Diversity, Community and Opportunity: Meeting the Needs of Those Bereaved by Suicide

• 1. ImpactofSuicideonOthers n SuicidalBehaviourdoesnotjusthaveanimpactonthesuicidalbuthassignificantimpactonothers. Diversity,Communityand n TheNewZealandSuicidePreventionStrategystates:OpportunityAmongstthoseNewZealanderswhomakeaserioussuicideattempt,almosthalfwillmakeatleastonefurtherattemptandMeetingtheNeedsofThose onein12willdieasaresultofsuicidewithinfiveyears(Beautrais,20032004bGibbetal2005)(AssociateMinister BereavedbySuicide ofHealth,2006,p.17). ChrisBowden n ThosewhohavebeenbereavedbysuicidehaveoftenlivedwiththeLecturer,SchoolofEducationStudies,VictoriaUniversityofWellington.suicidalbehaviourofothers. Chris.Bowden@vuw.ac.nz n Peoplebereavedbysuicideareatgreaterriskfor:& Developingcomplicatedmourningresponsesandotherpsychiatric CarolineCole andmedicalcomplications(Jordan&McMenamy,2004). Counsellor,Skylight,WellingtonSouth,Wellington. Heightenedlevelsofguilt,angerfamilydysfunction,social cs4@skylighttrust.org.nz stigmatisationanddisorderssuchastraumaticgriefandPostTraumaticStressDisorder(Jordan,2001). Increasedriskofengaginginsuicidalbehaviouranddyingby29Nov20062006SPINZSymposium:Understand ingSuic idalBehaviour:UpdateYourKnowledgeandPracticesuicide(Jordan&McMenamy,2004).TheRoleofPostventionPreventiveInterventionsTheNeedforCollaborationnPostventionispreventionandanefficientwaytoprevent n Designing,implementingandevaluatingpreventivefuturedistress,psychiatricdisorderandmentalhealth interventionsandsupportprogrammesisbestdonerelatedproblems,andevensuicidalbehaviourandsuicidethroughdevelopingpartnershipsbetweenresearchersanditself(Shneidman,1981).practitioners.nMaukandSharpnack(1999)definepostventionas:n Throughcollaborationresearcherslearnmoreaboutwhat (i) aprocessduringwhichpeopleworktowardsemotionalworksandwhatispracticalandpractitionerslearnmore andpsychologicalrecoveryandreadjustment,andaboutresearch,theoryandeffectivewaysofsupportingthoseaffectedbysuicidalbehaviourandsuicide. (ii) astheprovisionofinterventionsthatcombineeducation andcounsellingthataimtopreventbereavementn Collaborationandpartnershipsprovidesgreater complicationsforindividualsaffectedbysuicide opportunitiestoupdateknowledge,learnmoreabout (includingfurthersuicidalbehaviour). effectivepractice,developmorecomprehensiveandcriticalsharedunderstandings.nTheBereavedBySuicideSupportGrouprecentlysetup n ThismeansthatpracticeismorelikelytobefocusedonandrunbySkylightinconjunctionwithVictoriaUniversitysimilargoalsandbeeffective.ofWellingtonwasaneducationalpreventiveinterventiondesignedtoprovidepostventionandmeetaneedidentifiedbyindividuals,clientsandtheWellingtoncommunity. LessonsfromtheResearchLessonsfromtheResearch Meetingtheneedsofthosebereavedbysuicide BereavedbySuicideSupportGroupsshouldaimto: n Beautrais(2004)inherreviewandsynthesisoftheresearchevidencearoundthesupportneedsofthoseaffectedbysuiciden Reducethelengthofthegrievingprocessforindividuals,identifiedthatsupportprogrammesneedtomeetthefollowingneeds n Reducethelikelihoodofmorbidity,subjectivestressandotherofthebereaved: negativeoutcomesthatresultfrombereavement, n Meettheneedsofbothindividualsandthegroup, Theneedforinformation, n Identifyspecialpopulationsandthoseatrisk(e.g.,thoseindividuals Theneedforassistancewithpracticalmatters,whomaybesufferingfromsevereandchronicgriefcharacterisedbyenduringsymptomsfittingwithearlydiagnosticcategoriesof Theneedforcontactwithotherswhohavebeenbereavedby depression,anxietyandPTSD), suicide, n Buildsocialcapitalandpersonalcapital(resourcesthatinfluence TheneedforsupportwithCoronersInquestandofficial coping,adjustmentandadaptation)bylinkingpeopleto: procedures. immediateservicesandgenericbereavementservices, shorttermservices(e.g.,thatprovideinformationonsuicidean n Twomaindifferencesbetweenbereavementbysuicideandotheropportunitytotalkabouthowithasaffectedthem,anprovideformsofbereavement:opportunitiesforindividualstofindpersonalunderstanding/putdeathin bereavementprocesstendstobelongeraftersuicide,andperspectiveandcontinueonwiththeirlives)andby longertermservices(e.g.,therapyandtreatmentgroups,selfhelpand recoverytendstobeslowerinthosebereavedbysuicide supportgroupsthatwillvaryintermsofleadership,duration,(Beautrais,2004). membership,format,structure)(Beautrais,2004).1

