How can you best offer support to someone who is bereaved by suicide? What attitudes, translated into caring actions, can best facilitate the bereaved person’s coping in the immediate and short term, and their healing in the longer term? In a previous article we provided you with a guide to clarify what you can do to help the suicide-bereaved. In this article we explore special issues and unique grieving needs for a number of groups of people, including parents, children and young people, older people, people with disabilities and minority groups (lesbian, gay, and bisexual people).

Parents who have lost a child

Perhaps in the tragic scenario that is losing a child to suicide, guilt is the foremost emotion among the many devastating feelings that parents go through. Most will wonder if anything they did or said was directly contributory to the suicide; they may feel sad or guilty that they did not notice signs that, in retrospect, were probably warnings: clues that they didn’t know their child as well as they thought they did. Parents often blame themselves and wonder if others are judging them harshly as a “bad parent”.

For many, there is the worry that their other children will get the idea to take their own lives, and so it is natural to become quite protective. The fear-engendered over-protectiveness adds a burden of reduced freedom to those children, especially adolescents, who are left. After they have lost a sibling, children need the parents’ support even more, and they particularly need not to be compared with the dead child, or somehow feeling like they must take that child’s place.

When parents lose an adult child, they may sense that most support offered to the family goes to the child’s spouse and children, with little offered to them. Too, parents may feel an extra burden of responsibility to compensate the grandchildren in some way, making things “right” for them.

In terms of parents’ relationship with each other, there can be strain as a result of different grieving styles. Grief sometimes affects men’s and women’s sexual feelings differently, resulting in one party possibly feeling hurt and/or rejected when wanting to initiate sex for comfort that the other does not share a desire to do. Divorced parents and step-parents can both feel excluded from mourning activities, or even blamed (Noonan & Douglas, 2002).

Children who grieve

The most notable pattern about children’s grief which is different to general adult expression of grief is that children seem to be able to “turn on” and “turn off” their grief responses. That is, because their expression of grief comes in bursts, they can be crying and very upset one moment and then going out to play as if nothing has happened in the next. Their behavioural changes in grief may include:

• Acting out the loss with toys or in repetitive behaviour
• Anger or aggression to friends, parents, or toys
• Acting much younger than their age or much older, like an adult
• Tantrums, crying, or giggling for no obvious reason
• Copying behaviours of the dead person
• Problems with wanting to go to school or with doing schoolwork
• Irritability, restlessness, or difficulty concentrating
• Attention seeking
• Being clingy and not wanting to leave the parent’s side
• Sleeping problems, bad dreams, or wanting to sleep with an adult
• Bed-wetting, thumb-sucking, or other earlier behaviours
• Eating problems (Noonan & Douglas, 2002).

How to talk to children about a suicide death

Children need and deserve to know the truth, within their ability to understand, about a suicide in the family. While it is not easy to tell children about a suicide death, parents will be glad that they have been honest. The child would be much more distressed to find out later by accident, and it is difficult to conceal something like that within the family. Some points for parents to keep in mind:

• Be honest and consistent.
• Ask the child what death means to them; be sure that they understand.
• Explain in small steps; children should not be overwhelmed with details.
• Children may not know the word “suicide”, but they might understand the concept. One way to talk about it is to say that the person “made their body stop working.”
• Very young children may not understand that death is irreversible, and that a dead body cannot feel anything. They may also fear that they have caused the death in some way, so it is helpful for the child to hear that the person is not in pain and that the child did not do or say anything that caused the death.
• Children may ask the same questions over and over again or ask to hear the story repeatedly. It is important to be patient with this, as they not take everything in at first.
• Do not say that the person “has gone to sleep”, as children may then fight going to sleep, fearing that they, too, will not wake up.
• Generally it is good to emphasise that suicide is not a good idea, as by telling problems to others who can help, we can find a way to solve the problems (Information and support pack, 2010; Hawton & Simkin, 2010).

