Based on the research detailed in this report, we co-produced a guidance document for NHS workers who are supporting their coworkers following the suicide of a colleague. For a full copy of our evidence-based guidance, see Report Supplementary Material 1. The document and an executive summary are both available to download from our study website (Identifying the impact on and support needs of NHS staff following a colleague’s suicide: A study to inform postvention guidance | University of Surrey). The guidance document has been disseminated through conference presentations (see Additional information), and a hard copy has been posted to every NHS Trust CEO.
Introduction
- Our guidance is aimed at supporting NHS staff affected by a colleague’s suicide, and those delivering that support.
- It draws on research interviews with 51 NHS staff members affected by colleague suicide, and 68 stakeholders like policy-makers and front-line staff.
- The goal is to enable effective postvention support to be swiftly delivered when a suicide occurs and ensure supporters are also cared for.
The guidance draws together and is based upon the recommendations generated across the research reported here. The priority for NHS Trusts and ICBs is to attend to the recommendations for ‘Preparation’ as listed below, in order that a timely and compassionate response can be delivered in the event of a colleague death by suicide.
Background
- In 2021, there were more than 5000 suicides in England and Wales. Rates are 24% higher among health professionals, especially nurses, paramedics and doctors.
- Each suicide impacts around 80–135 people. Those bereaved by suicide report high levels of rejection, shame, stigma and concealment.
- Bereavement by suicide is linked to complex grief, increased suicide risk, and occupational dropout.
- Some 2% of respondents to a UK survey36 were bereaved by a colleague’s suicide. Impacts include trauma symptoms, shame, anger, guilt and effects on work.
- Wider networks beyond close family/friends can be deeply affected. Perceived closeness to the deceased amplifies impact.
Methods
- We gathered evidence via:
- A critical review of studies on the impact of colleague suicide and existing guidance.
- Interviews with 51 NHS staff affected by colleague suicide.
- Stakeholder workshop with 68 NHS policy-makers, leaders, staff, unions and so on.
- Findings were synthesised to create the first evidence-based postvention guidance for NHS organisations.
Key findings
- Effective postvention requires well-resourced, adequately staffed organisations.
- Immediate response must include quick, compassionate communication and acknowledging likely impacts.
- Postvention must be proactively offered, include education, and give staff protected time and space to process the suicide and their feelings about it.
- Supporters need practical and emotional assistance since postvention has emotional costs.
- Postvention should be sustained, including appropriate staff-led memorialisation.
- All activities should be evaluated to enable continued improvement.
Guidance
Preparation
- NHS Trusts and ICBs should foster open, supportive cultures that challenge stigma and promote suicide awareness. This will require top-down role-modelling and narratives.
- Supporters must not respond to suicides with silence. Communication strategies should be planned for informing staff compassionately and checking in.
- Trained postvention teams should be set up in advance, with clear response strategies, resources and out-of-hours plans.
- Supporters need specific training in postvention before a suicide occurs. This should be incorporated into existing training.
- Education is needed on suicide, its causes, effects and the stigma that surrounds it. This training might be included in staff induction videos.
Immediate response
- News must be shared compassionately and likely impacts acknowledged. Trusts and ICBs should have a social media strategy to handle the spread of news.
- Postvention should be offered proactively and immediately. Supporters and team leaders should be visible and should facilitate group and individual support.
- Staff need time off to access support and protected time together to process what has happened. Bring in bank staff to cover if needed.
- Staff support needs should be assessed individually. Workers should be consulted on their ability to return to duties, especially those working with suicidal patients.
- Postvention team members must also be supported proactively.
Ongoing response
- Postvention must be sustained over months or even years following the suicide. Availability of ongoing support should be proactively communicated.
- Staff-led memorialisation activities must be offered. Consult staff on their ideas for how to best memorialise the person who died.
- Important dates such as birthdays and anniversaries should be acknowledged. Check in with staff at these times.
Review
- Gather feedback afterwards from staff and supporters to improve future postvention responses.
- Formal evaluations should be carried out to enable learning to be shared between NHS organisations.
Conclusion
- Preparing suicide-aware cultures and trained postvention teams enables effective support when needed.
- Swift, compassionate communication and acknowledging impact is crucial.
- Postvention must be proactively offered, with education, protected time and space for processing the suicide and resulting emotions.
- Support needs to be sustained and to include memorialisation.
- Evaluating activities fosters continued learning and improvement.
- Overall, this guidance will better support NHS staff well-being after a traumatic loss.