2. LessonsfromtheResearch TheProgramme Beautrais(2004)suggeststhatthosedesigninganddeliveringBereavedbySuicideSupportGroupsshouldconsider: n 6weekprogrammeEducationalpreventive n Includingaapretestandposttestmeasureinordertoevaluate intervention.interventionchanges(e.g.,ameasureofgriefexperience,distressetc),n 2hrspersession,79pm. n Considerthenumberofsessions, stndn 1 hrInformation/skillbasedand2 hrEmotional n Considertiming(soonorlateronsomeevidenceearlierinterventionsaremoreeffectivebutdependsonreadinessofparticipants),supportfocusedcomponent(educationaland n Considerdifferenttypesofprogrammesfordifferentgroups(i.e.,counsellingapproach).malesandfemales,youthvsadults), n Considerdifferenttypesofprogrammesandinterventionswithhighn Facilitatedbyexperiencededucatorandriskandlowriskindividuals(importanttoscreen/assessparticipantsbeforeselectionforgroupformentalhealthissuesthatcouldberiskcounsellor.factorsforfuturesuicidalbehaviour) n Supportthedevelopmentofnaturalhelpersfamily,friends,n Closedgroup(commitmentto6weeks).neighbours,peers,employers.n Participantsvolunteered. AimTheStrategyTohelpthosebereavedbysuicidetodevelop:n Understandingof:Providethosebereavedbysuicidewith: Griefprocessn Factualinformationaboutsuicide,grief,copingstrategiesand Suicideresources.n Asafe,respectfulandnurturingenvironmenttotalkabouttheirn Skillsandstrategiesfor: experienceswithothers. ManagingGrief. n Opportunitiestolearnmoreaboutsuicideandwaystounderstandit Maintainingpersonalwellbeing.andputitintoperspective. Protectingselfandothersandimprovingfamilyfunctioning.n Opportunitiestolearnandsharestrategiesforenhancingindividual Developingpersonalandsocialresourcesandsupport. andfamilyfunctioning,dynamics,communicationandwellbeing(to reducerisk,assistwithearlyidentificationofatriskindividuals,and promotepositivesocialandindividualcapitalandselfcare).n Ultimatelytoreduceriskofnegativeoutcomes,bereavementtime, shortenrecoveryandreduceriskoffuturesuicide.n Addresssocialinequalitiesfreetobereaved,appropriatetimeand accessiblelocation(doneinconsultationwithbereaved)n LinkbereavedwithSkylightandotherservicesthatcanprovide ongoingsupportandaccesstoresources.ApproachContentn Responsiveandflexibleapproach.n Respectfulofthediverseneedsandwaysthatpeoplerespondtosuicideand n MeetingthechallengeofDESIGN learn.n BasedonNewZealandreviewofresearch(Beautrais,2004).n Safetyandeffectivenessdonoharm.n Aspectsofprogrammebasedoninternationalresearchandpractice(Murphy,n Strengthsbased. 1996Murphyetal.,1996,1998,1999)n Informedbythefollowingconceptsandprinciples: Communitybasedpreventiveintervention. Griefisanactiveprocessoflearning,relearningandresocialisation. 2dimensionalsupportprogammesfollowingsuddenorviolentdeathsofRelearningprovidesunderstanding,allowsindividualstoaddresstheirchildren(includingsuicide).helplessnessthataccompaniesgrievingandprovidesaframeworkforsupporters/caregivers(Attig,1996). Informationalskillbuildingsupportandemotionalsupportprovided(both ratedhighlybyparticipants). QualitysupportprogrammesprovidebotheducationandcareorEducare(Smith,2003). 