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Practical Needs of Survivors

By Kari Dyregrov, Ph.D., Norwegian Institute for Public Health division for Psychological Help, Oslo and Center for Crisis Psychology, Bergen. Norway

What do we know about perceived needs for help after suicide?

Despite some minor differences in findings, the existing postvention research shows astonishing similarities– both regarding the impact on the psychosocial situation of the survivors and their coping resources, as well as their needs for support. Overall, the suicide bereaved experience feeling the need for help (Andriessen et al, 2001; Dyregrov, 2002; Dyregrov et al., in press; Farberow, 1991; McMenamy et al., 2008; Provini et al., 2000; Wilson & Clark, 2005). Moreover, they state that it is not a matter of either professional help and public assistance or informal support from social networks and peers. Each source of help can address different needs (Dyregrov, 2002; Wilson & Clark, 2005).

 “Peer support” may come about when a bereaved individual meets with other survivors in support groups, peer organizations, or when those who have experienced the same kind of loss meet one-on-one through private initiatives or connections (McMenamy et al., 2008). Support groups, help lines, weekend retreats, and conferences for survivors are considered very valuable. They offer a safe and confidential environment in which survivors can share their experiences and feelings, as well as gain and give support from each other. Many survivors, though not all, wish to meet others who have experienced losing someone through suicide (Dyregrov, 2002; Feigelman et al., 2008; Provini et al., 2000; Wertheimer, 2001). We need not say very much when we meet, because we know, is what one often hears regarding these unique encounters.

The extensive support that many survivors receive from family, friends, colleagues and neighbours is greatly appreciated and needed (Dyregrov & Dyregrov, 2008). Of greatest importance, however, is the experience that the network “cares," that they make contact, are available when needed, and that they listen, showing empathy and willingness to talk about the deceased. Support in the form of flowers, visits, telephone calls and letters is appreciated, as is stepping in to help with children and practical matters in everyday life. The survivors appreciate when networks gradually help them to return to a more normal daily life through work and social activities. Family and friends become an important part of daily life at a time when the world has fallen apart and everything has been turned upside down. Therefore, one often hears the survivors say that “without family and friends I would have never managed”, or that the social support is “alpha and omega” (Dyregrov & Dyregrov, 2008; Feigelman et al., 2008; McMenamy et al, 2008; Wilson & Clark, 2005).

Although support from peers and networks is considered to be of the utmost importance, the bereaved also stress that different professionals (GP, priest, psychiatric nurse, psychologist/psychiatrist, police, teachers, etc.) should be included according to needs. Different researchers have found that professional intervention has been the most frequently reported need and type of desired help (Dyregrov, 2002; 2009a, b; Provini et al., 2000; Wilson & Clark, 2005). De Groot and her group (2006) documented that the perceived need for professional help was nine times higher among suicide survivors compared to other bereaved individuals, even after adjustments for relevant variables. Suicide survivors in the USA, Australia and Europe (from where we have documentation at present) want: 1) Early and outreach assistance, where they need not take the first initiative for contact (Andriessen et al, 2001; Dyregrov, 2002), 2) Information about the medical aspects of the suicide, the grief process, about how the death can affect family members and the family as a unit, and in particular advice to help children and young people, and with handling communication problems in the family (Dyregrov, 2002; Murphy, 2000; Wilson & Clark, 2005), 3)Varied help, meaning help with regard to existential, practical, economical and juridical questions, as well as specific psychological assistance and advice on self-mastery to reduce stress reactions, nightmares and flashbacks, 4) Help for bereaved children, i.e. direct help for children, family counselling to improve the family dynamics, resolve conflicts in parent-child relationships and receive support and discuss their own thoughts about the best possible way to provide care for their children (Dyregrov, 2002; Dyregrov & Dyregrov, 2009; McMenamy et al., 2008; Wertheimer, 2001; Wilson & Clark, 2005), and finally 5) Long-term follow-up implying that professional help measures must be of a longer duration than is usually the case (Clark, 2001; de Groot et al., 2006; McMenamy et al., 2008; Murphy, 2000; Provini et al., 2000; Wertheimer, 2001).

