The Experiences and PerceivedNeeds of Parents Bereaved bySuicideDr. Sharon McDonnellCentre for Mental Health and Risk, University of ManchesterSharon.email@example.com
Centre for Mental Healthand RiskSuicide Prevention• Suicide• Self harm• Suicide bereavement
Aim of the Presentation• Describe the experiences and perceivedneeds of parents bereaved by suicide• Highlight the progress that has beenmade to try and support those bereavedby suicide.
Suicide PreventionResearch has threeaspects:• Prevention• Intervention• Postvention (care ofthose bereaved bysuicide)
Suicide Bereavement• Suicide bereavement is a risk factor for suicide.• Little is known about the experiences of those bereavedby suicide.• No specialist services within the NHS.• Health professionals uncertain how to respond..• Those bereaved feel isolated and helpless.
SuicideTip of the iceberg:The small perceptible partof a much larger problemthat remains hidden.What lies beneath?
Statistics• 5,000 die by suicide in England each year.• Estimated 7-10 people are profoundly affected byeach suicide. (Lukas and Seiden, 1987)• Translates to 35,000 to 50,000 bereaved by suicidein England and Wales annually.• Suicide rates are between 80% - 300% higher thanthe general population. (Lukas and Seiden,1987)
Parents Bereaved by Suicide• High suicide rate amongst young men under theage of 35 years.• Some parents can feel suicidal and find itdifficult caring for surviving children who arealso finding it difficult to cope.
Aim of the Study• Investigate the experiences of parentsbereaved by suicideo Experiences of contact withprofessionals.o Perceived needso Responses to the death
Professionals are often uncertain howto respond to those bereaved bysuicide.o Psychiatrists (Brownstein,1992)o GPs (Halligan, 2000)o Intensive care staff (O’Dell, 1997)
Disillusionment with Services• Often began whilst caring for theirsuicidal child.• Intensified with subsequentcontact both prior and after theirchild’s death.
Findings: Parents’ perceptions• Being informed of their child’s death.• Professionals avoiding contact.• Inappropriate responses to the suicide.• Failure to refer suicidal parents tospecialist services.
Breaking bad news• All parents were able to recollectgraphically their experiences of beinginformed of their child’s death.o Traumatisedo Angryo Lasting distress (2 years post loss)
Breaking Bad News: Transport PoliceFather found son’s suicide note and phoned thepolice.“They said “Well where do you think he‟s gone?And I said, “I think he‟s gone on the railway, puthimself under the train (distressed). And theysaid, Well that‟s exactly what he‟s done.”(crying)
Avoiding contact: GPs• None of the participants were visited by theirGP after the death.• Every participant in the study would haveliked their GP to have visited them.
Avoiding contact: GPsR: “Have you ever felt a professional hastreated your loss in an insensitiveway?”“Well….to say nothing at all [GPs] is themost insensitive of all.”
Avoiding contact: GPsGPs at place of death“He pronounced him dead and went. And Inever heard another word from him, not „Howare you?‟, not, „Are you suffering? Do you wantany help?‟…..nothing.”
GPs inappropriate responses tothe suicide• Father„He (GP) just said it‟s (suicide) on theincrease in the North west.‟• MotherHis first words, (GP) „Well you knowschizophrenics tend to do that.‟
GPs failure to refer suicidalparents to specialist servicesMother bereaved 20 monthsR : “You said before that you‟ve felt like you wanted toend your life?”“Yeah, I told him [GP] that and I said, „I really needsomebody to talk to.‟ He said, „Well have you got afriend?‟ I said, „I haven‟t [..]‟ So he said, „So there‟snobody you can talk to?‟ So I said, „No not really.‟ Ihaven‟t had no help. I wanted somebody to talk to.He said he‟d get in touch with them, erm abereavement counsellor.”
Disengagement with ServicesHusband referring to his ‘suicidal’ wife:“Mary went to see doctors (asking forcounselling) and they said there‟s a 3month waiting list, so what‟s the point? Ithink she‟s just give it up…..nobodyseems to be bothering.”