12weekand10weekprogrammes(510parentspergroup). ThefivestrandsoftheearlychildhoodcurriculumTeWhriki: (Ministryof Offered4mthsafterbereavement.Education,1996):belonging,wellbeing,opportunitiestoexploreand Goodmeasuresusedtoassessoutcomesonmentaldistress,Postlearn,communication,andresponsibility. TraumaticStresssymptoms,lossaccommodation,physicalhealth,marital Learningenvironmentsareculturalsiteswhereindividualssocially rolestrain.negotiatethemeaningofexperiencesandlearnhowtoadapt,use Pretreatmentvariablesassessed,controlgroupsused.strategiesandculturaltoolsthroughinteractionsandthroughtheuseof LongitudinalstudiesFollowedupparticipantsat4,12and24mthspostscaffolding(Smith,2003,Santrock,2004).deathaftercompletingprogramme. Akototeachandlearn(Williams,1992)aprocessofreciprocal Mixofquantitativeandqualitativemethodsforevaluation.teachingandlearning(Glynn,1993).Facilitatorsandthebereavedwork Promisingresults(particularlyhighlydistressedwomenbutalsoformen).togetherinanintegratedwaylearningandteachingeachother.AkoAkowhichimpliesamutualteaching/learningdiscussion(Williams,1992). 2 3. ContentofModulesSession 1Module Introduction ObjectivesIndiv idual,groupandprogrammeInformationContent Definingbereavement,grief,SkillEmphasis IdentifyingfactorsthatinfluenceEmotionalComponentShar ingexperiences,building Recruitment&Screeningobjectivesmourning duration,extentandoutcomesoftrustSettinggoals&boundariesbereavement Sourcesofsupport nInitially,supportgroupadvertisedthroughnewspapers,funeralhomes 2TheGrieving Pr ocessUnderstandingdiversityingrief,w hatisnor mal,cognitive,emotional, Griefreactions GriefMapping How griefaffectsus Realisticexpectationsf orgriefDiscussingcommonanduniqueaspectsofgrief andemailnetwork(poorresponse).social,physicalreactions gender,individualandfamilyLearnnew strategiesfor managing AccommodatingGriefmodel DifferentGrievingstyles accommodationandfunctioning Strategiesformanaginggrief differences nBetterresponseusinglocalradio,friendsandcolleaguesinformedgrief intuitive,instru mental,dissonantImpactonfamilydynamics familymembersandparticipants.Participantsslowtoregister. 3Understanding Suic ideUnderstandingcomplexcauses,developingapersonaltheory,putting Theories,modelsand explanations,r iskandprotective Developingpersonaltheory, PuttingsuicideintoperspectiveDealingw ithWhy?Guilt,responsibilityandunfinis hed nPotentialparticipantsnonclinicallyscreenedandaskedforsuicideintoperspectivefactorspracticalw aysoftalkingaboutand explainingsuicidetoothersbusinessManagingstrongemotions backgroundinformation(didnotusescreeningquestionnaireasthis wouldputoffindividuals). 4Respondingto Understandinghow suicideaffectsEffectsonchildre n,yo uth,others Ex plaining&talkingaboutsuicide Copingw ithchangeinfamily Othersothersandoursocialnetw orks Ec omapofimpactofsuicideonModellinggoodgrieving Helpfulandhurtf ulresponsesnDecisionmadetoexcludethosebereavedforunder6mths,theywereHow todealw ithunhelpfulresponsesbyothers relationsh ips Identifyingw aystostrengthen socialsupportnetw orkbyothersWaystocommunicateneeds offeredalternative1:1supportandfamilycounsellingofferedtothose 5Self Care&Learningmore aboutw hatsupports TeWhareTapaWhamodelof Assessingandmeetingneeds Dosingfeelings, managing wantingsupportforchildrenandyoungeradolescents. Supporting Othersandcompromisesw ellbeingAdaptive&maladaptivestrat egies w ellbeing Import anceofrituals Recognisingriskinself&others Achievingbalanceandconnectionthoughts,behaviours nIndividualsweremonitoredduringsessionsforsignsofsevereand How tosupportfamilymembers Identifyingprotectivefactors chronicgrief,symptomsofdepression,anxiety,PTSDandother 6LookingAhead Achievingafutureor ientedfocusRevisitingGriefMap Recognisingw hen,w here,how toRenegotiatinganew mentalhealthproblems(oneparticipantwassubsequentlyreferredtoIdentifyfactorsthatcontributetoresiliency TheChallengeModel SourcesofInfo&Support gethelp Repositioning,r edefiningselfrelationsh ipw ithdeceased,preservingmemories GPandcounsellorafterdisclosingsymptomsofPTSD). Identifyingfuturetas ks,skillsand Whathashelpedthem support bounceback,Hopesforfuture 7datacollection Closureforgroup,chancetofeedbac k evaluation Participants