Helping those bereaved by suicide: what we have learnt at Support After Suicide

Transcription

1 Helping those bereaved by suicide: what we have learnt at Support After Suicide Martin Ryan, Louise Flynn, Anne Giljohann, Sehar Warren, Colin Charles, Jackie Ballantyne Counsellors Support After Suicide, Melbourne, Australia Paper presented at 3 rd Australian Postvention Conference, Sydney, NSW, June 28-30, 2012

2 Helping those bereaved by suicide: what we have learnt at Support After Suicide Outline of presentation: 1) Suicide statistics in Australia and Victoria 2) Support After Suicide program 3) Suicide bereavement s particular features 4) Applicable theoretical approaches 5) Key learnings from Support After Suicide 6) Conclusion

3 Suicide in Australia 2010 Australian Statistics 2,361 deaths registered as suicide (1.6% of all deaths) 1,816 men (77%) 545 women (23%) highest rate males aged 40-44(27.7 per 100,000), followed closely by males aged (27.5 per 100,000) This represents many children losing a father to suicide for males aged = lowest rate (11.4 per 100,000 ), but 23% of male deaths in this age group Males nearly 4 times that of females Most frequent method was hanging (56%) (most frequent method for both men & women) (Causes of Death, Australia ABS, released March 2012)

4 Helping those bereaved by suicide: what we have learnt at Support After Suicide In 2004 Support After Suicide was funded as the sole specialist suicide bereavement counselling service in the Australian state of Victoria. Population of Victoria (2010) = 5,679,337 Number of suicides in Victoria in 2010 was men (76%) and 126 women (24%) (Causes of Death, Australia ABS, released March 2012)

5 Support After Suicide program A program of Jesuit Social Services (non-government welfare agency adhering to the traditions of St Ignatius Loyola, founder of Jesuits) Main work is with disadvantaged young people, particularly those involved in the criminal justice system

6 Support After Suicide program Funded by the Australian Commonwealth government as part of its National Suicide Prevention Strategy. Enacting Shneidman s (1972) dictum that postvention is prevention for the next generation.

7 Support After Suicide program The goal of the program is to increase the availability of timely and appropriate support to individuals & families (especially those with young children) who are bereaved by suicide

8 Support After Suicide program Employs 3.8 EFTSU (6 counsellors /community educators) +.5 admin person Central location plus access to 4 other sites around Melbourne including a CBD office. Staff have variety of backgrounds including psychology, social work, counselling and psychotherapy, plus bereavement counselling experience. All work part-time, with exception of Co-ordinator

9 Support After Suicide program Direct service: Melbourne Counselling Individuals/Families/Couples Based in inner city Richmond, outreach in Dandenong, Lalor, Ferntree Gully and CBD Support groups Early bereavement closed group Monthly drop in group

10 Support After Suicide program Forums for siblings/ partners Writing/performance group Nothing prepared me for this project Volunteer program engaged in range of activities from fundraising through to peer support (bereaved to bereaved) and co-facilitating support groups

11 Support After Suicide program Capacity building: statewide Education and Training Secondary Consultation to Professionals Health, education, welfare, community sectors Resources Information sheets Website: for bereaved people and professionals Facebook Online community

12 Support After Suicide program The program believes that people need access to highly skilled clinical support to be provided immediately post-suicide Support should continue long term due to the enormous impact and disruption as a consequence of suicide

13 Support After Suicide program Service is free of charge No maximum limit on client sessions (mean number of sessions = 24) We try to see people as soon as possible after initial contact

14 Suicide bereavement s unique and complex features (Flynn, 2009) involves trauma (sensory or informational) impact of suicide on identity and sense of self experience of failure impact of stigma search for an explanation young people and developmental issues impact on social network and family relationships increased risk of suicide

15 Support After Suicide program Applicable theoretical approaches: Dual Process Model (Stroebe & Schut, 2008) Disenfranchised grief (Doka, 2002) Grieving styles (Doka & Martin, 2010) Continuing Bonds (Klass, Silverman & Nickman, 1996) Narrative approach (Neimeyer, 2001; White, 2007) A broadly psychodynamic approach (Chandler, 2005)

16 Key learnings 1) the need to work with the grief, the trauma and that the death was self-inflicted; 2) persisting with people for the long haul (expert companioning, Jordan, 2009); 3) the need to be flexible and creative, particularly with young people; 4) the power of group work; 5) the need for factual information about suicide and processes surrounding it for clients; and 6) to be open to clients extraordinary experiences and the use of psychics and mediums.

17 1) Need to work with the grief, the trauma and that the death was self-inflicted All three important and at some point may need to engage with each of these?when/how Dosing important (self) for both traumatic images/memories and for grief (DPM) (Jordan, 2010) Follow clients lead on this, plus some control needs to be exercised by counsellor Counsellors need skills and knowledge to work with each of these three elements

18 2) Persisting with people for the long haul (expert companioning, Jordan, 2009) Mean no. of counselling sessions is 24 (even at 1 a week = half a year) Sticking with it through ups and downs (with the latter predominating) Groundhog Day at times, but look and listen for small changes in story Looking for signs of improvement in progress Not just companioning, it is expert and all that this entails (with belief, optimism and caring) (Ryan et al., 2004 and 2005)

19 3) Need to be flexible and creative, particularly with young people Not necessarily traditional counselling or therapy Not necessarily office-based Activity-based e.g. camps, circus arts, swimming, playing football or cricket Discussion of tattoos Casework not just for emotional engagement, but practical assistance Running with hunches and intuition in sessions

20 4) Power of group work Can have a significant impact for people Group participants can be very helpful to each other Support and information from others who have been through the same experience, often more important than what counsellor can do People feel isolated, alone, outsider, freakish. Group restores connection to society, restores a sense of belonging.

