UNDERSTANDING THE IMPACT OF SUICIDE ON FAMILIES OF PEOPLE WHO WERE IN RECEIPT OF MENTAL HEALTH SERVICES

The aim of this thesis is to understand the impact of suicide on families of people who were in receipt of mental health services. Suicide survivors are often researched as a homogenous group and considering only a quarter of the decedents in the UK were in receipt of mental health services prior to their suicide, their family members have been subject to few studies. Suicide is a distinctive form of death and suicide survivors are at an increased risk of poorer physical and mental health so they may wish to access health services, such as counselling. However, a generic response by services fails to address family member’s individual needs because of the different personal, social and cultural factors influencing suicide bereavement.

For family members, a key feature of dealing with a suicide is making sense of the death by drawing on their life with the deceased prior to the suicide. By focusing on the mental health context, this study highlights how some family members may have experienced personal challenges in caring for or supporting the deceased, and/or encountered difficulties with health services in providing effective treatment and support. However, not all family members will have had knowledge of the mental health context of the deceased. Therefore, gaining a deeper understanding of the impact of a suicide requires exploration of the family members’ and decedents’ personal, social and cultural context. Considering that a limited amount empirical literature is available in this area, the following objectives for this thesis were:

To identify the individual needs and experiences of suicide survivors.

To investigate suicide survivors’ perceptions of the health service support, which they and the deceased received before the suicide.

To generate recommendations for improving health services for suicide survivors.

The study was designed utilising constructivist grounded theory, a method that involves a cyclical process of data collection and analysis. Participants were recruited via the NHS and a Survivors of Bereavement by Suicide group, leading to 17 semi-structured interviews and a focus group with 7 participants.Data analysis resulted in the development of a conceptual model incorporating ‘life before the suicide’, ‘the suicide’, and ‘the impact on life after suicide’. The model highlights the mental health context of the study, particularly the importance of prior knowledge of and involvement with mental health services, and emphasises the ‘private’ and ‘public’ ways of ‘dealing with the stigma of the suicide and the mental illness’, ‘changing perceptions of the suicide’, ‘creating symbolic ties with the deceased’, ‘personal ways of coping’, and ‘dealing with grief’.

Recommendations from this study include stronger collaborative working between mental health services, families/carers and the patient in order to provide effective support and to prevent future suicides. Moreover, health services should proactively share information on support to families/carers to cope with the challenges of care. Finally, after a suicide, health services should provide suicide survivors with information on support to ensure they receive timely and effective interventions to address their individual needs and minimise negative health outcomes.

Sadly, a suicide has changed the lives of these participants and focusing on the mental health context of the study has demonstrated that there is significant diversity in their experiences. Most participants believed that the suicide was preventable and hope that these findings can prevent future suicides or help other suicide survivors.