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Suicide “postvention”: what do we know about social support?

To mark World Suicide Prevention Day, researcher Hannah Scott shares the benefits and challenges of social support after a loss to suicide. The blog includes discussion of suicide based on the author’s lived experience and academic experience.

World Suicide Prevention Day happens each year on 10th September to raise awareness of suicide and promote action to help those with suicidal feelings and those bereaved by suicide. It’s a chance for people and organisations to talk about key issues and share ways to make a positive impact.

We spoke to Hannah Scott, who recently completed a PhD in the subject, about her research, the importance of “postvention”, and how to support loved ones dealing with a loss.

You’ve recently finished a PhD looking at the role of social support after a loss to suicide. Can you tell us a bit more about that?

A lot of suicide prevention work is, quite rightly, about trying to understand the risk factors for attempting suicide and trying to mitigate them. Unsurprisingly, it’s incredibly complex; typically no single thing causes a person to take their life, it’s a wide range of challenges.

One risk factor is suicide bereavement itself, so people bereaved by suicide are more likely than someone who isn’t to die by suicide. As a result, an important area of suicide prevention is “postvention”, where we help people bereaved by suicide to cope with their loss.

Studies suggest that under half of people bereaved by suicide in the UK access professional services (like counsellors or GPs) to help them with their bereavement. The NHS doesn’t currently provide any services specifically for people bereaved by suicide, and whilst there are charities that do fantastic work supporting people bereaved by suicide, they run on limited resources and aren’t often national.

Additionally, some people might not feel comfortable accessing professional services. This means that a lot of people bereaved by suicide are relying just on social support from their family and friends to help them get through their loss.

We know from research that social support does help after a suicide loss, although it can be challenging as it’s likely that at least a few people in a friend and family group will be bereaved and trying to cope with their own grief as well as help others.

“Shifts in relationships and group dynamics tended to happen quickly after a loss.”

Can you summarise the key findings of your research? Was there anything that particularly surprised you?

The main part of my PhD project was a qualitative study (in which non-numerical data is analysed) that looked at the social impact of suicide loss on groups of friends and family.

Up to now, almost all of the research I’ve read about has explored the impact of suicide loss on individuals, so I really wasn’t sure what I’d find when I looked at the context of relationships, and of friend and family groups as a whole.

Shifts in relationships and group dynamics tended to happen quickly after a loss. I repeatedly found that the loss strengthened relationships that were already strong and supportive before it happened, whereas it seemed to magnify and reveal the challenges of relationships that hadn’t been as positive.

The literature on grief I’ve reviewed often describes a distinction between “enfranchised grief”, where it’s socially accepted for somebody to show that they are grieving, and “disenfranchised grief”, where it’s not socially accepted.

Suicide is often labelled as a type of disenfranchised grief because it can still be a stigmatising topic, particularly within some religious and cultural groups, and in countries where it is still illegal. In my research I found that this binary distinction didn’t exist within the groups of participants I spoke to, instead there was more of a continuum, or ‘hierarchy’ in which members of the group were seen to be more or less bereaved.

These hierarchies were quite consistent across friend and family groups, even though participants didn’t always seem to be consciously aware of them. They could be a useful framework for a group to cope with a loss overall, with people instinctively focusing support on others who were believed to be the most impacted, like the mother or father of the person who died. They could also sometimes leave other members of the group, like friends or siblings, with less support because it was assumed that they wouldn’t need it or because they didn’t feel they could ask for it.

When a group has been impacted by a loss people may feel they don’t have the capacity to engage in social support. What would you say to someone in this position?

It can sometimes be really hard to ask for help. However, in my research I never encountered a participant who was upset by an offer of or a request for support. I did often find that friends and family wanted to help each other, but weren’t sure exactly what was best to do, or felt uncomfortable asking because they didn’t want to bring up the loss and make somebody upset.

By asking for support, you’re likely giving somebody who wants to help you permission to do so.

By offering help, you’re showing that you care; you can do it in a way that makes it easy for the person to say no if they don’t need anything at the moment, for example, “Is there anything I can do to help you? I understand that you might not need anything right now, but if there’s anything I can do in the future do let me know”.

It’s also worth thinking about what kind of support works for you, as social support isn’t just talking. You might not feel comfortable having an in-depth chat with someone about how you feel, but you might appreciate a chance to work on a hobby or activity with a friend for a few hours to decompress and have a mental break from what’s going on.  Other practical friends or family might be able to help you with cooking meals or organising memorial events.