DeliverynClosedgroup.Firstnight,someparticipantswhohadregistereddidnotshowup,othersshowedupwhohadnotregistered.2leftafterfirstnight(citing nMeetingthechallengeofDIVERSITYrdgroupdidnotmeettheirneeds),2othersjoined3 week(oneparticipantfeltthiscompromisedtrustofgroup). nDemonstratedtheyhaddiversegriefexperiencesand nGroupruninSkylightsWellingtonSouthOffice,groupseminarroom. supportneeds.Accessibleparkingandpublictransport,resourcescentre(librarywithbooks,videos,DVDs)available. n7groupmembers(2male,5female). nst1 hourdiscussinformationandskillbuilding(someskillsdiscussed,modelledandpracticedothersintroducedandcriticallyreflectedon). nAgesrangedfrom2050yearsofage.nBreakteaandcoffee,informallearning&sharingopportunities. nLengthoftimebereavedrangedfrom7mthsto8years10nnd2 houremotionalsupportfocusedonsharingexperiences,obtaining mths. feedbacktofacilitatereframingaspectsofsuicide,sharingstrategies.nBothprogrammecomponents(information/skillbuildingandemotional nPredominantlyPakeha/NewZealander. support)implementedjointlybythe2facilitators(educatorandcounsellor).nEndofeachsessionparticipantsaskedtoidentifytheirsupportpeople,future nManyhadchildrenandfamiliesoftheirownandwereactivities,taskstheywouldworkonandstrategiestheywouldpracticeforthe managingtheirowngrief,familyrolesandwork.followingweek.nFinalmoduleparticipantswereprovidedwithfolderwithmodulesummaries, nGroupranTuesdays79pmfor6weeks,timeandday generalresources,factsheets,sourcesoffurtherinformation,andalistof suitedgroup,childcarearrangementsandtravelling.contactsanddescriptionsforcrisisandsupportservices.nInitiallyitwasenvisionedthateachmodulewouldbeevaluatedweekly,butparticipantsindicatedtheywouldpreferminimalpaperworkanddecisionwasmadetoevaluatemodulesatendofprogramme.TheRippleEffect Evaluation nMeetingtheneedsoftheCOMMUNITY nBackgroundsandExperiences:Howsuicidehadaffectedthem.FocusedonperceptionsofParticipantsof: MotherandDaughterson/brotherdiedbysuicide,fathernotcopingathome. n Information/Skillbuildingcomponent Twobrothersbrotherdiedbysuicide. Relevance(usefulness), Widowedmotheroftwochildrenhusbandsuicided. timingand Youngwomangrandfathersuicided,hushedupbyfamilyandthen understandingofcontentandskillspresented.mothersuicided. Opportunitiesforlearning(whatwaslearnt). Middleagewomansonsuicided.n Emotionalsupportcomponent nMosthadlivedwithsuicidalandselfharmingbehaviourforsometime. Whatthegroupexperienceandfacilitatorsprovided(basedonYaloms nTheysawthemselvesasdifferenttootherfriendsandextendedfamilywho1985,therapeuticgroupfactors). hadalsobeenbereavedbysuicide(didnotwantsupportpeople/natural n Facilitation helperscomingtothegroup). Leadershipandexpertiseoffacilitators. nAllwereconcernedabouttheeffectsofsuicideonotherfamilymembers, n UsefulnessofthePreventiveIntervention familyfunctioning,futureriskparticularlyonchildren. Mostandleastusefulaspects nGainedeachotherstrustquickly(within2weeks). nInitiallysomeparticipantswantedaneducationalapproach(learning),others wantedamorecounsellingapproach(sharingexperiences),somewantedn5pointLikertScaleitems both.nOpenEndedquestions nStartedcurryclubmetsociallythehourbeforethegroupinlocalIndian restaurantfordinner. 3 4. Information/SkillBuilding Relevance&Timing n Relevanceofcontentandinformation:Alltheparticipantseitheragreedorstronglyagreedwiththefollowingstatements: Component themajorityofmaterialpresentedwaspersonallyuseful themajorityofmaterialwouldbeofusetootherpeople n Mostrelevantmodules: theskillstaughtandmodelledinthemodulesareuseful Module4Respondingtoothers(100%) n Timingofcontentandinformation: Module5Selfcare&SupportingOthers(100%) Module6Lookingahead(83%) early(n=1bereaved5years) Module3Understandingsuicide(67%) attherighttime(50%,n=3,bereaved8years,bereaved9mths,bereaved Module2TheGrievingProcess(50%)7mths) Module1Introduction(50%) late(n=1,bereaved8years10mths) n note2participantsmissedmodules1&2 muchtoolate(n=1,bereaved8yearsandsecondsuicide8+years) n