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Support after Suicide report: 'Fighting the system as well as the illness'

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During this year of virus, isolation and loss of income, health workers have constantly expressed concern about its impact on mental health. They have also warned about a heightened risk of suicide. The time is now approaching when economic supports will be reduced, and we shall experience more deeply the painful effects of recession. This week’s scheduling of World Suicide Prevention Day could not be more timely.

Main image: Woman sitting on bed at home (Getty)

Coinciding with the day, a recent report from Jesuit Social Services’ Support after Suicide program reflects on the experience of people who have accompanied a friend or family member before, through and after their suicide. It illuminates the devastating effects that suicide has on family and friends, and what needs to be addressed if they are to find help for the person at risk, and to find support and assistance for themselves during their ordeal and after the death of the person they care for. At the heart of the report is its insistence on the importance of the human face in health care.

Support after Suicide is a program that offers opportunities for people to find healing after the suicide of a friend or family member. They can find there a listening ear, counselling, group conversation and other programs with people who have suffered similarly. The report gathers the reflections of over 140 people who have found accompaniment through these programs. It records their experience on seeking help within the health system — including hospitals, mental health units, GPs, police and other services — before the suicide of the person for whom they cared. It goes on to describe their experience of the services from which they sought help immediately after the suicide, and of those they approached subsequently for assistance to deal with their loss.

The recent experiences of the people who took their own lives underline how well grounded is the fear that in our time of disruption suicides will increase. Of the people whose deaths lie at the centre of the report, about a half had suffered from bullying, had recently been separated, and were unemployed or under financial stress. These are the harsh experiences that we might expect to find multiplied in times of isolation and economic crisis.

The perspectives recorded in the report are both poignant and challenging. The quotations from the participants reveal the pain, bewilderment, anger and sense of rejection that were part of their experience. They take the reader beyond statistics and programs to see people’s faces, and to hear their stories and be deeply moved by them. Their accounts are challenging, because their judgement of the services from which they sought advice, support and help is so overwhelmingly negative. They record some good experiences, but more often they found themselves variously excluded from conversation, offered platitudes, not consulted about discharge from hospital, sent from place to place none of which accepted responsibility, and left on their own. As one participant said, they had to spend their energies ‘fighting the system as well as the illness’.

The report itself mentions that these negative judgements reflect the response only of people who sought help vainly for someone who suicided. Those for whom others applied to the health services may have survived, leaving their friends and relatives more appreciative of the services involved. Nevertheless, these negative judgments are significant in their own right. The relatives and friends of people who have suicided are numerous, the mental health of many of them has been affected, and statistically they are at higher risk themselves of suicide. It is vital, then, that the health services be receptive to their appeals for help.

The report points to the implications for mental health services of its enquiry, and makes a number of recommendations. The responses of bereaved people suggest that weaknesses in the system may have sometimes failed to prevent suicides, that this may continue to be the case, that families and friends may feel deterred from approaching services to help people at risk, and that after the suicide of people whom they love, they are left without the support they desperately need.

 

'The report asks for a simpler system that is person and community centred, and which takes special care to recognise the needs of family members and close friends and to involve them.'

 

In response to these deficiencies, the report asks for a simpler system that is person and community centred, and which takes special care to recognise the needs of family members and close friends and to involve them. It offers a list of detailed proposals, many of which involve changing the orientation of programs. It demands that the safety and care of people at risk must be at the heart of any response, that families and carers must be supported to advocate for the people they care for, that people affected by suicide must be recognised as being themselves at risk and be properly supported, and that all practices must be supported by a strong evidence base. Each of these proposals is accompanied by instantiating the consequent needs for research, training, coordination and funding.

This splendid report embodies the compassionate focus on persons and the rigorous attention to the response of health care systems to vulnerable people for which it calls. At its heart is attention to persons as the basis for all health care, and the need to enshrine this focus in the detailed way in which vulnerable people are greeted, received, heard, responded to, and treated at each point of their relationship to the health system.

