Postvention: An important tool for preventing suicide contagion

It is estimatedopens in new window that about half of the population will be exposed to the suicide of someone they know at some point in their lifetime. While those who have lost loved ones are vulnerable to grief and trauma, studiesopens in new window suggest they are also at a heightened risk of suicide themselves. To reduce this risk, many schools and universities are prioritizing postvention, a suicide prevention strategy that focuses on planning ahead for how to support a community after a suicide has occurred.

From determining how to communicate about the suicide to mobilizing grief counseling and psychological first aid, postvention is an important tool for preventing contagion, or clusters of suicides that can happen among survivors. Preparing resources in advance can ensure the plan is as comprehensive and supportive as possible to those affected by the death. “In the midst of a crisis response, you don’t want to try to build the plane as you’re flying it,” said Monica Osburn, PhD, executive director of the Counseling Center and Prevention Services at North Carolina State University in Raleigh.

Many postvention models exist and can be applied in various settings where suicides occur, from K–12 schools to colleges and universities to workplaces and the military. While their suggested steps may differ in the details, most postvention plans encompass the same goal: “We want to be prepared to manage the unexpected crisis of the tragic death while also taking steps to ensure it doesn’t happen again,” said Marina Niznik, PhD, a licensed psychologist and president of Inlight Psychological Services PC in Walnut Creek, California, who has led school postvention responses.

According to Osburn, postvention plans usually involve multidisciplinary teams that include counselors, administrators, and other staff members who work together to implement the steps. School, clinical, and counseling psychologists also play essential roles in developing and implementing postvention plans, thanks to their social-emotional training and ability to effectively communicate with a variety of individuals, said Scott Poland, EdD, a professor and director of the Suicide and Violence Prevention Office at Nova Southeastern University in Ft. Lauderdale, Florida.

Learn more about how postvention plans can support communities affected by suicide, and best practices for building a postvention response of your own.

Most postvention frameworks offer guidelines for developing a strategic communication plan in the event of a community suicide. The first step, according to Niznik, is to gather important details about the death, verify that information with reliable sources, and communicate with the deceased’s family about what details they’re comfortable sharing with the broader community.

While accuracy is essential, providing the right amount of detail in communications is critical for preventing additional suicides, said Stephen Brockopens in new window, PhD, a professor emeritus of school psychology at California State University, Sacramento. For example, it’s best not to disclose the method of suicide. “Too many details can lead to copycat behavior, especially in those who are already vulnerable to suicidal ideation,” he said.

The individuals to whom the suicide is disclosed depends on the community. In a smaller school or college where everyone knows each other, it may make sense to communicate to the entire student body—ideally, Brock said, in person. But some experts recommend that in large universities, suicide postvention teams focus on only those who knew the deceased: friends, classmates, and people in the same residence hall, sports teams, or other activities.

Mass emails are discouraged in most cases, other than to address potential safety concerns (for example, to dispel rumors or address the presence of emergency vehicles on campus). “Doing more personalized outreach can protect people from unintended exposure that can pose a risk for depression, prolonged grief, substance misuse, and survivor suicide, while also creating opportunities to offer survivors resources,” said Kurt Michael, PhD, senior clinical director of The Jed Foundationopens in new window (JED), a leading national nonprofit that protects emotional health and prevents suicide in teens and young adults.

If national or local news outlets are covering the suicide, discrete and targeted communication becomes even more important. “Then there are multiple avenues through which students are getting inundated with information, which could be a risk factor in itself,” said Osburn. If the news is rapidly spreading, Osburn said it can be helpful for the postvention team to reach out to media and ensure they’re providing suicide risk resources in their coverage.

Support offered to survivors should also be strategic. Postvention teams typically identify those closest to the deceased in order to offer targeted, timely support—these individuals, Michael said, are often most at risk for mental health concerns and suicide. Targeted care, like triage in an emergency department, also conserves school or campus resources that may be limited for those who need it most.

Along with classmates and other close associates, Brock said it’s important to identify other individuals at risk. Staff members who knew the deceased, including faculty or residence hall staff, should be included in targeted outreach.

In some cases, people who didn’t know the deceased personally may benefit from support. Studies show acquaintances can be affected by deaths as much as or more than close friends (Gould, M., et al., International Journal of Environmental Research and Public Health, Vol. 15, No. 3, 2018opens in new window). If the deceased was involved in a specific activity or represented a certain group, for example, then it would be important to reach out to fellow members. “If you view the person as someone you admire or whose circumstances are like yours, then you could be put into the suicide loss survivor group,” said Brock.

