IT HAS now been categorically proved those exposed to suicide are at a greater risk than those not, yet despite this knowledge, mental health services are failing their patients who are suffering from complicated grief.

As Antonia Murphy says in Out of This World: “Suicide leaves its mark on those left behind in a particular, peculiar and devastating way.”

For such patients, issues and problems they could face as a result of this loss include:

• Need to understand

• Guilt, responsibility

• Rejection, perceived abandonment, anger

• Stigma

• Trauma

• Suicide risk in survivors (thoughts, plans, attempts)

Tom was an inpatient on a psychiatric ward, when just before 5am he heard a scream followed by the sound of a man shouting and staff running down the corridor. Later that morning he found out that a close friend on the ward had taken her life, but despite his anguish and distress Tom wasn’t offered any help on the ward, nor in his care when an outpatient.

That led him to try and find services locally but when he told the bereavement group organiser about what caused the grief, the panic attacks and night terrors he has suffered since and his diagnosis, he was told he would be better going to his GP and getting referred back to the mental health services.

At a total loss, Tom made an appointment with his GP. The GP hadn’t been informed about this suicide on the ward, so asked Tom to tell him what happened. For the first time Tom felt able to talk about that morning on the ward, and his feelings, guilt and how it reminded him of what happened to his gran; something he hadn’t told anyone else about.

The GP recognised his need for someone to simply listen to him in a non-judgemental way, someone who wasn’t scared about the things he might say and not being able to deal with them.

Mental health services often give a stock answer to service users, that work with those bereaved is something they “don’t do” and leave the service user to seek out their own help.

It does seem bizarre that, as liaison psychiatrist Dr Chloe Beale says, “for people who have experienced bereavement due to suicide, there really is very little help available for them in the mental health system.”

John was initially able to get help from a specialist bereavement service (which is now closed due to cuts). He says: “I had counselling with a suicide loss specialist but then the specialist thought I was clinically depressed, so I had to go to the Child and Adolescent Mental health Service (CAMHS) but as soon as I was moved to the team, I got no support and that has been the same story to this date.”

Unfortunately in John’s case, grief was seen as unimportant compared to his depression, meaning the depression got treated, but not the grief. Being discharged from counselling services, might also give the impression to some mental health staff that his grief had been “dealt with” so was no longer a matter of concern.  

It can also be the case that depression is seen as grief, leaving the depression untreated.

Another route service users often face is being given medication instead of help to deal with their bereavement. This is what happened with Chris.

Chris was already in secondary mental health services when a close member of his family died, so he asked whether he could receive specialist support such as counselling. They refused, saying they didn’t think he would be able to cope with it.

Instead, they prescribed medication without informed consent as to the risks of this drug, especially with regard to dependency. It is only now, some years later, he is getting the help he needs to taper off the drug in order to stop taking it completely.

As Chris couldn’t get the support he needed from mental health services, he looked online and found a self-help group he could attend. During the session he disclosed he had himself attempted suicide, but was then informed how distressed and alarmed certain members of the group were about what he had said – making Chris feel like he didn’t fit in.

To this day Chris has still not received specialist support for his bereavement, yet on his notes it says he is at high risk of suicide due to the suicide of the member of his family.

Why aren’t many mental health nurses able to help their patients who have suffered a bereavement due to suicide? What is behind the “we don’t do bereavement” attitude?

There could be many reasons, but generally we all as a society find it difficult to talk about death, as we all will have suffered a bereavement either directly or indirectly.

Mental health staff might feel that bringing up the subject of suicide bereavement will be very painful for a patient, so much so that they might both be unable to deal with the emotional fallout.  

Concerns regarding potential litigation may also prevent staff from talking openly with their patients.

Then there is the widely held view by society that those bereaved need specialist bereavement counselling, when what is needed is an empathic, listening ear.

If they feel the third-sector offers such support, the nurses might feel it is better to tell the service user to access these services rather than access mental health care. Third-sector support is still patchy even though changes are underway. It can also lead to difficulties in sharing information between services.

Such factors can act as a barrier between staff members and patients, preventing an honest conversation with the patient in front of them, that, yes, might be upsetting, that might mention death, but might be just what the patient needs.

The community picture for those bereaved by suicide is changing for the better and this is due in a large part to the research from Dr Alexandra Pitman and her colleagues showing severe risks to the mental health of those who have experienced the suicide of a family member or friend, including an increased risk of self-harm, hospitalisations and suicide.

Pitman also is a Patron of Support After Suicide (supportaftersuicide.org.uk), a hub of information and support with the aim that everyone bereaved or affected by suicide is offered timely and appropriate support.

This hub links in with the NHS Long Term Plan, which aims to implement suicide bereavement support in every area of the country. Professor Tim Kendall said: “We aim to offer practical and emotional support to those closest to the person who’s died. It needs to be available for family and friends in the early days after a bereavement. Our new model will deliver support locally to a national standard.

Beale acknowledges the plan for all areas to have postvention support for those bereaved, but she said: “I still worry it will leave a gap for some of the most vulnerable such as those bereaved who also have mental health problems.”

That is especially the case for those who are inpatients on a ward when another patient takes their life. This is what happened to Vicki who one day heard a lot of commotion with nurses congregating in the bathroom directly opposite her room.

She was told by a staff member to put on her headphones but despite that Vicki heard everything. As Vicki was already suicidal, knowing this patient had completed the act gave her the confidence to try herself, and she only just survived.

At no point on the ward was she or any other patient offered the chance to talk about what happened or were given the details of where they could access support if they needed it.

Like Tom, details of the suicide on the ward were not passed onto her GP or CPN. When asked about this, Vicki said it would have helped if this information had been shared, but added: “I’m not surprised as it wasn’t spoken about on the ward when it actually happened.”

There are currently big improvements in the community support of those bereaved by suicide underway. It is now imperative that this is matched by support in psychiatric services. It’s no longer acceptable for mental health staff to claim they “don’t do” bereavement.

Some names have been changed to protect confidentiality.

Ruth F Hunt is a freelance journalist and an author. Linda Gask is a writer and psychiatrist. Her most recent book is Finding True North (Sandstone Press).

When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at [email protected], or visit samaritans.org to find your nearest branch.