ConsequencesMultiple assaults to parents assumptive world byhealth professionals• Perceive them to be insensitive and uncaring.• Reject the NHS as a source of support.Intensifying the parents sense of:• Helplessness• Hopelessness• Isolation
Positive ExperiencesParents were able to recognise +veexperiences with professionalso Funeral directors and coroners officersFew reported +ve experiences withhealth professionals and policeo But those that did found it valuable sourceof support
Positive Accounts of HealthprofessionalsP. “My ex GP he‟s known me from being 6 years ofage and he knew Rick (son). He‟s my mum‟s doctor,he knew what had gone on and he was very upset.He kept sending messages to me. Please tell her tocome and see me. I had to go to see him becausehe‟d asked so many times.”R. “Were you glad he was bothering though?”P. ”Yeah, but this particular day.”
ContinuedP. “ I was really upset and I didn‟t want to go and I didn‟tthink anybody could help me you see, and then when Iwalked in, I just walked in the door and he just put hisarms around me […] He just held me really tight and hesaid. “I‟m so sorry. I‟m so sad” and he was holding myhand and I was crying you know, I was devastated.”R. “ Did it make you feel better?P. “Of course it did. I thought thank God… Thank God forhim.”
ImplicationsImplications for clinical practice• Training for health professionals on how to respond to thebereaved.• Aim of interventions: Ensure parents remain engaged withhealth professionals after the child’s death.NegativeexperiencesFindings give a vivid insight into parents’perceptions of contact with professionals.Reducedcontact withHealth ServicesIncreasedhealth risk?
NHS/Health Professionals:To Summarise• Our understanding of how to respond and carefor those bereaved by suicide is far behind ourunderstanding of other ‘at risk’ populations.• No specialist services within the NHS.• Currently, no specialist training in suicidebereavement for health professionals.
Development of a Parental SuicideBereavement Training Pack• Funded by the National Institute for Health Research(Research for Patient Benefit)• 3 year project (July 2011 – June 2014)Aim• To develop a training pack to provide healthprofessionals with knowledge, skills and a frame-work in which to guide them on how to respond andcare for parents bereaved by suicide.
MethodStage 2BereavedparentsperspectiveStage 4Communitymental healthteamsperspectiveStage 3GPsperspectiveStage 5A&E staffperspectiveSynthesis of four stagesDevelopment of parental suicidebereavement training pack forhealth professionals (DVD)Stage 1Identifydeceased andparents
RecruitmentParents• Children aged between 16-34 years• Subsequent suicides• Self recruitment posterGPs• Would welcome guidance on how torespond to parents
Timing of Current Study• Launch of Suicide Prevention StrategySept 2012• Interest at National level (House ofCommons)
Progress Made• 1999 DH funded the parental suicide bereavement study.• 2002 Suicide prevention strategy identified those bereavedby suicide as a vulnerable population.• 2006 DH resource pack for those bereaved by suicide.• 2008 Release of health talk on line (suicide bereavement).• 2011 DH funding the development of a parental suicidebereavement training pack for health professionals.• 2012 Suicide prevention strategy: emphasis on the needs ofthose bereaved or affected by suicide.
Resource Book forPeople Bereavedby SuicideProvides practical guidancefor those bereaved bysuicide including healthprofessionals.Suggestions that thisdocument could be used astraining material for healthprofessionals.(DH, 2010)
Web based Information:Suicide BereavementHealthtalkonline.orgPerceptions of• Why the suicide took place;• Suicide notes;• Being informed;• Seeing the body or not being ableto do so; and• Suicide in prison.
Identifying the Needs ofThose Bereaved by Suicide
Going in the Right Direction‘One way to keepmomentum going is tohave constantlygreater goals.’Michael Korda (novelist)
Centre for Mental Health and Risk• Annual suicide bereavement conference• Develop a suicide bereavement research unit1. Children2. Adults3. The offender pathway4. Those responsible for their careEmail: firstname.lastname@example.org
Suicide Bereavement ConferenceSuicide Bereavement is Everyone’sBusiness: Policy Research and PracticeManchester conference centre18th September 2013Contact: email@example.com