Whenaskedabouttheirperceptionsofthemostappropriatetimingof n Whatwasmostrelevantandwhy?workshopsforotherpeoplebereavedbysuicide: Understandingsuicide[module3]andtheGrievingProcess[module2].Thisprovided mostusefulforthosebereaved46mths(33%,n=2)mewithinformationthatIknewIcouldtrustandinacontrolledandsafeenvironment.Withsomuchinformationavailableitisdifficulttofindconstructive, mostusefulforthosebereaved79mths(50%,n=3)helpfulinfoetc.Thisgroupgavemeanopportunitytoaskquestionsandclarify mostusefulforthosebereaved1013mths(50%,n=3)whichwasinvaluable(Participant6). Thisisdifficult.UponreflectionIwishIhadthisinformationearlier.However, n Whatwasleastrelevantandwhy? IamunsurethatIcouldhavecopedearliertooraw.Ithinkhavingthese Module3.[Understandingsuicideandputtingitintoperspective]probablytoosoonkindsofworkshopsoccurringregularlyallowspeopletocomewhenthey sincetheloss(Participant2).areready.Theyneedtoknowitsalwaysgoingtobeavailablethough Module2,theGrievingProcessIamfinishedwiththispart.(Participant4). (Participant6).UnderstandingofContentLearningOpportunitiesnLearningOpportunities:Nearlyalltheparticipantseitheragreedorstronglyagreedwiththefollowingstatements: Theworkshopsprovidedopportunitiestolearnskillsandstrategiesformanaging grief. n Understandingofcontent:Alltheparticipantseither Theworkshopshelpedmelearnmoreaboutwaysofmaintainingpersonal wellbeing.agreedorstronglyagreedwiththefollowingstatements: Theworkshopshavehelpedmedevelopstrongerpersonalandsocialresources. ThemajorityofthematerialpresentedisofusetonCommentsaboutwhattheylearntandwhichlearningtoolswereuseful:TheGriefMap inthewaythatitaidedintoworkingwhatwasimportantindealingwith me. grieforsuicide(Participant1). Theobjectivesofthemoduleswereclear.Te WhareTapa Whaconceptwasuseful.MakingaconsciousdecisiontoensurethatIamnurturingmywholebeing.Suicideisincrediblytraumaticandneedsspecial Theworkshopshelpedmeunderstanddifferent treatment(Participant,6). aspectsofthegriefprocess. TheEcoMap Throughhelpinginworkingouttherelationshipswhichareimportanttomeintermsofsocialresources.AndTeWhareTapa Whainrelationtopersonal Theworkshopshelpedmeunderstandsuicideand resourcestheworkshophelpedmeworkouttheimportanceof[having]timeto putitintoperspectivewithinmyownlife.onesself(Participant1) IhavereallyfeltlikeavictimoverthepastfewyearsandwiththatIhavefeltquite depressed.IsleptALOTandstilldo.ByworkingandschedulingtimetohealIhave givenmyselfpermissiontogrieveandstartaroadtorecovery(Participant6). EmotionalSupportComponent EmotionalSupportComponentn TheExtenttowhichthegroupprovidedemotionalsupport:Nearlyallthen The9therapeuticfactoritems(Yalom,1985)weremeasuredbyparticipantstickingthe participantseitherstronglyagreedoragreedwiththefollowingstatements: followingthatappliedandstartedwithacommonstem: Theworkshopsandsupportgroupprovidedasenseofcommunityand belonging. Themembersofthegroup Theworkshopsprovidedanonjudgementalenvironmentforsharing Helpedmewanttoforgetmyselfandthinkofothers(Altruism)(50%,n=3). experiencesandexpressinggrief. Helpedmesaywhatisbotheringme(Catharsis)(50%,n=3). Theworkshopsprovidedanopportunitytosharediverseexperiences, AcceptedmeasIam(CohesionItem1)(100%,n=6). needsandperspectives. HelpedmefeelIbelongevenwhenIrevealedembarrassingthingsaboutmyself Theworkshopsprovidedasafeenvironmentfordiscussingfearsand (CohesionItem2)(67%,n=4). concerns. GaveadvicewhenIaskedforit(GuidanceItem1)(17%n=1). Theworkshopsgavemehopeandhelpedmeseebeyondsurvival. GaveadvicewhenIdidntaskforit(GuidanceItem2)(17%n=1). Helpedmeseethatothershavesolvedproblemssimilartomine(Installationof Fourofthesixparticipantsstronglyagreedoragreedthatthey hadlearntahope)(50%n=3). lotfromtheothergroupmembers. Recognisedwhensomethingwastroublingme(Interpersonallearning)(0%). HelpedmefeelthatIamnotalone(Universality)(83%n=5).Whathaveyoulearnt?Other BasicallythatsuicideisnotaneventthatjustIhaveexperienced,andalotof