Sometimes it can be good to talk to others who knew the person who died because you’re sharing an experience that is unique and challenging and you share memories of your loved one. It’s also completely OK to not feel like you want to talk to others impacted by the loss; you might feel as though it’s a bit much for you to take on their emotions too. In your case it might be easier to talk to a friend or family member who didn’t know them and has an outside perspective of what’s going on.

There are several support lines in the UK (links below) where you can talk to a supportive, trained volunteer about what’s going on.

“That experience and that loss has shaped how I see the world and the things that I do, so profoundly that perhaps I don’t always realise it.”

A Public and Patient Involvement (PPI) group has been involved throughout your project. Why was it important for you to include this, and what impact has it had on your research?

Researchers have areas of expertise, and can spot gaps in scientific literature and hypothesise about what’s important, but people with lived experience of that topic have clear perspectives of what matters through their day-to-day lives.

I also found that working with PPI group members who weren’t as familiar with academia was really helpful as they were able to challenge some of the assumptions and perspectives I had through only having worked in universities, for example how and where to recruit participants for the study.

There are, of course, researchers with lived experience of the thing they are researching. Throughout my PhD I saw myself as a lived experience researcher as my best friend died by suicide a few years before I started my project. That experience and that loss has shaped how I see the world and the things that I do, so profoundly that perhaps I don’t always realise it.

When I came to choosing my research questions and interpreting the data that I gathered there were times when I had to pause and reflect on whether this was something that was true or important just for me, or for others as well.

One of the key roles my PPI group played was to sense-check what I was doing and ensure that I was asking questions and reporting information that felt applicable to everyone, not just that which amplified my own voice.

What advice would you give to other researchers when involving people with lived experience in such a sensitive research topic?

It’s important to create a group dynamic where everyone feels comfortable sharing their personal experience as, with a topic like suicide bereavement, this will inevitably come up in discussions.

Most of my PPI group worked with me on my project over the whole three years, so we spent a lot of time together and I think managed to build really good relationships with each other.

At the beginning of the project, I met with each group member, individually at first, to talk through my plans for the project, how I saw the PPI group working, and to make sure everyone felt comfortable working on a project which would bring up memories of their loss and possibly challenge their own thinking about it.

We also had a meeting all together before we started actually working on the project just to build rapport and get to know each other over a cup of tea. I made sure that our meetings had a mix of discussions in the main group and work in smaller sub-groups, to facilitate people who felt less comfortable voicing opinions in a larger group.

At the end of each meeting we’d take some time to decompress and have a more general chat so that we weren’t all immediately going back to the rest of our day.

“Talking about it serves as a reminder of the significance of living with a suicide bereavement. It is a trauma, but it is something you can get through.”

Is there anything else you’d like to add?

There is some debate about whether it’s helpful to talk publicly about the fact that suicide bereavement is itself a risk factor for suicide. Ultimately, I think talking about it serves as a reminder of the significance of living with a suicide bereavement. It is a trauma, but it is something you can get through.

With my researcher hat on it’s easy for me to suggest things that might help, but as a person with lived experience of suicide loss, I know that it’s a really difficult thing to go through. With so many emotions and things to cope with, nobody could expect anyone to get everything right in supporting themselves and their loved ones through it.

People often talk about the ‘stages of grief’, but in actual fact very little scientific evidence supports the idea that grief or bereavement is something that happens in uniform stages. Bereavement is a journey that is unique to everyone, even those grieving the loss of the same person, because of who they are and their relationship with that person who died. The most important thing we can do is to be accepting of each other’s journeys and ways of coping.

I’d like to thank and acknowledge the McPin Foundation and the Gibby family for their work in supporting and funding my PhD research alongside the Economic and Social Research Council.

If you’ve been impacted by suicide, there are links to UK support lines below. To find out more about previous research projects McPin has done relating to suicide take a look at our website.


Hannah Scott is an academic researcher who completed her PhD in Psychiatry and Epidemiology at University College London. She currently works as a research associate in the department of Psychological Medicine at Kings College London exploring the impact of COVID-19 on the wellbeing of NHS staff. You can find her on Twitter at @HannahRachScott.  

If you’ve been impacted by suicide, the Support After Suicide Partnership website is a hub for written information about suicide loss, and is where you can search for locally available support services.

The Survivors of Bereavement by Suicide runs peer support groups for people bereaved by suicide nationally and has a phone line open from 9am-9pm daily (0300 111 5065).

The Samaritans has a 24/7 phone line (116 123) and email service (jo@samaritans.org) that provides emotional support to people in any circumstances.

You can find more sources of support on our website.