Bereavement through suicide and the impact on young people

Shirley Potts, director of regional development, Child Bereavement UK

Child Bereavement UK supports families and educates professionals when a baby or child dies or is dying, or when a child is facing bereavement. Every year we deliver training to around 5,000 professionals, helping them to better understand the needs of grieving families.

The charity has experience in delivering direct services at a growing number of locations across the country:

Buckinghamshire, Milton Keynes, Cheshire, Cumbria, Newham and West London.

We offer:

• individual, couple and family support sessions;
• parents’ support groups for baby and child death and support through a subsequent pregnancy;
• children and young people’s groups (CHYPS) for children to attend with adult carers;
• a Young People’s Advisory Group (YPAG) for bereaved young people up to age 25;
• we also offer consultancy and bespoke solutions for organisations looking to address specific local needs.

Our helpline (0800 02 888 40) responds to more than 1,600 calls each year, and our website receives 10,000 visitors a month. We have produced a range of award-winning resources and books. We offer a schools information pack and downloadable information sheets.

Statistics and context

Numbers of deaths due to suicide were falling until the recession. Unfortunately, since 2008, there has been an increase in the number of UK suicides – and there is concern that current economic and political uncertainty may lead to further rises.

• In 2014, there were 6,581 recorded by suicide in people aged 15 years and over in the UK [1], a rate of 10.8 per 100,000 people.
• These figures have decreased slightly from 2013, when there were 6,708 recorded suicide deaths [2].
• Coroners do not record deaths of under-15s as suicide; these are normally recorded as death by misadventure.
• Suicide rates are higher in areas of poverty – studies have found that in areas of extreme deprivation, levels are double the national average [3].
• Rates are generally higher in men; however female suicide rates have increased in recent years. The female suicide rate rose 8.3% in the UK and 14% in England in 2014 [1].
• Suicide is the leading cause of death in men aged under 49. The overall UK male suicide rate was 16.8 per 100,000 people in 2014, and 5.2 per 100,000 women.

Stigma

As suicide is tragically the cause of an increasing number of deaths, there are also a large number of people who have been bereaved and suffer trauma. Suicide bereavement carries a huge amount of stigma – and people who are bereaved by suicide can often be left to feel isolated. Support workers and educators should ensure that they treat someone bereaved by suicide in the same way that they would to any other form of death.

Bereaved people often state a perception that ‘nobody wants to talk about suicide’, and it can be difficult for individuals to engage with support. It is important for educators to avoid an attitude of ‘Least said, soonest mended [4]’ following any bereavement, particularly in relation to suicide deaths.

Suicide clusters

Suicide clusters have been defined as a series of three or more deaths within a specific community or location, although this definition is flexible. Clusters include areas of geographical, psychological and social proximity, which can all overlap in a particular area, as was witnessed in Bridgend, South Wales, in 2007-8.

Whilst suicide clusters occur relatively rarely, they can result in widespread trauma throughout communities, exceeding the grief that would normally be experienced. Social media in particular has been blamed for its impact on the prevalence of suicide clusters. It is believed that around 1% of total suicide deaths occur within the context of clusters [5].

Sadly, research has confirmed that suicide rates are higher among bereaved people, and studies have found evidence of suicide contagion in those bereaved by a loved one’s suicide [6].

Factors that affect the grieving process

• The nature of the death. Whilst there is crossover in the grief and shock that follows both sudden and expected bereavement, an unexpected death can be particularly difficult to cope with. Suicide can be harder for an individual to come to terms with – and also seek support for and discuss – than other forms of bereavement.
• The relationship between the person and the deceased. This is not just limited to family and friends – it is important for caregivers to recognise the severe impact that the bereavement of a teacher, or an individual who was important in the child’s life and development, can have.
• The individual, their personality and background. Some people are more resilient; others may be more inclined towards depression or other mental health problems.
• Recovery environment. Schools can be a fantastic environment for bereaved children: they offer normality and stability. Children rarely want to stay off school after a bereavement. A household where people are grieving can be a difficult place to be a child in – particularly following a suicide bereavement where there may be anger and confusion.

Permission and honesty

It is vital that adults share honest information with children – and important to understand that children may ask ‘unusual’ or ‘gory’ questions; this is all part of the grief process. Whilst it can be difficult, adults should try and avoid withdrawing permission through facial expressions.

Development stages

0–2 year olds (Bowlby’s attachment theory)

• After a bereavement, even very young children may be aware of a change. Support should be focused on ensuring that there is good substitute care – particularly if a parent has been deceased.
• Challenges can arise if the person providing substitute care is grieving, and it is important for family members to be provided with good external support.

Lower Primary (Piaget’s preconceptual stage)

• At this stage, children are still highly egocentric – this can lead to issues of claiming responsibility and blame.
• It is very important to help children understand that they didn’t have an influence on the death, and to explain the real causes
• Concepts of ‘finality’ and ‘foreverness’ can be difficult for younger children to understand
• Many children’s first bereavement will be of a pet – this can help develop understanding of death

Upper Primary (concrete operational stage)

• Understanding of the permanence of death is improved, but death is still upsetting and unsettling, and emotional understanding will not have fully developed

Puberty and adolescence

• Difficulties due to this transitional stage: it can be hard to differentiate between ‘normal’ teenage emotions and grieving. If in doubt, it is best to validate the grief and address emotions

Ripple effect

The financial impact of any bereavement can be very challenging, and is something that educators and caregivers should be aware of. Families may have to move location, change schools and leave behind their friends and community, and sense of security.

Reactions educators and caregivers may see in children

• Regression, particularly in younger children. Signs of this may include bedwetting and other symptoms of anxiety
• Separation anxiety
• Sleeping and eating problems
• Lack of concentration, that can have a ripple effect
• Imagined illness, and increased concern over minor ailments
• A wide and unpredictable variety of emotional responses, which may change quickly.

Talking to children

When talking to children who have been bereaved through suicide, it is vital that adults engage in honest conversation. Providing age related accurate information is crucial, but even young children can have a good understanding of what has happened. All explanations should be taken at the child’s pace, and patience and understanding are very important. Initial conversations may focus on the simple details of ‘how’ and ‘where’ a death occurred. Providing these basic facts is very important to ensure that children are protected from misinformation that may be spread through rumours.

Whilst it can be very difficult to explain the reasons behind a loved one’s suicide, it is helpful to explore the reasons why a person decided to take their own life. Adults should also avoid phrases such as ‘committed suicide’ or ‘killed themselves’ that are stigmatised, and instead try and use ‘took their own lives’ or ‘didn’t want to live any more’.

Supportive interventions

• The more children know, the better equipped they are to be resilient
• Including children in the funeral and any discussions after the death is very important
• Meeting other children who have been bereaved can be incredibly beneficial – particularly if they have experienced suicide bereavement
• Literature and practical resources can be very effective

Child Bereavement UK have further details and resources available on their website.

References