21 5) Need for factual information about suicide and processes surrounding it for clients Not mentioned in the literature but we have found it to be very important Counsellors need to be prepared and able to do this Information regarding suicide, especially hanging (predominant method in Australia) (Sauvagneau s work e.g & 2010 useful here) Coronial processes Assisting client to understand the autopsy/toxicology and coronial reports

22 6) Open to clients extraordinary experiences and the use of psychics and mediums People will tell the counsellor about these experiences if they trust them Can be comforting and helpful to them May be disturbing Key question to ask: how did you feel? What do you think it means? Going to psychics/mediums is not uncommon Can be comforting, and/or provide answers, but not always (LaGrand, 1999 and 2006; Sanger, 2009)

23 Conclusion In working with those bereaved by suicide, one size does not fit all A variety of types of responses and supports, needed from individual work, family work, group work, activity-based work to online responses that provide a range of supports (counselling, therapy, practical information and assistance) for the long haul involved in having someone close to you suicide Working well involves: 1) clinical training; 2) working effectively; and 3) working compassionately with a sense of belief and optimism

24 An earlier version of this paper was presented at the 9th International Conference on Grief and Bereavement in Contemporary Society & ADEC 33rd Annual Conference, Miami, Florida, June 22 25, 2011 and also a version of this paper is in press and will be published as an article in the journal Grief Matters later in 2012

25 Acknowledgements I would like to acknowledge the contribution of my counsellor colleagues at Support After Suicide to the development of the ideas in this paper, particularly Louise Flynn as Coordinator of the program, and my current colleagues Anne Giljohann, Sehar Warren, Colin Charles and Jackie Ballantyne, as well as former colleagues Barbara Friday, Brendan Fitzgerald and Felicity Elkiana

26 References Chandler, R. (2005). Psychodynamic therapeutic approaches with people who are grieving. Grief Matters, 8(2), Doka, K. (2002). Disenfranchised Grief: New directions, challenges and strategies for practice, Champaign IL: Research Press. Doka, K. & Martin, T. (2010). Grieving Beyond Gender: Understanding the Ways Men and Women Mourn. (Revised edition), New York NY: Routledge. Flynn, L. (2009). Is suicide bereavement different? The experience of Support After Suicide. Grief Matters,12(1), Jordan, J. (2009). After suicide: clinical work with survivors Grief Matters, 12(1), 4-9. Jordan, J. (2010) Principles of Grief Counselling with Adult Survivors in Jordan, J. & McIntosh, J. (eds.) (2010) Grief After Suicide: Understanding the Consequences and Caring for the Survivors, New York NY: Routledge, Klass, D., Silverman, P., & Nickman, S. (Eds.). (1996). Continuing bonds: New understandings of grief. London, Taylor and Francis.

27 References LaGrand, L. (1999). Messages and miracles: Extraordinary experiences of the bereaved, St. Paul, MN: Llewellyn Worldwide. LaGrand, L. (2006). Love lives on: learning from the extraordinary encounters of the bereaved, New York NY: Berkeley Books. Neimeyer, R. (2001). Meaning Reconstruction and Experience of Loss, Washington, DC: American Psychological Association. Ryan, M., Merighi, J., Healy, B. & Renouf, N. (2004) Belief, Optimism and Caring: Findings from a cross-national study of expertise in mental health social work. Qualitative Social Work, 3 (4), M. Ryan, C. Dowden, B. Healy & N. Renouf. (2005) Watching the Experts: findings from an observational study of expert Australian mental health social worker. Journal of Social Work, 5(3), Sanger, M. (2009). When clients sense the presence of loved ones who have died. Omega, 59 (1),

28 References Sauvagneau, A. & Racette, S. (2007). Agonal sequences in a film suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging. Journal of Forensic Science, 52, Sauvagneau, A., LaHarpe, R., King, D., Dowling, G., Andrews, S., Kelly, S., Ambrosi, C., Guay, J., and Geberth, V., for the Working Group on Human Asphyxia (2010). Agonal sequences in 14 film hangings with comments on the role of the type of suspension, ischaemic habituation and ethanol intoxication on the timing of agonal responses. American Journal of Forensic Medicine And Pathology, (undergoing post author corrections, 29 th of July 2010.) Shneidman, E. (1972). Foreword. In Cain, A. (Ed.) Survivors of Suicide, Springfield, Ill: Charles C. Thomas, ix-xi. Stroebe, M. & Schut, H. (2008). The dual process model of coping with bereavement: overview and update. Grief Matters, 11(1), White, M. (2007). Maps of Narrative Practice, New York, NY: W.W. Norton.

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