Helping children with their grief

At school. As soon as possible, parents should advise the school of the death. When the child returns to school, the parent should talk with the teacher and school counsellor, discussing any potential problems: for example, what the child should do when other students are making, say, a “Father’s Day” or “Mother’s Day” gift and that parent is now gone. Children can be helped to practice what to say to their classmates and others (suggesting wording will make it easier on them).

At home. Children need to have regular routines – for example, for homework, dinner, and bedtime – maintained as far as possible; this gives children consistency and a sense of security. Birthdays or holidays may be difficult, and children should be involved in planning for them. Children can be encouraged to play with their friends, as friends are an important source of support. Parents should play with children, too, and also should let children see their grief when they are in touch with it, as children will learn about grieving from their parents. Parents should not compare any of their children’s behaviour to that of the deceased person (Information and support pack, 2010).

When the child grieves for a lost parent

In addition to the points mentioned above, it is important in supporting children who have lost a parent to suicide that they understand that their strong feelings are normal. They may be frightened, abandoned, angry, and hurt (that they apparently weren’t loved enough or important enough for the parent to stay for). They might feel that they need to suddenly grow up and become a surrogate partner (that is, replacing their father for their mother if they are a boy, or their mother if female and the mother of the family has died). They may feel the burden of looking after younger siblings, and they may sense the need to hide their own grief because they believe that it would upset the family.

If you are working with such a child, or anyone in a family with this situation, it is important to help remaining family members understand that children need to meet their own needs for grieving and for growing. They need to have a life independent of their role(s) in the family; going out with friends and enjoying themselves has always been important to their development, and it still is (Hawton & Simkin, 2010).

Children losing a sibling

To lose a brother or sister by suicide means to suddenly lose a friend, a companion since early life, a fellow (or sister) rebel against parental injunctions. It means to lose someone that the child has fought with, felt jealous of, and also loved and cared for. It is hard. Children will often believe that they should have (could have) done something to prevent the sibling taking their own life. They may feel angry with the deceased. They may also have strong feelings of being neglected if parents are too full of their own grief to pay much attention to the child’s needs. And there is the ever-present danger that the dead sibling will be idealised, with unrealistic expectations that the remaining sibling(s) will have the same achievements as the one who has died.

If you are counselling anyone in a family where children have lost a sibling, some crucial considerations to assist the grieving process in the family are: Asking who else (perhaps another family member or close friend) an unsupported child could talk to in order to work through grief; the child may benefit from his or her own sessions with you. Reminding the parents (and alerting the child) that idealising the dead child and expecting the other sibling(s) to follow in those footsteps is futile: a recipe for disaster. Each child is a unique individual, with his or her own particular strengths and qualities.

Older children and adolescents

A death of someone close, particularly a family member, is difficult for anyone. For a pre-teen or adolescent, who is also coping with the pressures of growing up, dealing with a suicide can be devastating. Like children, adolescents do not necessarily grieve in the same way that adults do. They may find it hard to express their feelings, becoming silent and withdrawn. Alternatively, they may cry, scream, or be angry and irritable. They may wish to be away from their sad household, out with friends. Like many bereaved, they may not know what to say to friends and others when asked about the death.

If you are working with a family who has a bereaved older child or adolescent, you can help your client-family understand that the watchword is “acceptance”. Teens and pre-teens need to be able to accept their feelings, however intense. Those looking after them need to accept that their grieving patterns are different from those of adults and that the teens need to be encouraged to express their feelings (not just verbally: poetry, music, and art are also good options). And the adult needs to accept that teens and pre-teens may find it easier to talk to people outside of the family. They need a private place to cry and/or punch pillows/kick a ball, etc.

You may wish to let the parent(s) know where they can turn if they are concerned that their adolescent children may develop suicidal feelings themselves (see Appendix for further resources) (Hawton & Simkin, 2010).

