Each year, more than 40,000 people die from suicide in the United States, making suicide the 10th-leading cause of death in our nation. Worldwide, more than 800,000 people are lost to suicide annually. These are devastatingly high numbers. But an even larger number encompasses the people who have been impacted by a loved one’s death from suicide. They are known as survivors of suicide loss.

In 1973, psychologist and suicidologist Edwin S. Shneidman — who founded the American Association of Suicidology (AAS) — estimated that for every suicide death, there were six survivors affected. Thirty-eight years later, research by psychologist Alan L. Berman — at that time the executive director of AAS — determined there were anywhere from five to 80 or more survivors of suicide loss for each suicide death. That year, 2011, was the same year my dad died from suicide.

The response to my dad’s death made Berman’s research findings seem like a significant underestimation. Hundreds of people showed up for my dad’s funeral and contacted our family after his death. A 2018 article published by the American Association of Suicidology found the number of people impacted by one suicide death to be around 135 people. Thus, approximately 6 million people in the United States are affected by suicide loss each year.

 

Survivor day

After I found out my dad had died from suicide, I called my previous college therapist. Even though I had not seen her in more than a year, she called me back. She listened, she validated, she empathized — all of the things you hope a therapist would do. She also told me about a day specifically to support survivors of suicide loss: International Survivors of Suicide Day (Survivor Day for short). In 1999, Sen. Harry Reid, who had lost his father to suicide, introduced a resolution to create an annual day for survivors of suicide loss to come together for healing and support. Congress designated the Saturday before Thanksgiving as Survivor Day.

The American Foundation for Suicide Prevention (AFSP) supports hundreds of Survivor Day events around the world. Each year, AFSP creates a documentary of the stories of suicide loss survivors that is shown at Survivor Day events. Both the documentaries and the events focus on healing, surviving and thriving. Survivor Day events offer survivors of suicide loss a safe space to “find connection, understanding and hope through their shared experience.” Past documentaries can be viewed on AFSP’s website.

Since 2012, I have assisted in hosting a local Survivor Day each year. This year, I am hosting the event in Greenville, North Carolina, at East Carolina University’s Navigate Counseling Clinic, part of the Department of Addictions and Rehabilitation Studies, where I am pursuing my doctorate. At past events, I have witnessed survivors talking about their loved one’s death from suicide for the first time — sometimes years or decades after their loss. I have heard survivors share their experiences of shame, guilt, anger and grief. I have also heard stories about funny, kind, caring, smart, artistic and achieving loved ones who have been lost to suicide. I have experienced connections that may not have been found anywhere else.

 

Support groups

In 2011, Survivor Day fell on the same day as my dad’s funeral, and in a sense, we held our own impromptu Survivor Day event. Without the actual designation or documentary, hundreds of people came together as survivors of the suicide loss of my dad. After I went back to Tennessee, where I was living at the time, I began individual therapy with a local provider. I remember feeling that she did not “get it”  — the “it” being all that comes with the loss of a loved one to suicide. However, she gave me information about the Tennessee Suicide Prevention Network, which was hosting a support group for survivors of suicide loss in my area. That support group is where I found others who did get it.

The support group members did not blame each other for their loved one’s death. They did not make comments such as “I hope God forgives your dad”; “You should have known this was going to happen”; “Your dad is in a better place now”; “I do not know how I could keep living if I were you”; “Why didn’t you stop him?”; “That was so selfish of him to do that to you”; or any of the other insensitive remarks that survivors of suicide loss so often hear.

Some of the group members had people in their lives who no longer talked to them or who actively avoided them. Yet the support group members continued to show up for each other. When group members tried to talk with other people about their pain or how their loved one had died, the conversations often shut down immediately. Yet the support group members encouraged one another to share and express their emotions.

Losing someone to suicide is very different from losing someone to another cause of death. And sometimes, finding someone who understands your loss requires finding someone who has also lost someone to suicide.

 

Postvention

Postvention is the work done to support survivors of suicide loss. In my master’s counseling program, we learned some about suicide prevention, yet suicide postvention was hardly mentioned. Although suicide prevention and intervention training can be inadequate in some counseling programs, suicide postvention training is often nonexistent. So, how can we as mental health professionals help clients who have lost a loved one to suicide?

First, we can be trained to provide services specifically tailored for survivors of suicide loss. AFSP’s website has a list of clinicians trained in suicide bereavement. These clinicians have been through a daylong training workshop that includes information about what being a survivor of suicide loss means, the impact the loss has on survivors’ mental health and well-being, and common themes survivors may experience in their bereavement. Clinicians also learn clinical techniques that can help survivors work through their bereavement and piece their lives back together. AFSP provides training for professionals interested in becoming suicide bereavement clinicians.

AFSP also provides training for clinicians who want to lead or facilitate support groups for survivors of suicide loss. There are two different versions of the training: one for facilitating adult support groups and another for child and teen groups. Each program lasts two days and includes lectures, interactive discussions, and role-playing.

Clinicians who are not interested in leading a group can still give clients a list of AFSP-curated support groups for survivors of suicide loss.

Hosting a Survivor Day in your area is another powerful way of helping suicide survivors, some of whom may be more comfortable with a one-day event rather than regularly attending a support group. The Out of the Darkness Community Walk is another one-day event. These walks, which take place in numerous locations nationwide, are not specifically for survivors of suicide loss. Their purpose is to raise awareness — and funds — to help prevent suicide. These walks are also where many survivors of suicide loss find support for the first time. Each walk is sponsored by a local chapter of AFSP, and being connected to those chapters can give clinicians access to resources to help themselves and clients.