Offeredusefulstrategiesandsuggestions(Interpersonallearning)(67%n=4). peopleincludingthoseinthegrouphavehadthesameexperience Helpedmefeelnormal(Destigmatisation)(83%n=5). (Participant1).WeareatdifferentstagesofthejourneyandthisallowedbothunderstandingtooccurIhavelearntthatthereareveryuniquefeelingsassociatedwithbereavement butatthesametimeallowedmemberstolearnfromeachotherin ameaningfulbysuicide.Thatthereisenormousvalueinbeingabletoconnectwithothersway(Participant6)whohaveexperiencedsuicide(Participant6).4 5. WhatWasImportant Facilitation n QualityofFacilitation:Nearlyalloftheparticipantseitherstronglyagreedoragreedwiththefollowingstatements:Belongingto Thefacilitatorsareinterestedinandsupportiveofourgroup.acommunity Thefacilitatorswereabletocommunicateinformationandideasclearly.Acknowledge Addressing Thefacilitatorsexpertiseaseducatorsandcounsellorswerevaluable. needs stigmaperspectives Thefacilitatorsencouragedparticipationindiscussions. Thefacilitatorsencouragedexpressionofdifferencesinopinionsamongstparticipants.Sharing Thefacilitatorsencouragedparticipantstothinkcriticallyaboutthetopicscovered.AcceptanceExperiencesofDiversityParticipation Thefacilitatorsencouragedparticipantstothinkcreativelyaboutwaystoworkonpersonalissues. ThefacilitatorsencouragedparticipantstoidentifystrategiesformanaginggriefandTheBereaveddealingwithissues. Overall,howsatisfiedwereyouwiththefacilitatorsdeliveryofcontent?(67%veryGainingsatisfied,17%satisfied,17%neutral/notsure).FactualControlinformation Autonomy n Whatsuggestionsdoyouhaveforimprovingthefacilitationoftheworkshops? Moreinteractiveactivitiesbetweenthegroup(Participant1)Seeing LearningapossibleStrategies None.Thismusthavebeenanexhaustingandchallengingcoursetorun.The Ideasfuture fromothersinformalityofitallwasgreat.Yougavepeopletimetoreflectandthinkaboutwhat &thinking Challengedwasimparted.Youallowedpeopletocryandallowedpeopletosetthepace.Ifeltagenuinedesirefromfacilitatorstobethere.Itdidntfeellikeyouconsideredthiswork.Thankyou!(Participant6) UsefulnessoftheProgrammeOutcomes n Foroneparticipantitwasaboutrecognisingthatshehadneeds,andneededn Whichpartwasmostbeneficial? toprioritiseherwellbeing(notjustfocusonmeetingtheneedsofherchildand 33%Information/skillbuildingcomponenthusband). 33%EmotionalSupportcomponentn ThemoduleonselfcareledoneparticipanttoidentifythatshehadsomeofthesignsandsymptomsindicatedthatwerelinkedtoPTSD.Asaresultthe 33%bothpartsfacilitatorswereabletoencouragehertocontactherGPandalsodiscussherexperiencesandsymptomswithhercounsellor.n Whatdidyoufindmostuseful? n Oneofthemenwasabletoputsuicideintoperspectiveandlearnhowsomeaspectsofsuicidalityarenonobservable(relievinghimofguilt).Healso TheTeWhareTapaWhamodellearningwaysinwhichtocreate identifiedapracticalwayofmaintainingapositiverelationshipwithhis abalanceinyourlife(Participant1).deceasedbrotherandincludinghiminhischildrenslifebymakingamemory BeinginaroomwhereeveryonedidunderstandwhatIwas book. feeling(Participant2).n Foranotherparticipanttheworkshophadhelpedherrealisehercounselling Hearinghowothersfeltandcoped(Participant5) wasworkingandtherightchoice,andbytheendshehadstartedtomoveawayfromafocusonherselfandherneedstohavingsomeempathyand BeinginanenvironmentwhereIcouldforthefirsttimepullback beingabletofocusonotherswhichwashealthyforher. thelayers,removethemaskandshowothershowIreallyfelt Weallcameinwithourownneeds.ItwasallaboutmewhenIfirstcame. (Participant6). Wearenowabletoempathisewithothers. n Foroneparticipantthegrouphadprovidedherwiththeability totalktoothersn Whatdidyoufindleastuseful?aboutsuicideandherexperiencewithmoreconfidenceandobjectivity. ImactuallyOKtotalktopeopleaboutitnow.W hichisamazing.Itgives Peoplecomplainingaboutotherpeoplenotdoingenoughabout youconfidencethatitsOKforyou.NowImpartofacommunity.Itallsuicide(Participant5)helpedmeIammoreobjective.Theemotionsdonttakeover. TheirWords:TheFeedbackSessionTheirWords:TheFeedbackSession