Provision of Cheshire & Merseyside Suicide Bereavement Postvention Service

Suicide is an individual tragedy, life-altering for those bereaved and a traumatic event for the community and local services involved. The impact on family, friends, workplaces, schools and communities can be devastating; it carries a huge financial burden for the local economy and contributes to worsening inequalities. Suicide is a major public health issue and a leading cause of years of life lost.

Suicide can have a profound effect on the local community, and in addition to immediate family and friends, many others will be affected in some way. They include neighbours, school friends and work colleagues, but also people whose work brings them into contact with suicide such as emergency and rescue workers, healthcare professionals, teachers, the police, faith leaders and witnesses to the incident. There may be a risk of copycat suicides in a community, particularly among young people, if another young person or a high-profile celebrity dies by suicide.

Effective and timely emotional and practical support for individuals and families bereaved or affected by suicide is essential to help the grieving process, prevent further or longer-term emotional distress and to support recovery. There is some evidence that referral to specialist bereavement counselling and other bereavement support can be helpful for people who actively seek it.

The provision of support after a suicide is critical to addressing suicide risk and to improve the mental wellbeing of people who have been bereaved by suicide. Children, young people and adults who are bereaved or affected by a suspected suicide are themselves at increased risk of suicide , psychiatric admission and depression . Providing support after a suspected suicide can reduce this risk, especially when tailored to the person's needs . In addition, post suicide interventions can promote community mental health awareness and resilience and support wider initiatives to tackle health inequalities and social exclusion. Thus, suicide bereavement support can mitigate the following:

• Risk - those bereaved by suicide have a greater risk of dying by suicide;
• Impact - the impact of bereavement by suicide is significant and different in nature to other sudden deaths with subsequent impacts on the wider community linking to social exclusion, poor education and employment outcomes;
• Demand - the increased demands on health, social care and support services.

A person's death by suicide has far reaching implications that stretch beyond the immediate family, with it being suggested that 135 people can be affected by each suicide . This notion is supported by a recent large-scale national study on bereavement by suicide where the most common relationship reported was the loss of a friend to suicide . Therefore, interventions that support those bereaved by suicide (i.e. postvention) can have a significant impact both to the bereaved and to the wider economy.

The impact of suicide on the bereaved can vary depending on the relationship and time since the death. Adverse effects of bereavement by suicide include financial problems, unemployment, relationship break-up, deterioration in physical and mental health, substance use, increase in casual sexual relationships, suicidal thoughts and also dying by suicide , , . These behaviours can continue to be problematic for the bereaved well beyond 12 months after the death of a loved one.

The evidence revealed in the literature indicates that the nature of suicide bereavement support should necessarily be different to other forms of bereavement support. The range of impacts is wide and can be particularly significant, not least the fact that those people bereaved by suicide are at greater risk of suicide themselves. Research conducted in 2016 by UCL found that people bereaved by the sudden death of a friend or family member were 65 per cent more likely to attempt suicide themselves if the deceased friend or family themselves died by suicide .