From this perspective it follows that any change to the system must begin by reflecting on the quality of relationships between people. Those who are drawn into contact with vulnerable people must themselves be caring, sufficiently knowledgeable and skilled to offer appropriate help, anxious to help both the persons at risk and those who care for them, and be given sufficient responsibility to ensure that they will receive appropriate help if referred. This demands, of course, not only empathy and the desire to be of service, but a well-founded trust that the services to which people are referred have sufficient resources of persons and funding actually to help people referred to them. The comments made in this heartbreaking report suggest that in this area, as in human services more generally, officers can be so overwhelmed that they are reduced to focusing only on moving people on.

To an outsider, the refusal to share information with family and close friends and to involve them in caring for the suicidal person may seem puzzling, even outrageous. To an inner world characterised by disconnection, close friends are often the only point of connection. Their exclusion may be yet another manifestation of the stigma that makes suicide something not to be spoken about. It isolates in silence the people touched by the suicide of a family member or friend, separating them from one another and from their own natural support groups. That exclusion from conversation and isolation may be echoed in the creation of silos of therapy where only those armed with technological knowledge may enter. If so it would represent the caricature of a medical model in which patients are defined precisely as patient and passive, professionals as active and controlling, and family members as a nuisance. If this exclusion does indeed reflect deploy rooted cultural attitudes, the training that the report recommends might need to be quite radical.

The report’s insistence that those who care for people at risk of suicide should be given information and involved in processes of healing may also meet cultural resistance. The responses quoted in the report show how important this sharing is. The insistence reflects a vision of human beings as intimately bound together in relationships within a community, so that privacy is something to be respected but set within the relationships that compose a person. This runs counter to a prevailing cultural view of persons as individuals who choose to form relationships outside themselves. Privacy then can be seen as a non-negotiable right, and so demanded in the health system even when it harms the relationships on which the person’s health depends.     

A great merit of this report is that in focusing on the experience of persons caught in crisis it raises larger questions about social values. It insists that the faces of the persons affected should guide conversation about those values.

 

 

Andrew HamiltonAndrew Hamilton is consulting editor of Eureka Street, and writer at Jesuit Social Services.

If you need crisis support, please contact Lifeline at 13 11 14.

Main image: Woman sitting on bed at home (Getty)

Topic tags: Andrew Hamilton, COVID-19, mental health, Jesuit Social Services, Support after suicide

 

 

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Existing comments

Australian suicide rates were already far too high prior to the COVID-19 crisis. This blight does not just hit the poor and disadvantaged. A friend of mine, an Honours graduate in Engineering, fell off a balcony at Stanford University whilst doing his MBA there. The coroner submitted an open verdict. I often wonder whether X was under the influence of drugs or had suffered some calamity which seemed to make life meaningless. I wonder what his family would have done had they been in California at the time and close to him. Ideally, unless obviously counter indicated, people's families should be involved in helping a possible suicide. I suppose any restrictions on this by the medical profession and law are to do with an eye to possible future litigation. Why suicide when help is usually available? I think there is something about the dark heart of our modern society which makes people think no one cares.
Edward Fido | 11 September 2020


Sensitive and compelling writing about an intensely difficult subject, Andy. These words are from Charles D'Ambrosio about his brother Danny's suicide: "And from then on the family's story can't be the same. Its identity must include death, a death shared in the blood. The old narrative breaks at precisely the moment you need it to speak for you. This death, this suicide, is shattering to what, at that exact moment, is your deepest need - family, security, identity."
Pam | 12 September 2020


History tells us that when great civilisations reach the pinnacle of achievement and affluence decline comes close behind. From ancient Israel via Mesopotamia and many others to Greece and the greatest of all, Rome, the beginnings of decline are expressed in proclivity in all things, an upsurge in in mental affliction, self harm, disrespect for others, suicide,, murder and self harm. In the wake of Rome's decline and fall it has taken Western Judeo-Christian Civilisation nearly 2000 years to reach its pinnacle. We are now living through its decline rapidly gaining pace since the liberating 1960s and increasingly marked by the very same features that accompanied the decline of the ancient great cultures. Our society has indeed a dark heart as Edward Fido suggests, a heart which has replaced the heart that brought it to greatness - the Judeo-Christian God of love and benevolence towards others. What needs to be done about suicide? Invite and accept Christ back into our lives. Simple!!
john frawley | 18 September 2020


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