The suicide bereavement support service may be a stand-alone service or part of a larger organisation. Even if there are already established governance structures within the organisation, it is important the service has its own framework and structure. This should include clear systems and processes for governance, staff reporting and communications.
The accountable bodies, agencies and systems may vary across the country but are likely to include one or more of the following: Integrated Care Systems/Sustainability and Transformation Partnerships/Public Health /Local Authorities.
In most areas, suicide bereavement support is an integral part of the local suicide prevention strategy. Engaging in an early meeting between relevant and involved agencies will help to agree a shared vision for the service. Some of the key points to consider at this meeting could include:
There is likely to be a range of stakeholders involved in local suicide prevention steering groups and delivery networks. This may provide an opportunity to share your service offer, work with potential partners to understand their roles, and consider approaches for collaborative working.
Most services will have a service specification which details the service’s aims and objectives, expected outcomes and performance indicators. Service monitoring meetings provide an opportunity for the service providers and commissioners to come together to share progress, explore any concerns and opportunities for continuing service development.
Providing suicide bereavement support can bring challenges, requiring a set of robust and evidence-based policies and protocols which are regularly reviewed and updated. The service will likely have a combination of policies, including those required by legislation, as well as policies and protocols based on the agreed model of working and service structures, for that specific service.
It may be helpful to establish a process for regular review and updating of all policies from the outset, responding to any changes to legislation or new best practice in suicide bereavement support.
Some of the key policies that need to be in place for all services are listed below, those marked with an asterisk as those required by legislation. This list is not exhaustive and organisations may have additional polices in place.
The role of a Suicide Bereavement Liaison (SBL) Worker is integral to the effectiveness of the service and it is key that those providing suicide bereavement support are appropriately skilled and experienced.
A template job description, based on current good practice is available on the SASP Hub website, alongside a job description and person specification which has been shared by Harmless & The Tomorrow Project. These can be used as a foundation for service-specific recruitment, adding any service-specific needs.
It is important to guide new staff through a process of induction and training, which may be a combination of internal induction e.g., as part of a wider organisation and specific induction to the role and operation of the service.
Staff may also require external training relating to their role and specific aspects of the service delivery. A range of suicide bereavement training opportunities are available.
Based on the model of delivery, staff and volunteers will need access to resources; including office/meeting space, laptop, phone/internet to do their job effectively and in a way that minimises the occupational stress of working in a suicide bereavement support setting. This provision will vary for different services and will reflect the nature of the service, however access to line management support and supervision are key.
As well as practical support, it will be important to support staff and volunteers to enable them to deliver bereavement support to all service users regardless of background, language barriers or any additional needs. This may require policy and practical guidance to be in place, to help guide staff.
The level and type of training will depend on the individual’s role but there are core areas of training/ education that will ensure that staff have the necessary skills and knowledge to provide support to all people bereaved by suicide.
Team members should have access to ongoing training and development, suitable to their role in the team and organisation. Training and development may vary for each staff member to reflect their individual needs; this could be identified as part of an annual review process.
Education and development may include a range of options; team training, mentoring and other learning opportunities.
Suicide bereavement support is a rapidly growing sector, and evolving practice and research evidence continue to identify new ways of working. Staying in touch with peers and networks across the country through use of resources such as the Support after Suicide Central Hub will help to support continuing professional development with benefits for staff and clients.
Suicide bereavement and prevention services work in a challenging field. It is essential to support and promote staff wellbeing in every service. All staff should receive regular clinical supervision and access to wellbeing support. Staff support should be structured and accessible to all team members – even those who don’t directly ‘face’ people impacted by suicide.
Senior management has an important role to play in being available to provide advice and support to team members, including enabling debriefing support in response to difficult situations.
It’s also important to consider what support staff may need beyond supervision, to mitigate the risks and impact of role-related strain; and what the service can implement to ensure the team are fully supported.
The service should form part of an integrated pathway of support for people bereaved or affected by suicide. Embedding the service within your area’s suicide prevention planning and delivery network will not only allow the service to influence and shape local suicide prevention activity (sharing data where appropriate and improving practice) but will also create links to local partner organisations and multi-agency networks. In areas where the pathway is not present or perhaps not well -established, the suicide bereavement service may have a role to play in supporting the development of the pathway of support.
Knowledge and awareness of the range of local agencies and organisations that offer support will enhance the range of options and promote choice for people who have been bereaved.
Involving people with lived experience in the development and delivery of the local service is strongly recommended. This could be at a steering group and service level, where their lived experience can shape and influence how services are delivered. They should also be involved in advising on how to respond to client feedback about the service, to ensure that services are acceptable and responsive.
