Care and loss

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.