Life After Suicide

   The third layer relates to the unanticipated nature of most suicides, which leads to an obsessive search for the "why." Family members and friends are literally shocked because they never saw it coming. Being blindsided by suicide generates anxiety, fear and a sense of vulnerability.

   The fourth layer relates to the stigma and shame attached to suicide. Even when outsiders do not express such feelings (and they often do), the family may hold deep-seated values that conflict with suicide. Those close to the victim may even be blamed for the death.

   Last are helplessness and worthlessness, which open the door for hopelessness, the potentially deadly mindset behind the emotional pain that may have precipitated the victim's suicide. Suicide survivors are at high risk of suicidality. Many victims had family histories of suicidal behavior.

IMMEDIATE NEEDS OF SUICIDE SURVIVORS

   In the first hours and days, suicide survivors may need:

• To see that what they are feeling is normal. Those bereaved by suicide may think they are suffering a severe psychiatric crisis. Losing someone to suicide is like a personal "9/11."
• To get support. A suicide is a sudden, unexpected and often violent death. Whatever got them through any previous deaths will fail them now. Suicide loss is best endured with help. Most suicide survivors find that the best source of help is contact with others who have lost loved ones to suicide. This is available through suicide loss support groups.
• To understand they will need time to deal with their loss and grief. A three-day funeral leave does not suffice with a suicide. Most survivors will need to take things slowly and take care of themselves and their families.

   Suicide survivors are the secondary victims of the suicide who manifest many of the physical and behavioral signs of victims of disasters or other trauma.

POSTVENTION "FIRST AID"

   As an emergency responder, you can:

   Establish rapport with survivors

   Extend an offer of help and caring by "being there." Introduce yourself and other responders on the scene. If there is a feeling that things are being forced, just back off. If not, continue.

   Initiate grief normalization

   Let them discuss their feelings and concerns. Be ready for a lot of emotion and conflicting sentiments. Don't try to sort things out for them. They'll get to that later. Let them know that their emotional turmoil is understandable given the abnormal nature of their loss.

   Facilitate understanding of critical incident processing

   Explain the investigative activities that occur with any unnatural death. Tell them why the coroner or medical examiner will take the body and how they can arrange pick-up by the funeral director.

   Assist in mobilizing the support system

   Help survivors identify those who may be resources, e.g., a family physician, clergyperson, other family members or trusted friends. Don't say they have to make these contacts; just note that they may be helpful.

   Share information on community services

   Provide contact information for local grief support resources like Survivors of Suicide or other services they may reach out to if necessary. Local resources may be found on the Internet or in the phonebook.

   Encourage follow-through

   Urge them to see their family physician. Grief isn't a medical problem, but it impacts health and may aggravate existing conditions.

   These simple actions can get the family started toward recovery from their loss.

   Being involved with a suicide will not be easy for you either. After you have helped the family, take care to minimize your own critical incident stress. Aiding the survivors is a form of mutual self-help that may ease a suicide's impact on you. Special care should be taken if you have personally experienced suicidality or lost someone close to suicide.

BEHAVIORS TO AVOID

   Routine death scene activities can cause distress after a suicide. Here are some suggestions for handling them: