It is a sobering fact that suicide is one of the most common causes of premature death among people with mental illness.
Loss caused by the suicide of a loved one with mental illness has a profound effect on families and friends. The bereaved often have to deal with a range of complex emotions including confusion, despair and anger both at themselves and at mental health services.
People bereaved by suicide are at higher risk of a range of heath problems and even of suicide themselves. Support for the bereaved is an important, yet often overlooked, suicide prevention strategy.
SANE Australia research suggests that families and friends who lose a loved one with mental illness to suicide often do not receive adequate support or acknowledgement from the treating mental health service. Services themselves recognise that this difficult issue is not always addressed as well as it could be.
In response, SANE Australia has developed Bereavement Guidelines for services encouraging them to have a more formal and thoughtful response to the bereaved. These guidelines offer strategies for overcoming common obstacles to supporting family and friends:
1. Fear of litigation
Many services respond to deaths by suicide within their service from a medico-legal management perspective.
Case notes are taken for the coronial investigation and there is often the attitude of ‘the less said the better’. Unfortunately this can leave families and friends confused, hurt and angry as to why services aren’t talking to them or acknowledging their grief.
Issues of liability can be a real concern and it is essential that services operate in accordance with medico-legal policy. However this should not prevent contact and support being offered.
When services acknowledged grief and engage with families after a suicide this can make a huge difference to the experience of those who are bereaved – supporting families is not an admission of liability.
2. Confusion about confidentiality
Confidentiality rules can be confusing. Health workers are sometimes unsure what they can say to families, and as a result do not say anything at all. It is important that workers check the confidentiality laws for their State or Territory, and be clear about what they can discuss.
If the family were already involved in the treatment, there is no reason why the client’s treatment cannot still be discussed. They are also entitled to access medical records of their deceased relative under Freedom of Information legislation.
Even when certain information can’t be discussed due to confidentiality, engaging with bereaved families and friends gives an opportunity to explain what will happen next – for example, the process of internal inquiries or the coronial inquest.
Opening up dialogue with the bereaved does not mean that confidentiality has to be breached.
3. Confusion about the role of mental health services in offering ongoing support to bereaved families
Another common obstacle that mental health workers talk about in supporting bereaved families and friends is that they do not have the remit or capacity to offer ongoing support to those who are bereaved.
Workers are often under tremendous pressure from high caseloads combined with limited resources, making support for people who are not formally clients extremely difficult. This is certainly a real obstacle for many, although some services are more flexible and willing to stretch the boundaries of the people they will work with.
There is a strong case for this flexible way of working as it can be an extremely important preventative measure – by helping the bereaved family to cope they are less likely to become a client themselves. In some communities it also provides a stopgap when other counselling or bereavement services are not available.
For services where follow-up support for the bereaved is not feasible, referrals to local bereavement services is an essential service that they can provide.
4. Fear of negative reactions from the families
When mental health services do take the step of contacting families after the death of a loved one to offer support, there can be concern about the reactions they may face. Friends and family can feel a range of emotions including anger, frustration and fear that they may unintentionally direct towards others.
It is important to be mindful of this to listen and let people sit with their grief and emotions rather than become defensive. This can be difficult if staff feel that negative emotions are being directed at them personally and it is natural to feel some anxiety.
It is important that the staff member making contact feels supported by the service and has the skills to sensitively engage with the family despite the reactions from they may encounter.