HELPING SUICIDE LOSS SURVIVORS: FINDINGS FROM A QUESTIONNAIRE ASKING LIFELINE CRISIS CENTERS ABOUT SUICIDE BEREAVEMENT SERVICES APRIL 2011

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1 HELPING SUICIDE LOSS SURVIVORS: FINDINGS FROM A QUESTIONNAIRE ASKING LIFELINE CRISIS CENTERS ABOUT SUICIDE BEREAVEMENT SERVICES APRIL 2011 BACKGROUND During late 2009 and early 2010, a number of advocates interested in providing better services for survivors of suicide loss ( survivors ) independently approached the National Suicide Prevention Lifeline about the potential for the Lifeline network to help increase and improve outreach to survivors. As a result of those initial discussions and a desire to learn more about crisis centers experience in serving survivors, an independent work group * formed to develop a questionnaire in order to assess: The nature of calls from survivors to crisis centers The scope of resources/materials currently offered by crisis centers to survivors Crisis centers need and/or interest in receiving additional support for assisting survivors SAVE (Suicide Awareness Voices of Education) provided organizational leadership to the effort, and several experts from the wider suicide prevention community volunteered to assist the work group, which developed and distributed the questionnaire to 149 Lifeline crisis centers in December A total of 123 crisis centers responded, representing an 82% response rate. The major findings are summarized below. CRISIS CENTERS MISSION Overall, 94% of crisis centers indicated that they either strongly agreed (84%) or were inclined to agree (12%) that serving suicide survivors is in line with their mission. FREQUENCY OF CALLS Only 35% of crisis centers collect data to track whether calls are related to suicide bereavement. Crisis centers that do not collect this data (n=80) were asked to estimate the frequency of calls from survivors Overall, it is clear that many crisis centers receive calls from survivors on a relatively regular basis. DAILY WEEKLY MONTHLY LESS THAN MONTHLY DON T KNOW 3.8% 21.3% 38.8% 28.8% 7.5% * Development Committee: Franklin Cook (SAVE, Lifeline s Consumer/Survivor Subcommittee), Karen Marshall (Consumer/Survivor Subcommittee), Doreen Marshall (Argosy University, American Association of Suicidology), Sally Spencer Thomas (Suicide Prevention Resource Center, American Association of Suicidology), Lidia Bernik (Lifeline). Leadership Group: John Draper (Lifeline), Dan Reidenberg (SAVE), Michelle Linn Gust (American Association of Suicidology). Additional Support: DeQuincy LeZine (Consumer/Survivor Subcommittee), Linda Langford (Suicide Prevention Resource Center), Deb DuFour (Wisconsin Acute Care Services Crisis Intervention Team, CSS), Leslie Storm (Oregon Partnership Crisis Line Program, CSS), Janet Kittams Lalley (HELP!Line).

2 NEEDS/REQUESTS FROM SURVIVORS The majority of crisis centers indicated that survivors most often call to request information about survivor support groups (59%) and resources on suicide loss (54%). WHAT DO CALLERS REQUEST WHEN A CALL IS RELATED TO SUICIDE BEREAVEMENT? Bereaved person is suicidal or needs crisis intervention (n=122) Bereaved person requests general resources on suicide loss (n=120) Bereaved person requests information about individual counseling (n=121) Bereaved person requests information about a suicide bereavement support group ( SBSG ) (n=121) Caller is not bereaved by suicide but is making a request on behalf of a family member or friend (n=122) NEVER OR SELDOM SOMETIMES OFTEN OR ALWAYS 27% 59% 14% 13% 33% 54% 7% 46% 47% 10% 31% 59% 25% 57% 18% RESOURCES CRISIS CENTERS CAN OFFER SURVIVORS In general, crisis centers are able to offer survivors a variety of different resources, most commonly, information about or referrals to a suicide bereavement support group or SBSG (91%) and information about or referrals to counseling (90%). Only 7% of crisis centers (n=8) indicated they have no information about suicide grief. INFO ABOUT INFO ABOUT INFO/REFERRAL TO INFO/REFERRAL INFO/REFERRAL NO SUICIDE GRIEF GRIEF SUICIDE LOSS COUNSELING TO SBSG TO GRIEF GROUP INFO 67% 75% 90% 91% 66% 7% Crisis centers were given the opportunity to provide written comments, as well. Their feedback highlights some of the gaps in survivor support that currently exist, including a need for: more variety in resources to meet the individualized needs of survivors, resources for underserved populations (e.g., child survivors), resources in rural areas, and resources provided directly by crisis centers. The qualitative data also suggest some specific areas of interest for crisis centers, such as: communications or networking systems for survivors (e.g., newsletter, listserv, social media), online survivor support and assistance, bereavement support training for professionals and other key community groups (e.g., funeral homes, law enforcement, clergy), financial support for special needs of survivors (e.g., transportation, funeral costs), and suicide prevention information. 2