n Usefullearningtoolsn Opportunitiestolearn,share,reflectandprocess Thegriefmapwasreallyuseful.IrealisedIhadbecomeamorefearful Ithasbeengreatbeingabletolistentootherpeoplesexperiences anduntrustingpersonandthatIneededtoworkonthat.andtotalkaboutourexperiences Ifoundthemodelreallyuseful(TeWhareTapaWha).Ihaveneverreallylookedatbalancewithinmylife.Younevergettoascertainwhatyouare Yeah,alotofwhatwetalkedaboutdidntsinkinuntilwewere doingthatcontributestoyourwellbeing.IthelpedmerealisethatwhatIdrivinghome.OrlaterintheweekIdbethinkingaboutwhatwe waseatinganddrinkingwasnthelpingandnowItakebettercareofmyweretalkingaboutanditwouldmakesense. physicalneeds.n Belongingtoanactivecommunity IwashorrifiedwhenyousaidIwouldnevergetoverit.Themodelwiththecircles(griefaccommodationmodel)helpedmerealisethatitnever Itisgoodtobepartofacommunityandbewithpeoplewhohave goesaway.Lifejustgrowsaroundit.Itwasreallyimportant.Ihavedayshadsimilarexperiences likethatnow.Thatisreallyhopeful.n Theimportanceofscreening,monitoringanddeveloping n Theimportanceofastructuredprogramme trust Havingastructuredmoduleisgood.Thatiswherethehealingstartedforme.Itvalidatedmyfeelingsseeingthemupthereonthescreen.Thats Thefirstsessionwasreallyintense.Iwasntgoingtocomeback. whentherealworkstarted.HavingtheopportunitytogetinformationbutBecausesomeonegotverypersonal.Youneedtobeabletoalsotoshareexperienceswasreallyimportantmonitorthat. ItwasreallygoodhavingthatfirstsessionandseeingwhereI couldgo.I Youcoulddoaquickonetooneattheendofthefirstsessionto neverthoughtthatIwouldevergettothepointwhereIwouldbereadyto seehowpeoplefeel.Youcouldusethistoencouragepeopletomoveforwardwithlife,butitwashopefultoseeitthere. comebackandchecktheirsafety. Hearingthatitwasgoingtobeinlecturestylemadeitsafeforme.Iknew YouneedthesixweekcoursetobuildthetrustIdidnthavetoparticipateifIdidntwantto.Itsaboutlearningaboutsuicideanditsaboutinformationgivingandformenthatmightbesafer.5 6. TheirWords:TheFeedbackSessionTheirWords:TheFeedbackSessionn Accesstoinformationandsupportn Facilitatorsgender Itsaboutcatchingtheinformationattherighttime.Therearepeaksand Itsgoodthatyouareabloke.Yourepresent. troughswhenyouneedthatinformationandcontact.W eneedtoknowits Theresagoodbalancehavingamanandawoman. thereandthatwecanaccessitwhenweneedit Funeraldirectorsarepeoplewedtakeinformationfrom.Youdevelopa Ifyouwereaguyandyoucameandyoufoundtheresaloadofspecialrelationshipwiththemandtheyarethereforyouatthetime. womenhereyouwouldntwanttocomeback.Ifhe(talkingabout Atthetimeyoudontwanttoreadit.Icouldnthavetakenitin.Butlater herpartner)washereandheardyoutalkingabouthowpeople onImighthavelookedatit. drinktogivethemselvespermissiontocryandgrievealightwould Everyoneisdifferentinrelationtothetimingofinformation.Itsabout havegoneonforhim. repetition.Itsaboutavailabilityn Ongoingneedsforcommunication,contactandsupport Thereneedstobesomethingprovidedforthosewhohavechildren.W e Anyfamilyaffectedbysuicideneedsregularcommunication.Atleasthavechildcareissuesandbabysitterstoarrangeandpay. onceaquarterforthefirstthreeyears.Theyneedtoknowwhatresourcesn Differentgroupsfordifferentpeopleandpurposes areoutthereandwheretofindsupportwhentheyneedit. Whynotsendanemailthatjustsayshello.Wehavebeenthinkingof Iwouldsuggestaseparategroupforteens.Theyhavedifferent you.Thatgivespermissionforthemtogetintouchormakecontactiftheyissuesandneedtobesupportedindifferentways needsupport.Youknowlikethoseemailsyougetfromfriendsoutofthe Aftereverysixweeksofworkshopsthecommunitygetsbigger. blueeveryonceandawhile.Thenyoucouldhaveamonthlymeetingorgroupforthosethat Thereisaneedforacasualsupportgroup.Peopleneedtoknowthathavecomethroughtheworkshops.Justleaveitopensopeople theresaregularvenueandatimethattheycandropinwhentheyneedit.frompreviousgroupscancomeornot.Itstotallyuptothem