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Addressing the Aftermath of Suicide: Why We Need Postvention

Addressing the Aftermath of Suicide: Why We Need Postvention

A selected list of postvention resourcesTable 1 – A selected list of postvention resources
A summary of Shneidman’s 8 principles of postventionTable 2 – A summary of Shneidman’s 8 principles of postvention

Take the suicide Survey

Matthew D. Erlich, MD, for the GAP Committee on Psychopathology

Suicide is increasingly a part of the national conversation. Deaths from suicide are now at their highest level in 30 years. Suicide is the 10th leading cause of death in the US—well ahead of deaths by homicide, which ranks 17th. In 2014, 43,773 people are known to have killed themselves, and there are likely more suicides that go unrecognized.1 More people die by their own hand than in auto accidents.

Attempted and completed suicides ripple throughout the community, affecting family and friends, community workers (such as police officers and teachers), and clinicians. Former NIMH Director Thomas Insel, MD, noted that with every suicide, there are 11 victims—the person who died and the 10 caregivers devastated by the loss who are themselves at risk.2,3 For those grieving in the wake of suicide, there are relatively few resources.

Interventions that occur after a suicide are called “postvention”—a term originated by Edwin Shneidman in 1968 at the first conference of the American Association of Suicidology.

Postvention addresses the care of bereaved survivors, caregivers, and health care providers. It aims to destigmatize the tragedy of suicide, promote survivor recovery, and strengthen suicide prevention efforts by providing multiple resources to the survivors—including behavioral health, psychosocial, spiritual, and public health services.4 To many, postvention is a secondary prevention effort, with the goal of assisting in recovery and mitigating trauma.5,6

Here, we briefly review the literature on postvention efforts. We consider the effects on the victim’s caregivers—especially the behavioral health providers who care for a patient who commits suicide. We also provide current resources to help manage survivors’ and caregivers’ emotions and dread.

Selected types of postvention efforts

Postvention efforts have been developed to address a broad array of responses to a suicide. Table 1 lists selected resources. Most organized efforts focus on the family and friends of the survivor. Fewer efforts address the emotional toll on other caregivers.

A 2015 RAND report for the US Department of Defense highlights the dearth of scientific evidence on how to best respond to a completed suicide, best manage survivors’ grief, and monitor caregivers’ risk for self-harm.7 Despite their heterogeneity, postvention resources can be organized into 3 groups:

• Active, early postvention approaches

• Therapy-centered techniques

• Containment strategies

These groupings, although not mutually exclusive, reflect the dominant themes of postvention responses and are described briefly below.

Postvention “first-responder” approaches. In the first few days after a suicide, there is immediate need for practical resources by caregivers to guide the survivors with the complicated tasks involved with the end of life after suicide. Active postvention approaches help improve survivor welfare, averting crises and assist with destigmatization.

In a Baton Rouge crisis intervention center, researchers followed 2 cohorts of suicide survivors between 1999 and 2005. One group received an active model of suicide postvention with guidelines and interventions; the other group received “treatment as usual” postvention. An active model of postvention led to earlier treatment for survivors and improved attendance at survivor support group meetings.8 Such early triage efforts function as a form of crisis intervention to manage current grief and to proactively address and anticipate future concerns.

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