3 The written feedback also emphasized that many survivors that call simply need to share their feelings with someone who is compassionate and understanding. SURVIVOR RESOURCES CRISIS CENTERS CAN OFFER A significant majority of crisis centers can offer survivors, either directly or by referral, a SBSG, printed materials on suicide grief, and a memorial event. WHICH RESOURCES ARE AVAILABLE THROUGH YOUR CENTER? HOME VISIT TEAM (n=121) RESOURCE LIBRARY (n=122) MEMORIAL EVENT (n=121) PRINTED MATERIALS (n=122) SBSG (n=123) Directly 20% 17% 32% 46% 43% By referral 25% 39% 38% 34% 50% Not available 55% 44% 30% 20% 7% Those crisis centers that were unable to offer certain resources were most interested in providing printed materials on suicide grief, a SBSG, and a public resource library on suicide grief. FOR THOSE WHO ANSWERED NOT AVAILABLE, IS THERE AN INTEREST IN MAKING THE RESOURCE AVAILABLE? HOME VISIT TEAM (n=62) RESOURCE LIBRARY (n=52) MEMORIAL EVENT (n=33) PRINTED MATERIALS (n=22) SBSG (n=7) Yes 50% 67% 46% 86% 71% No 50% 33% 54% 14% 29% When asked how important certain specific resources are to helping survivors, crisis centers emphasized four resources. MOST IMPORTANT RESOURCES FOR HELPING SURVIVORS Specialized training in suicide grief support 62% Resources, material, and information designed for suicide survivors 62% Information about referral sources that could help survivors 62% Guidelines or protocols for crisis workers on providing suicide grief support 59% Fewer crisis centers (31%) were interested in guidelines or other assistance starting or running a suicide bereavement support group, likely because 91% of crisis centers indicated they can provide information about or referrals to a SBSG (see above). However, the majority of crisis centers that cannot currently direct callers to a SBSG (n=7) expressed an interest in starting one. 3

4 Written responses also indicated that many of the crisis centers that do not currently facilitate their own SBSG would like to establish one. Additionally, there are several areas where crisis centers see gaps in SBSG coverage, namely with respect to the need for support groups: closer to crisis centers, in rural areas, for underserved populations, and for children. TRAINING IN SUICIDE BEREAVEMENT SUPPORT Overall, 62% of crisis centers offer some kind of training to staff and volunteers to prepare them to help survivors. However, 37% of crisis centers report that their staff and volunteers do not receive any training specifically designed to help them assist survivors with their grief. Furthermore, the written answers in this section, which described the training being offered, suggest a need for more training. They included: ASIST and QPR (which have no significant focus on bereavement support), viewing a single video (e.g., Fierce Goodbye ) and discussing it, and a curriculum written by a local survivor. CHALLENGES IN PROVIDING ASSISTANCE TO SURVIVORS When asked about the challenges their centers face in assisting survivors, crisis centers responded as follows: CHALLENGES CRISIS CENTERS FACE IN HELPING SURVIVORS Lack of funding or staffing targeted for suicide bereavement services (n=74) 61% Limited contact with survivors of suicide loss (n=59) 48% Lack of staff/volunteer training in suicide grief support (n=35) 27% Lack of information or material to help survivors with their grief (n=28) 23% Not able to treat suicide grief services as a crisis center priority (n=18) 15% No challenges at this time (n=19) 15% Calls from bereaved people are emotionally difficult for staff/volunteers (n=5) 4% 4