It is important that consideration and care should be taken in the recruitment of people with lived experience to suicide bereavement roles to ensure the welfare of those providing the service. Through the recruitment process, training and the ongoing well-being support and supervision
Suicide bereavement support services should actively promote the service to their partners in other agencies explaining the availability and importance of timely access to support. Once again, local multi-agency networks should ensure that there are strong relationships with partners such as all first responders, mental health services, coroners and coroner’s officers.
Existing services have been successful in developing partnerships with schools, colleges and workplaces in their area. Promoting the service widely within the local community will increase the awareness of what support the service itself can offer. It is important that healthcare, education, social care, voluntary sectors partners and the general public are kept up to date with relevant services/supports in the locality and any changes to what is available. An effective suicide bereavement support service is an integral part of the local community’s infrastructure.
It will be important for services to publicise the range of national resources available such as the SASP website and the Help is at Hand resource, providing key partners with access to these sources, as well as to specific information on their own service so that they can be immediately shared with those who have been bereaved.
Providing clear and accessible information to those who may require suicide bereavement support or to those making a referral is key. Leaflets or online promotional material should outline what someone might expect from the service (i.e. whether support will be online or face-to-face, how they will be contacted, whether there are exclusion criteria such as the first few months after a loss). The language used in leaflets and online material should be inclusive.
If the service is within a wider organisation, you may be able to access advice and guidance on accessible communications from within.
Support needs will vary depending on a range of individual factors. Understanding different demographics and the needs of groups will enhance the accessibility of the service and ensure inclusion is core to your offer.
You may wish to consider building relationships with organisations that offer support specific to certain cultures, languages, sexualities, genders, and economic backgrounds. Connecting with local organisations with specific knowledge of different communities may be helpful in understanding and addressing possible barriers to access. It’s also important to consider whether your service is practically and physically accessible to people who have additional needs.
Socio-demographic factors, geography and other local indicators as mortality and morbidity can all play a role in how bereavement support can be delivered most effectively. The views of people with lived experience will be an important source of feedback to inform future service development. By linking into wider suicide prevention networks (via the steering group, or multiagency networks), the service should be able to identify and use local data and intelligence to provide a focused service that reflects local need.
Suicide bereavement services are in a strong position to contribute their knowledge and expertise into local systems to inform the local suicide prevention response.
The suicide bereavement support service is an integral part of the local suicide prevention strategy. It is anticipated that, where appropriate, it will form part of the local response to local and national events. For example, during the pandemic, many local services needed to respond rapidly to an ever-changing delivery environment, moving support online or to telephone where necessary.
Real time referral (RTR) is a growing area of suicide bereavement support practice, with increasing numbers of local partnerships being established between coroner’s offices, first responders and suicide bereavement services to share data immediately after a suspected suicide.
The benefits of real -time referral is clear, in that bereaved individuals are quickly in touch with support at a time of most acute grief and potentially least support. Real- time referral may already be established in your local area or work may be in progress; working in partnership will help to deliver a clear pathway to offering timely support.
Providing a single point of access (for example phone or email) will simplify the referral pathway and assist people to contact the service quickly and to facilitate support, referral and signposting where appropriate. A local directory of services or have agreements with other organisations to warm transfer a (for example) young person to the most appropriate service.
A single point of access will also be helpful to referrers and stakeholders who will be able to provide one contact to people bereaved.
Relationship-building with stakeholders in the local community has been highlighted across a number of the standards as being key to the successful and effective running of your service. While a service may not be able to reach every bereaved person immediately after their loss (or indeed, not every bereaved person may want to access support at that time), sharing resources via first responders and coroners may expedite the process of the bereaved being aware of how to access support.
Make use of resources already available nationally, as well as your local service information
Evidence suggests that many people bereaved by suicide want immediate outreach from a range of voluntary and statutory support services (see link 1 below). Different services use different ways to make that first contact, but many will contact by telephone in the first instance, using that telephone conversation to talk about what support a person might want and how and when that might be offered.
Whilst proactive contact within 72 hours, is important, support may not be accepted immediately. Some people may find it helpful to know that support is available, yet prefer to access it at a later stage and services should consider developing a suitable follow-up process.
It is important that a potential service user understands what your service can offer to them. How will you meet and how often? What range of support will be offered directly by the service and what will be signposted to other local support?
Having a clear support pathway in place, that you can tailor to individual need, can help to communicate your offer and set people’s expectations.
Each person will have different needs. Bereavement after a suicide brings emotional and practical challenges and the support required can range from signposting to local or national agencies for support with legal or practical issues; liaison with the coroner’s staff and police on behalf of the bereaved; liaison with other support organisations; as well as containing the distress associated with complex grief. Again, partnerships are key to be able to signpost to specialist support and expertise where it is required.