 

Other resources

When I called to set up therapy after my dad died from suicide, I was told the wait was several weeks. During that time, I leaned on the support of family, friends and co-workers. I wish I had known about some of the resources available to recent survivors of suicide loss.

Healing Conversations is an AFSP program that connects recent survivors of suicide loss to volunteers who are also survivors and have been through a training and vetting process. Healing Conversations, formerly known as the Survivor Outreach Program, offers that connection to people without the pressure of therapy, groups or events. Survivors simply submit a form through the AFSP website, and a coordinator connects the survivor and a volunteer for an in-person visit, phone call, or video call.

AFSP’s I’ve Lost Someone page contains a variety of helpful tools, including practical information for immediately after a loss, resources to help loss survivors find support, and self-care recommendations. Schools, colleges and workplace managers can also access postvention toolkits. Survivors can use the page to identify ways to honor loved ones lost to suicide through digital and physical memory quilts, memorial funds, and Out of the Darkness walks.

AFSP is not the only organization that provides helpful resources and information. The Suicide Prevention Resource Center (SPRC) offers a variety of suicide prevention resources, training programs and toolkits, including “Suicide Prevention Competencies for Faith Leaders.” SPRC’s website also has sections devoted to postvention and supporting survivors of suicide loss.

The Tragedy Assistance Program for Survivors (TAPS) offers “compassionate care to all those grieving the loss of a loved one who died while serving in our Armed Forces or as a result of his or her service.”

The U.S. Department of Veterans Affairs (VA) has suicide prevention coordinators at each VA medical center nationwide. They can help active-duty members and veterans get counseling and needed services. The suicide prevention coordinators are also incredible resources for families, loved ones and communities.

 

Talking about suicide

The phrase “commit suicide” can be one of the worst things that a survivor of suicide loss hears. Where did this phrase come from? For hundreds of years, attempting or dying from suicide was an actual crime in Britain. Punishments may have included denial of a funeral, burial alone without a marker, desecration of the body, and confiscation of the person’s property. States such as Maryland and Virginia, despite having developed their own laws, continue to recognize this law. The phrase “commit suicide” reinforces the suggestion of suicide as a crime.

Two other phrases that come across as icky, for lack of a more scientific term, are “completed suicide” and “successful suicide,” as if death were the preferred outcome of an attempt. Advocates for suicide prevention and postvention encourage the use of “died by suicide.” While I see this as a much-preferred phrase, I take the phrase one step further and use “died from suicide.” I have never heard anyone say someone “died by” a heart attack, an accident, cancer, or any other disease. People commonly say that someone “died from” whatever the cause of death was. Therefore, I prefer “died from suicide.”

Other advocates prefer to say that someone “died from a mental illness” rather than from suicide. Although I can see the intention behind this phrasing, the reality is that not everyone who dies from suicide has a mental health condition. In 2018, the Centers for Disease Control (CDC), after examining suicide statistics in 27 states from 1999-2016, released a report showing that more than 50% of people who died from suicide did not have a diagnosed mental health condition at the time of their death. Reading and quoting these statistics can make the conversation confusing, and the bottom line is that there are tens of thousands of people dying from suicide each year who do not have a mental illness.

Regardless of your current or future involvement in supporting survivors, I ask one thing of each of you reading this: Please be aware of how you talk or joke about suicide. Both AFSP and SPRC have guidelines for talking about suicide: Speaking Out About Suicide and Suicide Reporting Recommendations.

 

Suicide’s impact on counselors

As mental health professionals, we are not immune to being impacted by losses from suicide. While I am not going to delve into our legal responsibilities, I will touch on our ethical responsibilities. If we lose someone to suicide, we may be affected by our grief more than we realize, and this can take a personal toll and negatively affect our work with clients. I encourage us as mental health professionals to take care of ourselves, to seek support, and to take off as much time as needed so that we can live up to the ethical responsibilities we have to provide competent care.

I also implore mental health professionals to bracket their values that may be harmful when discussing death from suicide with clients. If someone comes to me and says that they will not attempt suicide because that would be a sin, I will use that as a protective factor with the person. However, I would not tell someone that attempting or dying from suicide is a sin. The reality is that many religions and places of worship no longer view suicide as a sin and have come to realize the part that mental health and life situations play in deaths from suicide.

If you do decide to offer services specifically to survivors of suicide loss, or if some of your clients are or become survivors of suicide loss, please consider seeking training, consultation and supervision. Survivors of suicide loss are at higher risk of having thoughts of suicide due to their exposure to suicide compounded with their grief. Grief journeys can be difficult enough without the additional layers that come with a suicide loss. Gaining additional expertise in counseling survivors of suicide loss through training, consultation and supervision can make all the difference in the care you provide to clients.

 

Conclusion

As we continue to raise awareness and work to prevent suicide, we can expand our efforts to assist those who have been affected by suicide. Please join me in supporting survivors of suicide loss by being aware of and using available resources, encouraging postvention efforts, talking about suicide safely, and taking care of ourselves so that we can continue to provide effective mental health services.

 

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Dana M. Cea, pronouns she/her or they/them, is a volunteer for the National Alliance on Mental Illness and the American Foundation for Suicide Prevention, a mental health professional, a survivor of suicide loss, and a current doctoral student at East Carolina University. She focuses her research on mental health and suicide, the LGBTQ+ community, youth, and autism spectrum disorder. Dana lives with mental health disorders, her spouse, and their three dogs. Contact her at danamcea.com.

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