Theyneedtoknowtheressupportavailableforthem.Theyneedaplace wheretheycanbearoundpeoplewhounderstand.KeyFactorsintheSuccessoftheDesign&Implementation:MessagesfromtheBereavedProgramme Dontwantsupporterstocometogroupforbereaved,unlesstheyn Informedbybutnotconstrainedbyresearchbalancebetweenwhatisarecomingtodealwiththeirowngrief. suggestedinresearchandtheoryandwhatispossibleinpractice. Trust(keepthegroupclosed)6weeksisgoodcommitmentton Notlosingsightofprioritiesthedesireforresearch/evaluationversusmeeting make. theneedsofthebereaved. Screenparticipants(wedontwanttobeexposedtovulnerablen Expertise,professionalismandexperienceoffacilitators. people).Lettingpeopleknowthatitisgoingtoberunbypeoplewhohaveexperiencedsuicideis Acceptance(itsOKtohaveadiversegroupaslongasthereis important.Ithinkhavingfacilitatorswhocouldinputpersonal expertisewasbeneficial (Participant6). maturity,respectandacceptance).n Collaborationandworkingpartnerships. Moreinteractionandgrouptasks(aswellassomediscussionandn SkylightandVictoriaUniversityofW ellingtontakingtimetobuildrelationships,informationproviding). understandeachothersstrengths,negotiatetimelines,reviewingmaterialProvideuswithOPPORTUNITIEStoregaincontrolandtolearn togetherandallowingeachothertoworktotheirstrengths. Needforinformallongtermgroupaswellasclosedshortterm group.TheNewZealandSuicidePreventionStrategystatesthat: Keepinregularcontactwithus:letusreconnectifweneedto.Serviceswillbemosteffectivewhentheyarecoordinated,integrated,andwhere peopleclearlyunderstandeachothersrole.Thisrequirescollaborationacross n Otherkeymessages sectorsandcommunities,andbetweengovernmentandnongovernment organisations(AssociateMinisterofHealth,2006,p.14). SuicidebereavementISdifferentbecausesuicideisaformof rejection.Illnessandotherunexpecteddeathsdontinvolve rejection. DesignandImplementation:Messages fromUsMessagesfromUsn Needflexibleapproach. Planning Considerwhat Understandtheproblemandbestn Advertisingwordofmouth,reputationisimportant. researchsuggests, ResearchProblemtheory whatpeopleneed, Programme waystoaddressit n Diversity desirablevsdoabletheoryn RepresentAddressingmensparticipationneeds.n Communityn Choosewhoandwherecarefully. CollaborateTraining Considerprinciples Considerthe Evaluation&update ofpracticen Ako flowoflearningandteachingbetweenall. purposeofProcessknowledge evaluation andOutcomeConnectofbest Ako,Learning,n OpportunitypracticeReducingrisk n CreateSpace Allowthebereavedtogainsomecontrolif youwantthemtohavemorecontrolintheirlives.n InformalrelationshipsarewheresharingandlearningalsoConsiderAccess, Delivery Design occurs. AimsFlexibility,Responsivity Monitor& collectdata Content ConsiderQuality,n Involveothers,selfcare(avoidingfacilitatorburnout)soParticipantANDEvaluation Timing,Groupsandthatgroupwilllast.Programmedriven Sustainability 6 7. Conclusions PostventionisPreventionn Importanceofintegratingresearchandpractice. n Postventionispreventionbutthereisnosinglebestapproachthatwillworkwithallindividualsandgroupsandineverycommunity.n Collaboratingandpartnershipsimportantfor n Theresearchcanandshouldguidepracticebutpracticeshouldalso effectiveness,responsivityandsustainability. beresponsiveandbasedoncriticalassessmentoftheneedsofthebereaved.n Educareprovidesagoodframeworkfor reducingriskandimprovingwellbeing(protect,Tosummarize,itseemslikelytousthattheonesizefitsallapproachtounderstandingandinterveningwithsurvivorswhichhasbeendominant educate,empower).sincetheinceptionofmodernsuicidology needsconsiderablen Bereavementbysuicidemayinvolvealossofrefinement(Ellenbogen&Gratton,2001) controlandautonomyandindividualsneed(Jordan&McMenamy,2004,p.345). compassion,assistanceandopportunitiesto movebeyondsurvivaltorelearnhowtolive.Referencesn AssociateMinisterofHealth.(2006).NewZealandSuicide PreventionStrategy20062016. 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