A selection of resources is listed below
Where there are children and young people who have been affected it will be important to provide specific information and advice, linking with specialist support as required.
National organisations that offer both support for children and young people bereaved by suicide and information and resources
NICE Guidance (QS189) on Suicide Prevention Quality Statement 5: Supporting People Bereaved or Affected by a Suspected Suicide outlines the importance of support that is tailored to meet the needs of individuals. Support should focus on the areas of most importance to the individual, with the understanding that those priorities may change over time, as a relationship develops with the suicide bereavement liaison (SBL) worker and a person moves through their support journey.
It will be important to consider, not only an initial assessment of risk, but also an ongoing assessment of risk and symptoms of depression, anxiety, post-traumatic stress disorder etc, with possible referral for treatment where appropriate.
It is not expected that the SBL worker or wider service will necessarily directly provide all the elements of support and particular/specialist expertise. Where appropriate the SBL should refer/signpost to other agencies, for example Citizen’s Advice Bureau, housing support, or other voluntary sector services such as the Coroner’s Court Support Service. An important function of the SBL worker or wider service is to work alongside the individual to facilitate the support that will meet their needs.
The approach taken to assessment and support planning will reflect the requirements of the organisation. Some services may be part of a larger organisation that can provide all appropriate support; whereas others may need to be aware of referral pathways into local services (e.g., IAPT, Community Mental Health teams, etc.).
Risk is dynamic and may change throughout the individual’s journey. It is therefore important to ensure they have contact details for agencies, such as Samaritans, and the local area’s single point of access number for NHS mental health services/NHS crisis helplines. This information can be listed on the service leaflet, or through support information provided, with occasional but appropriate reminders that these numbers are available.
Building a relationship with one person is important and should be facilitated where possible. Where offered continuity of input, bereaved people may feel reassured that they will not need to retell their story to different team members. However, there may be circumstances in which this cannot be offered, this could be due to staffing/operational structures, leave, sickness or staff turnover.
Any changes in personnel should be communicated carefully and reassuringly with those in contact with your service well in advance of any changes, where possible
People may want to access support at different times in their journey. For example, bereaved individuals may find birthdays, anniversaries, and other important events that included the person who died particularly difficult, even years after their loss. Christmas and family occasions may bring up painful emotions leading to a need for more support. Understanding that there is no fixed endpoint to grief after suicide is important in providing a service that can respond to this.
Services should have the capacity for flexibility, partnership working and signposting, where appropriate, including anticipating difficult milestones.
Where a bereaved person’s needs change over time, a flexible approach to signposting and linking with other services will be important. Some people may need more therapeutic support, others may need guidance on employment or housing, each at differing points. It may be helpful to have a set check-in or follow up point several months following the end of a support period, so that any further help is identified and offered – perhaps through partners and organisations locally.
Most services collect activity and outcome data to understand their reach and impact. Data provides an opportunity to review the service to identify what is working well and where improvements can be made. Activity and outcome data may also provide an opportunity to realise and address local inequalities.
An important element of evaluating and monitoring the service should be in gathering and responding to the experience of people who have used the service. There are a number of ways that existing services have managed this process, from the use of brief tick-box forms to more in-depth methods. Establish and engage in a co-production model to inform and develop your service monitoring structures.
The collection of feedback from people using the service can form part of a wider evaluation framework but may also be used by service to prompt a more immediate response to improve how they work.
The suicide bereavement support sector is developing all the time and as more services are established, there is much to gain from engaging in that overall development. By sharing good practice, taking part in research and being part of national policy influencing activity, we can ensure that the sector continues to respond to the needs of the bereaved.
National opportunities for networking and engagement can be found via the Support after Suicide Central Hub, as well as through the National Suicide Prevention Alliance.
This may include reading key articles, research digests, attendance at training events, following Twitter and Facebook accounts, and attending conferences.
An evaluation framework to guide the systematic collection and analysis of information supports service development, provides thorough monitoring of activities and ensures good governance. Evaluation enables people delivering services to understand the needs of service users and to improve the support that they provide.
Evaluation should start at the outset, when you are planning your service and putting in place aims, objectives and key performance indicators to review on an annual basis.
Demonstrating capacity to support people bereaved by suicide through evaluation can support the service to remain effective and sustainable. Monitoring service uptake can also allow you to plan for any necessary expansion in capacity once the service becomes more established and well known. Plan in advance for this longer-term outlook by including costed proposals for growth in your sustainability plan.