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Reducing the suicide rate, particularly among young people, is a major government target.¹ However, a recent study of the views of parents who have lost a child through suicide reveal a high level of dissatisfaction with the support they receive from services both before and after their children's death.

Why was there so much dissatisfaction with the support offered, what were the parents' needs and do social care professionals have a role with such families?

The 46 young people covered in the study were, as a group, similar in profile to those found in national studies of suicide. Twenty-nine were aged between 19 and 24 at the time of their death and more than three-quarters were men. Carbon monoxide poisoning and hanging were the most common methods of suicide, and young men were more likely than women to choose violent methods.

Most of the parents surveyed (83 per cent) felt they had not received the professional advice or help they needed. Crucially, many of their comments related to the period when they were struggling to respond adequately to a young person known to be distressed or in need of help. One-third said they wished they had been more insistent in attempting to obtain help from health services. The need to be proactive and assertive was a constant theme in their responses. For example, one parent advised others in the same situation to "lobby institutions, be a nuisance, make a fuss - even if it leads professionals to condemn and resent you".

Many of the responses (20) identified service deficits. These included specific problems such as lengthy waiting lists for appointments, with some saying that young people had to wait weeks for appointments with counsellors, particularly in primary care settings.

Other parents were concerned less with delays and more about an absence of appropriate provision for young people in crisis. One parent argued that the "psychiatric" service should be replaced by community-based provision for young people. Another had considered paying for an adolescent centre place in the private sector but the cost had been "prohibitive". Some wanted a dedicated or specialist service for young adults with mental health needs.

In some cases, parents' sense of pessimism about existing services seemed to derive from professionals themselves. One parent who consulted her GP about her son's depression was told that, even if her son saw the doctor, there would probably be nothing he could do for him. "He [the GP] gave us no advice and made no suggestion that we might see someone else who might help," she said.

This lack of information and appropriate care was echoed by another parent who described how, in the period after a suicide attempt when her son was living at home with his parents, they "were not informed or advised what services could be available".

Twelve of the parents who considered that they had not received adequate or appropriate help identified a lack of communication between parents and health services. Several felt they had been excluded from their child's assessment and treatment, and that professionals had missed the chance to ask them for background information. They argued that their perceptions as carers were relevant and should have been incorporated into assessments. "We, as a family, should have been included as we were living through this with him and could see how ill he was," said one.

Codes of confidentiality were experienced as being one barrier to communication, with parents subsequently feeling only peripherally involved. Others felt that had they known more they could have done more; though one parent, while wishing that the family had been more involved, acknowledged that their son "did not wish it. And we respected his right to be a free adult."

Also, some parents identified their own support needs while they were struggling to care for a son or daughter who was actively suicidal. Consequently, several highlighted the potential value of professional help for themselves at such times. In particular, they needed guidance on how best to support their children.

Similarly, they experienced a lack of support after the death of a child. Other research² has described support for those left behind after a suicide as a neglected area, and this was confirmed by this study. For example, one parent noted that "nothing at all was offered", while another referred to the need for "more compassionate treatment and understanding by the police and coroner's office".


The need for support was thrown into relief by the fact that the parents often experienced a heavy burden of guilt and self-blame - in some cases over many years. So it seems clear that systems of support need to be developed that take account of the views and experiences of parents themselves.³

Although the parents made little reference to input from social workers, they have skills and relevant experience in many of these areas of need. Principally, social workers can act as advocates for families with limited experience of negotiating with health and welfare services, offering advice and information on local and specialist resources.

This is underlined by the fact that parents needed an intermediary at some points in their interactions with health professionals. In this role, social workers can draw on the experience of psychosocial approaches in mental health work, which seek to identify and build on the positive contributions families can make to the care and treatment of service users. Such a model would value parents' roles as carers and seek to involve them as partners in the assessment and treatment of young people. This approach emphasises the caring capacity of families, rather than focusing on family pathology.

Social workers may also have a role in negotiating confidentiality between families and professionals. Families need to understand the purposes of codes of confidentiality, while professionals need to look for ways in which relevant information can be made available to those managing crisis situations on a day-to-day basis.

In short, supporting parents is a central task of social work. The profession needs to develop its understanding of the short and long-term impacts of suicide and develop ways to reach those needing support. There may also be a role for social work in collaborating with other professional groups to develop joint awareness and skills in this area.

The professional response to suicide is often confined to refining systems of risk assessment, though the rarity of suicide limits the capacity to predict risk accurately. But this work suggests a need for service activity that considers the needs of families and carers; it also offers useful pointers for social care workers in primary care or specialist settings.   

Nicky Stanley and Jill Manthorpe are researchers and lecturers in the department of social work at the University of Hull. A full, or summary, report on this study is available from Nicky Stanley at N.E.Stanley@hull.ac.uk 

References

¹ Department of Health, National Suicide Prevention Strategy for England - Consultation Document, DoH, September 2002 
² Nicky Stanley and Jill Manthorpe, "Responding to student suicide", in N Stanley and J Manthorpe (eds), Students' Mental Health: Problems and Responses, Jessica Kingsley, 2002 
³ See M Harvey, "When our children kill themselves: parental perspectives following suicide", in N Stanley and J Manthorpe above

The study

Forty-six parents completed a questionnaire distributed by Papyrus, a voluntary organisation that campaigns to reduce young suicide. The responses were analysed by researchers at Hull University. The parents provided a range of information about their children and the circumstances surrounding their deaths as well as their evaluations of services.