This research makes an important contribution to understanding the experiences and needs of NHS staff who have been impacted by the suicide of a colleague as well as those who are offering support to others. It generated the first evidence-based, postvention guidance tailored specifically for supporting NHS workers after such traumatic losses.
The elevated risk of suicide among healthcare professionals was established. Impacts on bereaved coworkers can include complex grief, trauma and effects on work ability. However, little research has explored supporting NHS staff after a colleague suicide.
Following a critical literature review, in-depth interviews with 51 affected staff and a co-design workshop with 68 stakeholders, key insights emerged.
It is clear that colleague suicide can impact workers in health care and other diverse workplace settings and that perceptions of grief are complicated by professional identities and workplace cultures. A common pattern across professions is the burden placed on managers to be knowledgeable, skilled and available to support staff. Current postvention guidance written for workplace support following colleague suicide, and the postvention offered to colleagues, while well-meaning, is not evidence-based, takes an overly individualistic view and may perpetuate stigma, and has not often been evaluated. As such, we conclude that more evidence-based, systemic postvention guidance for workers and managers is required across all workplace settings.
For NHS staff affected by a colleague suicide, our findings showed that the needs of those affected were rarely met. Some of those affected appeared to fall between the gaps that were created by lack of provision. Stigma and unhelpful narratives were shown to be prevalent in our data. We conclude that work is required to challenge such stigma and narratives. Such work will open the door to improved provision of targeted support which will be of benefit to the affected NHS staff.
With regard to those NHS staff who deliver support to those affected by a colleague suicide, it was clear in our data that they had little control over the context within which support could be offered. It was also clear that these staff experience a strong emotional impact associated with this role. We concluded that the current situation for supporting staff appears unhealthy and unhelpful for the supporting staff and for those they are aiming to support. It is clear that better resourcing and education, alongside compassionate care for supporters, are needed.
These conclusions pointed towards a clear need for evidence-based postvention guidance to inform and support managers and leaders to provide a timely and compassionate response to staff affected by a colleague’s suicide. Recommendations in the guidance that we produced include establishing compassionate, suicide-aware cultures, designating trained postvention teams, rapidly mobilising support, facilitating staff grief and memorialisation, and ensuring supporters are also cared for.
Overall, this project has generated crucial learning about the impact of colleague suicide in healthcare settings. Implementing the resultant best-practice guidance will enable NHS Trusts to provide appropriate care following these losses. This will foster staff well-being and may act as suicide prevention. The guidance constitutes an evidence-based, co-produced framework for organisational postvention policies in the NHS and beyond going forward.
Impact and learning
The guidance produced as an output of this study is the first evidence-based postvention guidance for NHS organisations on supporting staff affected by a colleague’s suicide. The guidance is designed so that implementation will foster suicide-aware cultures and the creation and training of skilled postvention teams that can meet staff needs following the loss of a colleague to suicide. We believe that NHS Trusts and organisations that implement this guidance will better support staff well-being and retention after such events.
The team have made concerted efforts to maximise knowledge exchange and mobilisation to key stakeholders and beneficiaries around the country. Below are examples of such dissemination activities at international, national and local level.
Department of Health and Social Care
The principal investigator (PI) is currently in conversation with Baroness Merron to request the guidance be supported by the Department of Health and Social Care to ensure nation-wide uptake and implementation across England. Baroness Merron is the Parliamentary Under-Secretary of State for Patient Safety, Women’s Health and Mental Health.
May 2024 – hard copies of the guidance plus cover letter including electronic links to the guidance and film were printed and sent to 250+ CEOs in hospitals and mental health trusts in England.
Media articles
www.nhsemployers.org/news/new-film-provides-insight-impact-colleague-suicide
Postvention guidance for staff impacted by suicide | NHS Employers
https://rcni.com/nursing-standard/newsroom/news/nhs-staff-suicides-grieving-colleagues-need-rapid-support-198506
www.nationalhealthexecutive.com/articles/uks-first-nhs-postvention-guidance-launches
Guidance published to help workers affected by colleague suicide – News Azi
New guidance to support NHS staff following a colleague’s death by suicide – Hospital Healthcare Europe
www.wisegp.co.uk/practice-management/supporting-staff-after-the-death-by-suicide-of-a-colleague
Guidance published to help workers affected by colleague suicide – News Azi
Other media.
Podcast: United States of America
The PI was invited to contribute to podcast series episode on postvention in the workplace: Headspace for the Workplace with Dr Sally Spencer-Thomas. Episode 40
www.spreaker.com/podcast/headspace-for-the-workplace-with-dr-sally--5712605
Online TV – Invited to talk about JAN Editorial and Wellcome project on Mental Health TV, a Nurses Association You Tube Channel, 22 November 2023.
