Your relationship with suicide

In November 2015, my 44-year-old elder brother took his own life. It was a shock to myself, family and friends. As the effect of his suicide rippled throughout the community, I was undertaking counselling training. 

During the first personal development group I attended following his death, silence gripped the room, waiting for me to share what had happened. Ever since then, I have been learning how to talk about suicide both in the context of being a family member who has first-hand experience of suicide, and as a practitioner psychologist.

For the past 10 years, I have also been supporting my eldest and youngest sons (17 and 21 years old) who have fluctuated between suicidal ideation and acts of suicide. Meanwhile, I developed a private practice specialising in supporting others who are grieving from a suicide and working with clients who are having thoughts of suicide.

Needless to say, I have been affected by suicide in both personal and professional contexts.

Following the completion of my counselling degree while still grieving the loss of my brother and supporting my son, I undertook a counselling psychology doctorate. 

My research project aimed to understand suicide loss further and how, as practitioners, we can support those who have been through this devastating type of loss.

Due to historical discourses of suicide being a sin (the Church of England only officially allowed full funerals from those who died by suicide in 2015), and a crime (suicide was only legalised in the UK in 1961), suicide is not an easy subject to talk about in any context.

Some of my family members have never told anyone that my brother died by suicide – just that he died. As a professional, I find that balancing risk, the prevention of suicide and the consideration of human rights issues complex and a subjective matter where safe, effective clinical supervision is vital.

A recent survey of 7,150 suicide-loss survivors in the UK found that, of the 4,621 who answered, 62 per cent of respondents felt the services they received were inadequate and 31 per cent did not know if they were supported effectively: leaving only 7 per cent feeling satisfied with the support they had received (McDonnell et al., 2020). 

I have heard this numerous times while providing support for this cohort of clients, who cite their over-arching feelings being those of isolation and a lack of adequate resources. A common phrase I hear is "no one else seems to care about the significance of this type of loss."

In 2016 the British Psychological Society's suicide prevention paper in the area of postvention, acknowledged an increased risk of suicidal thoughts and behaviour by the relatives and friends of the deceased and it is therefore imperative we address the lack of suicide loss support services.

The recognition for personalised suicide bereavement support is growing and specific suicide-loss support services are being implemented throughout the UK, as confirmed by the Department of Health and Social Care's (DHSC) allocation of £1,082,000.00 funding across the UK in 2019.

This funding comes as a part of the National Health Service's (NHS) long-term plan to transform mental healthcare services and the DHSC's long-term suicide prevention plan.

Although suicide grief research is in its infancy, we know that a suicide is often shrouded in stigma (Scocco et al., 2017), with feelings of responsibility (Peters et al., 2016), guilt (Barrett, 2013) and shame (McIntosh & Jordan, 2014).

Research findings confirm that survivors feel they need to conceal the cause of death (Sveen & Walby, 2008) and do not always feel able to share their stories, which complicates their grieving process (Peters et al., 2016). 

My doctoral research (Egan, 2022), a narrative enquiry into suicide grief, found that the act of suicide shook the survivors' assumptive worlds, their perceptions of their loved ones and themselves. They had not identified with suicide until it happened to them.

In each story, the suicide-loss survivor had to integrate the suicide into their life story and their subjective sense of self. They were thrown into a world in which they now had to identify with 'suicide;' – that is, because their loved one died by suicide they had to: 

• make meaning of the suicidal act – "why did they do it?";
• understand their own implications to the suicide – "why didn't I see it coming/do more?";
• deal with significant family disruption due to feelings of responsibility and blame; 
• accept that others in their families may feel suicidal too; and 
• negotiate the implications of complex grief on other family members.  

While they attempt to integrate their loved ones' suicide into their life, my research highlighted that the social understanding of suicide in the community affected these processes. The psychosocial analysis showed that, for suicide-loss survivors, negative discourse around suicide includes the terms "prevention" and "zero suicide."

We know that these terms are vital in the medical movement to reduce suicides because they show it is a behaviour that can be changed. However, in the suicide-loss movement, they only add to the feelings of guilt and shame while the loss is processed (Egan, 2022). Feelings or thoughts such as "If her death was preventable, why was I not able to stop her?" are common among those that I have counselled since.

Naturally, no one person experiences any type of grief in the same way as another. Suicide grief is complex and anyone supporting someone through this type of loss should be aware of the effect it can have on those left behind.

With the complexity of suicide grief, different levels of long-term informal and formal support are needed as part of a well-integrated system (McDonnell et al., 2020). 

Additionally, as practitioners concerned with social policy and social justice, psychologists are encouraged to deconstruct the social and historical stigma around suicide and suicide loss. 

One very significant, important alteration to services would be to continue developing specialist suicide grief services away from the rhetoric of suicide prevention. Another would be changing the discourses used throughout services that are implicated by social policy.

Find out more

The author, Dr Sue Egan will deliver a two-hour webinar, 'A practitioner's insight: Your relationship to suicide' on 10 September. Find out more about this webinar on BPS Learn.

If this article has affected you in any way, the Samaritans has a free helpline for adults who need to talk. Call 116 123. It's open 24 hours, 365 days of the year. They also offer email support.

You can also find out more about World Suicide Prevention Day via the International Association for Suicide Prevention's website.