/safely-communicate-about-suicide.
Dena Ali is a battalion chief with the Raleigh (NC) Fire Department. She previously served as a police officer for five years. Ali has a degree from North Carolina State University and an MPA from the University of North Carolina—Pembroke, where her research focused on firefighter suicide. As a graduate student, she was awarded the 2018 MPA student of the year, and she has also received several other awards, including the NC Office of State Fire Marshal Honor, Courage, and Valor. Dena has also served as a subject matter expert at the National Fire Academy, where she assisted in curriculum review for their health and wellness curriculum. Dena is an advocate of awareness, education, and understanding of mental health disorders and suicidality. She speaks locally and nationally on these topics and is a QPR Suicide Prevention Gatekeeper Instructor. She is the founder and director of North Carolina Peer Support, where she helped to develop their statewide curriculum. She is also a founding member of the Carolina Brotherhood, a group of cyclists/firefighters in North Carolina who honor the fallen and their families annually.