Invitation to conferences/professional talks
- 5th Zero Suicide International Summit Agenda 2024, Liverpool.
- Panel: Considering Workforce Wellness in Zero Suicide Implementation.
- Facilitated by: Julie Goldstein Grumet (USA). Panel: Sally Spencer-Thomas (USA), Kathryn Turner (Australia), Ruth Riley (UK), Christopher Wojnar (USA).
- Riley R, Causer H, Spiers J. Postvention Guidance for Health Workers and Their Supporters Following a Colleague Death by Suicide [Paper presentation]. Pelion, Greece: Wellmed; 2024.
- Causer H, Spiers J, Riley R. A Novel Method for the Development of Evidence-based, Co-produced Guidelines to Support Health Professionals [Paper presentation]. Pelion, Greece: Wellmed 2024.
- Royal College of Psychiatrists and Society of Occupational Medicine, London. Seminar on postvention guidance. December 2023.
- Mental Health: Supporting NHS Workforce Resilience 2024 Conference, Manchester, May 2024 (postponed until 2025).
National Health Service Employers. National Health Service well-being leads, August 2023
Workforce Issues Group, Social Partnership Forum. August 2023 – includes NHS Employers, NHS trade unions, NHS England, and the Department of Health and Social Care to contribute to the development and implementation of policy that impacts on the health workforce.
The PI, Ruth Riley was invited to contribute to a postvention expert group led by the Royal College of Psychiatrists and Society of Occupational Medicine to develop cross-sector postvention guidance. Published here:
Uptake of guidance and film
Uptake in the NHS – we regularly received correspondence from NHS staff across the country, expressing their gratitude for the guidance which they found helpful following a death by suicide of a colleague.
Training resource
Lincolnshire Partnership NHS Trust have used the film as a training resource.
Guidance uploads to external websites
International – Australia-Zero Suicide Alliance in Australia: www.zerosuicide.com.au/s-projects-side-by-side
UK – NHS Employers – www.nhsemployers.org/articles/suicide-prevention-and-postvention
Wise GP – Guidance added to resources on website: The WiseGP programme is a joint initiative between the Royal College of General Practitioners (RCGP) and the Society for Academic Primary Care (SAPC) to champion the distinct clinical scholarship that lies at the heart of person-centred general practice:
www.wisegp.co.uk/practice-management/supporting-staff-after-the-death-by-suicide-of-a-colleague
Dissemination has been supported by NHS Employers, Unison, the RCN and the Social Partnership Forum and is ongoing. Co-applicants have disseminated across their networks: Chew-Graham (RCGP); and Grayling (Health Education England).
Our provision of an implementation workshop as detailed in the output summary (Appendix A) provided development and training opportunities for 50 attendees from within and beyond the NHS.
Key implications for decision-makers
Information, actions and conclusions contained in this report that are relevant to decision-makers are drawn together here:
Context/culture
- Contexts and cultures shape the experiences of staff after a colleague suicide; they also inform how postvention is delivered and accessed.
- A supportive and non-stigmatising culture which is open and accepting about mental ill health will give staff permission and space in which to process their responses to a colleague suicide and will enable the delivery of effective postvention.
- The context from which support is offered needs to be well-resourced and well-staffed to enable effective support.
Organisational response
- Organisations need to be prepared to respond immediately and with a skilled workforce to support staff.
- Organisations are encouraged to create a suicide-aware culture where conversations are welcome and supported.
Delivery of support
- Thought must be given to who delivers postvention; it might be useful to include external supporters.
- Resources and training will be required so that a prepared and skilled postvention team can be established and maintained.
The successful implementation of the guidelines presented herein will depend upon top-down support through the provision of time and resources, and bottom-up leadership in terms of identifying personnel with the best attributes, knowledge and skills to read, plan and implement the guidance.
Recommendations for research
The findings of our review study suggest that future researchers may wish to explore the impact of colleague suicide on those with pre-existing mental health conditions (such as military personnel with PTSD). In addition, development and evaluation of postvention guidance that is informed by empirical evidence is needed across a range of specific professional groups (e.g. anaesthetists).
A limitation of this study was the lack of ethnic diversity among the recruited study participants. With that in mind, future research is needed to explore the experiences of minority ethnic healthcare workers following a colleague death by suicide. Further, other minoritised groups such as workers with neurodiversity may also experience loss by suicide differently, and as such may benefit from targeted research to understand any specific needs that they may have. Our guidance includes suggestion around review and evaluation following implementation. We suggest that evaluation of the implementation, following these suggestions, could form the framework of a robust evaluation project across trusts in order to increase understanding of what works in practice.