Effective postvention plans strategically mobilize support to those impacted by the community death. Rather than large assemblies or generalized communication about resources, support is typically best offered in small-group or individual settings—where students are more likely to speak up about their feelings and ask questions—according to Poland. Because suicide can be a stigmatized topic—and those most at risk are often the least likely to reach out for support—Brock said postvention teams should be assertive in outreach.

Interventions typically focus on reducing isolation and connecting survivors with people and resources that can help them process the event. “We want to reach out to those impacted by the death and assess their immediate needs so we can provide the best resources,” said Carla Stumpf Patton, EdD, LMHC, vice president of suicide prevention, intervention, and postvention programs at the Tragedy Assistance Program for Survivorsopens in new window (TAPS).

For example, people in the person’s inner circle may benefit from trauma care and grief counseling—or, if postvention teams identify someone is at risk for suicide, they may need to be connected to a higher level of acute mental care outside the school setting. TAPS connects military families affected by suicide with an internal case worker who can recommend local resources, such as trauma-informed therapists familiar with the unique needs of military communities. Those affected by the suicide or knew the deceased informally may need psychoeducation to contextualize suicide, along with more general suicide prevention resources.

Because mental health clinicians on campus may be in short supply, it’s important to mobilize support in advance. This may include partnering with community resources that can offer support, building relationships with mental health clinicians outside the school setting, or training staff members in psychological first aid. At Stanford University, for example, staff are trained in suicide response so they can recognize early signs of suicidal ideation and refer students to the campus counseling center after a campus suicide. Peer support groups, which offer the ability to connect with others who have been affected by suicide, can also be helpful. “The more of us who are involved, the more we can create a safety network around those who have been impacted,” said Stumpf Patton.

Along with psychological support, Poland said students may benefit from other opportunities to process grief, such as a living memorial that involves raising money for suicide prevention. In any case, Poland said, it’s important to memorialize the death of all deceased students the same, regardless of the cause of death, popularity, or socioeconomics.

Grief isn’t always linear—sometimes, it doesn’t set in for months—so postvention efforts don’t always have an end point. “Long-term check-ins for those at an elevated risk are an important part of postvention plans,” said Helen Hsu, PsyD, director of outreach at Stanford University’s Counseling and Psychological Services (CAPS). “Organizations tend to provide all of this support in the first week or month, and then 6 months to a year or more later, someone has finally processed what happened and nothing is being offered.” For example, postvention teams may reach out to at-risk students at important milestones, such as the anniversary of the death or graduation. (Suicidal ideation typically occurs for a period before a precipitating event, such as a death anniversary, said Poland.)

Those closest to the death, or students who have experienced trauma because of the death, may need more intensive follow-up. “I had a case where a student found the deceased, so they had a traumatic experience and not just a grief response,” said Niznik. “This type of student would need ongoing psychological support, whether that’s on campus or a referral to an off-campus clinician.”

The first step to creating a postvention response plan is choosing a framework to follow. Many postvention models exist, and the organizations that created them—such as the Higher Education Mental Health Alliance or the Suicide Prevention Resource Center—offer training materials and tool kits. “Knowing what’s available ahead of time, learning about best practices, and coming up with your own crisis response team can help you be prepared if and when a crisis occurs,” said Stumpf Patton. Staying abreast of research literature on the topic can also help you stay informed about best practices.

If you want to create your own postvention team and plan, prioritize partnering with a multidisciplinary team. While psychologists’ clinical expertise is an asset, partnering with others who have different skills and expertise can ensure better outcomes and prevent burnout. At North Carolina State University, the postvention team has a representative from the counseling center, a director of prevention services from the dean’s office, and a dedicated postvention coordinator who handles logistics during the postvention process. “We can concentrate better on what we’re trained to do when we work as a team,” said Osburn.

Building relationships with students beforehand can encourage better outcomes during a crisis, according to Hsu. “Even though postvention makes therapists available, students need a level of connection or trust before they open up,” she said. Consider hosting ongoing mental health awareness outreach events for students and equipping staff with resources and time to build trust with students, particularly those from marginalized communities.

If you work in a clinical setting, you can lend your psychological expertise to postvention teams. Niznik suggests looking for ways to get involved with schools and other campuses—such as providing consulting services or making yourself available for therapy referrals after a campus suicide or other crises.

While any evidence-informed postvention model can offer a helpful framework for handling an unexpected crisis, be open to customizing your plan to your community setting—and pivoting as needed to address needs and reduce further suicide risk. “Your guidelines can guard against risk, but they’re not one size fits all,” said Michael.