5 SURVIVORS INVOLVEMENT IN CRISIS CENTER OPERATIONS Crisis centers responses indicated that survivors are involved in many aspects of crisis center work. WHICH ACTIVITIES ARE SURVIVORS INVOLVED IN? Answering crisis calls (n=63) 52% Providing grief support services to other suicide survivors (n=44) 36% Volunteering as advocates, fund raisers, or prevention workers (n=46) 38% Serving on the board of directors or other advisory body (n=39) 32% SUMMARY Although the questionnaire was intentionally brief and general, it clearly shows that numerous crisis centers in the Lifeline network already have substantial interactions with survivors, whom they help in coping with their grief and potential mental health problems, including suicide risk. Furthermore, the results demonstrated that although many crisis centers already invest significant time and resources serving survivors, they have clear needs that, if addressed, would enable them to improve and expand their services for survivors. Lastly, the responses highlighted the fact that most crisis centers would not only like to improve their services for survivors but also want to have more opportunities to engage survivors. NEXT STEPS The results of this questionnaire were shared with the Lifeline Steering Committee in February 2011 and with the Consumer/Survivor Subcommittee in March While both committees expressed concerns about expanding the Lifeline s focus given limited resources and its primary mission of serving people at risk of suicide, there was general agreement that exploring how to better assist survivors is in the best interest of crisis centers and the communities they serve. To that end, Franklin Cook of SAVE is establishing a work group comprised of select members of the Lifeline s Consumer/Survivor Subcommittee as well as other key stakeholders to: identify existing resources/materials that could be helpful for crisis centers, more fully explore the needs of survivors, and foster greater and mutually beneficial collaboration between crisis centers and the survivor community. Anyone interested in more information about the results of the questionnaire or about the workgroup may contact him at fcook@save.org.. 5

6 ADDENDUM QUOTES FROM THE QUESTIONNAIRE Our commitment to suicide bereavement services is very high, and we would gladly expand our services. I believe that this is an emerging field that demands attention. Too often survivors are dealing with guilt and shame as well as grief. They need to know that they truly are not alone and they are not to blame for the suicide of a loved one. I would like to see many more resources devoted to this population, particularly with the suicide of a close friend/family member, the survivor has now increased his or her risk for suicide. As a 24 hour crisis call center, I feel that we could certainly benefit in receiving more specific training and education in serving those individuals bereaved by suicide. We find that individuals have a difficult time finding out about our support group. We do advertise through our website, and we are listed in the local newspaper under the support group listings. Revenue is very tight and paid advertising quite expensive We do not currently offer support groups for adolescents/teens. The one agency in [our community that] does offer this age group a support group, unfortunately asks survivors to add their name on a waiting list most often, leaving the children to put their grieving process on hold until a space becomes available. We work closely with the local hospice and other grief centers that provide all these services in our community. We have collaborated on events with them and serve on committees. Would be interested in [a] list of good web site referrals for online support [and] what specialized care you all think we should be providing. We give them the same listening, crisis intervention, referrals and invitation to call back that we give other callers. More resources for training and for survivors are needed, so I applaud and support your efforts! Thanks! At this time the only resource we have to offer is a local Survivors of Suicide group. I would welcome the chance to expand our resources and would also welcome some type of online site that we can refer people to. I would welcome any information that would help me improve the bereavement training by giving more information about bereavement after a suicide. Our center has been more passive about providing services to survivors, and I would like to be more active. Given our small staff and strong volunteer base, I want to be realistic about what we do so we do it well and are able to offer it consistently.