Importantly, what is mentioned here are some commonalities from research in “Westernized societies” and this must always be contextualised. In order to understand a person’s reaction to a suicide, his/her perceived needs for support, and what the society can do, we must always attend to the ascribed meaning of suicide and suicidal loss in a given society. As a help to understand what we see, we may consider some important questions (Barnes, 2006; Dyregrov, 2011):

–      How do the survivors actually respond to the suicide?

–      What attitude does the society have to suicide?

–      What knowledge of suicidal processes and the situation of the bereaved do professionals have? Does the public have this knowledge?

–      Are survivors willing to accept help?

–      Are peers, networks and professionals willing, and do they have the opportunity, to offer help?

–      Is there any economic basis for welfare programs for public postvention?

–      What rituals does the given society have when crisis strikes?

 

References

Andriessen, K., Delhaise, T., & Forceville, G. (2001). Zorgbehoeften van nabestaanden van zelfdoding. Een exploratieve studie. Studie in opdracht van het Ministerie van Sociale Zaken. Eind rapport.

Barnes, D. H. (2006). The aftermath of suicide among African Americans. Journal of Black Psychology, 32, 3, 335–348.

Clark, S. (2001). Bereavement after suicide- how far have we come and where do we go from here? Crisis, 22, 3, 102–108.

de Groot, M. H., de Keijser, J., & Neeleman, J. (2006). Grief shortly after suicide and natural death. A comparative study among spouses and first degree relatives. Suicide and Life Threatening Behavior, 36, 419–33.

Dyregrov, K. (2002). Assistance from local authorities versus survivors’ needs for support after suicide. Death Studies, 26, 647–669.

Dyregrov, K. (2009a). The important role of the school following suicide. New research about the help and support wishes of the young bereaved. OMEGA– Journal of death and dying, 59, 2, 147-161.

Dyregrov, K. (2009b). How do the young suicide survivors wish to be met by psychologists? A user study. OMEGA– Journal of Death and Dying, 59, 3, 221-238.

Dyregrov, K. & Dyregrov, A. (2008). Effective Grief and Bereavement Support: The Role of Family, Friends, Colleagues, Schools and Support Professionals. London: Jessica Kingsley Publishers.

Dyregrov, K. & Dyregrov, A. (2009). Helping the family following suicide, pp. 213-228. In B. Monroe & F. Kraus (Eds.)(2nd ed.), Brief interventions with bereaved children. Oxford: University Press.

Dyregrov, K. (2011). What do we know about needs for help after suicide in different parts of the world? A phenomenological perspective. Crisis, DOI: 10.1027/0227-5910/a000098.    

Dyregrov, K., Plyhn, E., & Dieserud, G. (In press). After the Suicide: Helping the Bereaved to Find a Path to Recovery. London: Jessica Kingsley Publishers.

Farberow, N. L. (1991). Adult survivors after suicide: Research problems and needs. In A. A. Leenaars (Ed.), Life-span perspectives of suicides: Timelines in the suicide process (pp. 259–279). New York: Plenum Press.

Feigelman, W., Gorman, B. S., Beal Chastain, K., & Jordan, J. R. (2008). Internet support groups for suicide survivors: A new mode for gaining bereavement assistance. Omega– Journal of death and dying, 57, 3, 217–243.

McMenamy, J., Jordan, J., & Mitchell, A. (2008). What do survivors tell us they need? Results from a pilot study. Suicide and Life-Threatening Behavior, 38, 375–389.

Murphy, S. A. (2000). The use of research findings in bereavement programs: A case study. Death Studies, 24, 585–602.

Provini, C., Everett, J. R., & Pfeffer, C. R. (2000). Adults mourning suicide: Self-reported concerns about bereavement, needs for assistance, and help-seeking behaviour. Death Studies, 24, 1–9.

Wertheimer, A. (2001). A Special Scar. Philadelphia: Brunner Routledge.

Wilson, A., & Clark, S. (2005). South Australian Suicide Postvention Project. Report to Mental Health Services. Department of Health. Department of General Practice. University of Adelaide.

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