Losing a friend

When people lose a friend to suicide, their first thought is often one of guilt: “How could I have been so unaware of what was happening with my friend?” This may be followed up by a further thought: “Was there something I could have done to help, or to prevent this?” In processing this sort of grief, other friends in the network are an invaluable source of help. If you are working therapeutically with someone who has lost a friend to suicide, help them to remember that no one can take full responsibility for someone else’s life.

Keep in mind that they may be experiencing a sense of betrayal of trust (refer to the paragraph: “Loss of meaning and trust/ crisis of faith”, above). You may also be able to help them hang in there while they are raw from grief, if they can accept that they will not always feel as bad as they do right now. Eventually, the grief will soften, and there will be some good days as well as bad.

As one teenager put it, “I think a lot about my special friend. Sometimes I feel sad and cry. Lately I’ve begun to smile when I remember what we did together. I feel better knowing that this person is with me – only a thought away” (Grollman, 1993).

Older people

Sometimes seniors, who may have grown up during years when huge stigma was attached to suicide, feel shame. They are reluctant to talk to other people about a suicide or to seek help outside the family. This makes supporting them difficult, as neither they nor others may realise how vulnerable they are. Their physical health may be less stable and they may be more at risk of developing depression than their younger counterparts. They may have less access to social support if some of their friends have died, their family lives far away, and, especially, if the deceased person was their spouse.

If you are counselling an elderly person, know that for them to have extra aches and pains while in grief is normal. If the person lacks energy and appetite, and especially if they seem to have lost interest in regular activities, professional help is needed (Hawton & Simkin, 2010).

People with learning disabilities

Often people with a learning disability understand the concept of death, but sometimes the learning-disabled person’s lack of ability in expressing themselves verbally means that other people mistakenly assume they do not have feelings. In the case of the dead person being the one who best understood their individual style of communication, the disabled person’s loss is even greater. The learning-disabled person may need help to understand the feelings that go with grief and loss, and those looking after them are encouraged to understand how some acting out or behaviour disturbance may in fact be bereavement reactions. In all cases, the learning-disabled – like children or anyone else – should be told the truth of what happened. If you are working with a family with a learning-disabled member, you may be able to help the parent(s) frame a simple, clear message to achieve this.

Lesbian, gay, and bisexual people

Lesbians, gay men, and bisexual people experience the same grief and loss as any bereaved partner in a marriage or heterosexual relationship, but there are additional complications for them in the aftermath of the suicide. One problem is that, depending where the couple has been living, the remaining partner may not be recognised legally as next-of-kin, so property, pension rights, inheritance tax, and other matters may not be sorted out favourably to the bereaved person. This is particularly true in cases where there was no will.

The other problematic area is the social arena. Family may not recognise the significance of the relationship – or they may be openly hostile to it – so the bereaved partner may be excluded from funeral and other arrangements. Similarly, people at the bereaved partner’s workplace may not recognise the depth and importance of the relationship to the bereaved, and may fail to appreciate the length and intensity of grieving that the person needs to do (Hawton & Simkin, 2010).

© 2014 Mental Health Academy

This article was adapted from Mental Health Academy’s “Supporting the Suicide-Bereaved” CPD course. Click here to learn more and subscribe to this course.

References

• Grollman, E.A. (1993). Straight talk about death for teenagers. How to cope with losing someone you love. Boston, Massachusetts: Beacon Press.
• Hawton, K., & Simkin, S. (2010). Help is at hand: A resource for people bereaved by suicide and other sudden, traumatic death. National Health Service (UK): copyright: Crown. Retrieved on 28 March, 2012, from hyperlink.
• Information and support pack: for those bereaved by suicide or other sudden death (Queensland). (2010). Commonwealth of Australia. Retrieved on 28 March, 2012 from: hyperlink. The ISBN number for this support pack is: 978-1-74241-106-4; the online ISBN number is: 978-1-74211-107-1.
• Noonan, K., & Douglas, A. (2002). Supporting children after suicide. Information for parents and other care givers. Children Bereaved by Suicide Project, NSW Health Department, Commonwealth of Australia.