While grief is always multifaceted, the grief experienced by those who have lost someone to suicide can be particularly complicated. Feelings of confusion, anger, regret and guilt are common, and it can be difficult to be open about the cause of death because of the stigma associated with suicide.
The South East London Suicide Bereavement Service is delivered as a partnership between Mind in South East London and South London and Maudsley NHS Foundation Trust, and is based at Bethlem Royal Hospital in Beckenham. We spoke to the service’s manager, Amy Kirk-Smith, about how her team supports those struggling with loss after a suicide.
Why was the service set-up?
The Suicide Bereavement Service was launched in August 2021, one of a wave of similar services being rolled out across England; the NHS is commissioning these services as part of its long-term plan for suicide prevention. There is a recognition that grief following suicide bereavement is especially complex and people are therefore particularly in need of support. People bereaved by suicide sadly are at greater risk of feeling suicidal and attempting suicide themselves, so one purpose of services like ours is to make sure this group is supported and prevent further deaths by suicide. On a day-to-day level, I see our purpose as making a deeply painful experience a little bit easier to cope with, a little bit less burdensome for the person going through it. We can’t change what’s happened but we aim to reduce some of the burden and help people feel less alone.
How many people have accessed the service?
In our first year we worked directly with around 160 people. A further 65 people received information and signposting or some initial phone support. On average, we provide around 40 hours of support each week.
How are people referred to the service?
Our focus is on supporting people who are recently bereaved (although we accept people at any stage). We receive around 70% of our referrals from the Metropolitan Police through a system called Real Time Surveillance. This tracks cases of suspected suicide in real time and provides details of next of kin and others affected by the death. This system is run by Thrive LDN, and allows us to reach out proactively to bereaved people within days or weeks of their loved one’s death.
We also accept self-referrals, referrals from friends and family and referrals from professionals. We try to make the process as easy as possible. There is a short referral form which can be emailed to us, but we also encourage people to just give us a call on 07933 393 397 between 9am and 5pm Monday-Friday. If we’re not available right away, we’ll call back as soon as possible.
Is the service open to all?
The service is available to people of all ages who are able to engage in talking-based support. We often work with different members of the same family/friend group, but we see each person individually and make sure they get support that is focused on their needs.
“We aim to normalise people’s reactions, help them understand what they’re feeling and connect them with others.”Amy Kirk-Smith
What can clients expect?
We offer support both one-to-one and through peer-to-peer support groups.
Our one-to-one support is very flexible and is built around each person’s needs – everyone needs different things when they’ve been recently bereaved. For some people, there might be a lot of immediate practical tasks, while others might just want a regular space to talk.
On a practical level, we can offer support with anything from registering the death and organising the funeral to dealing with the financial impact and the inquest process. The emotional support we offer at this stage is not therapy but a space to be listened to without judgement, to explore emotions in the here and now and learn more about the grieving process. Most people access this support for around three to five months, but there is no set time limit or number of sessions.
For people who are further along in their bereavement journey, we offer peer-to-peer support groups and bereavement counselling. Our groups provide a space to meet and connect with people who can relate to the experience of losing a loved one to suicide. Counselling allows people to explore certain emotions in more depth, particularly where they feel stuck in being able to process what’s happened.
“Every day we see from people who’ve used our service that it’s absolutely possible for life to be fulfilling and meaningful after suicide loss.”Amy Kirk-Smith
Do people bereaved by suicide face different challenges to those bereaved by other types of death?
There’s a phrase I’ve heard to describe the experience of bereavement by suicide: “Grief with the volume turned up”. From our experience, it seems the emotions people feel could accompany any bereavement, but some of these may be felt much more intensely with suicide loss, for example regret, confusion or guilt. There’s no denying it is an especially painful way to lose someone. Other common emotional experiences include having a lot of unanswered questions and thinking about what ifs.
There are also practical challenges which can arise with any sudden death, such as the absence of a will or funeral wishes. In England, any death considered to be unnatural will be referred for a coroner’s investigation, which can take a long time to conclude and sometimes be an upsetting process.
Are people bereaved by suicide at greater risk from mental ill health?
Sadly, there is evidence to suggest this. In a University of Manchester study of 7,000 people bereaved by suicide in the UK, over a third of respondents reported mental health problems following the death. Women were more likely to report a deterioration in physical health and increased use of prescription drugs, while alcohol use and illicit drug use were more common among men. Three per cent had been hospitalised for mental illness following their loss.
Does the stigma around suicide negatively impact on the lives of those affected by it?
Based on my conversations, I think stigma still has a significant impact. Some find those around them don’t want to talk about the person who has died, or avoid the bereaved person more than they would someone who’d been through a different type of bereavement. Stigmatising attitudes still exist about suicide, for example that it is selfish or that people who attempt suicide are attention-seeking; however, I think this is changing.
Some people may feel they have to – or may choose to – keep the way the person died a secret, which can make it more difficult to talk openly about what has happened. An example of this is with children: when someone dies by suicide, people may not want or may not know how to tell children what really happened. Expert guidance suggests that children should be given truthful information in an age-appropriate way. There is helpful information about this at Child Bereavement UK and Winston’s Wish.
What are you hoping for the client to have achieved by the end of the support period?
We aim to normalise people’s reactions, help them understand what they’re feeling and connect them with others. We hope to support people through the extremely difficult period immediately following the death and help them find ways to manage going forward. Ultimately, we hope that through accessing support, people will feel more resilient: more able to face life without the person they’ve lost, and to recognise their own strength. Every day we see from people who’ve used our service that it’s absolutely possible for life to be fulfilling and meaningful after suicide loss.