Pillars of Postvention Presentation

The Pillars of Postvention
for Suicide Events
Is your organization ready if
a someone kills
Presented by:
Project Coordinator
Funding for this presentation was made possible (in part) by grant number U79 SM060427-01 from SAMHSA. The views expressed in presentation materials do not necessarily reflect the views,
opinions, or policies of CMHS, SAMHSA, or HHS; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Yesterday, 17 year old Sarah Smith, a client of a XYZ
Behavioral Health Center for 6 months, watched a video
about bullying in her health education class.
During school, Sarah texted a friend that she often thought
about harming herself. That afternoon, the friend told the
guidance counselor about the text, and the school resource
officer (SRO) made a visit to her home. Sarah said she was
just venting to a friend.
At 4 pm, after the SRO left, Sarah contacted the counseling
center and left a message for her counselor that she needed
to see someone immediately. No one returned her call.
This morning, before school, Sarah killed herself.
What happens next…
What is the agency’s role?
Provide mental health/psychological first aid to
Engage community, school and family in crisis
Strive to balance support for the grieving;
including those that worked with deceased
Help family members with practical matters
Review clinical files
Contact the legal department
What is the school’s role?
Identify youth and staff that may want to
address mental health concerns or suicidal
Strive to balance support for the grieving
Attempt to maintain educational routines
Prevent suicide contagion; which is critical to
the prevention of future suicidal behavior
Training Outline
Define Suicide Postvention
Overview of the Pillars of Postvention
Utilizing community resources
Development or implementation of Immediate
Response Plan
Considerations for implementing of the Pillars
Keys to Suicide Prevention efforts
Goals for training
Definition of Suicide Postvention
Providing crisis intervention,
support, and assistance for
survivors of a suicide event
*Requires effective planning
Person who has lost someone
Process of adjusting to a loss (such as death by suicide)
Physical, emotional, cognitive and spiritual response to actual or
threatened loss of a person
Common Reactions
Responses to suicide and attempts to cope vary among
family, friends, staff, faculty, administration and community
 Confusion and shock
 Sadness
 Helpless
 Nervous and frightened
 Aversion and avoidance
 Adversarial
 Irritation, disgusted or angry
 Sense of responsibility and guilt
 Emotional exhaustion
The Pillars of Postvention
1. Crisis Response Team
2. Community Connections
3. Immediate Response Plan
4. Media Communications
5. Bereavement Support
6. Self-Care
7. Memorials
8. Long-Term Monitoring and
Suicide Prevention Training
Crisis Response Team
Crisis Response Team
Recommended Team Members
 Director of the Team
 Assistant Director
 Clinical Staff
 Safety/Security
 Quality Assurance
 Finance
 Administrative Support
 Facilities or Grounds
Crisis Response Team
 Once identified, convenes to develop
protocol and plan for decisions and
 Responsible for determining details of
protocol and implementing tasks of
response plan
 Established ahead of time
 Identify individuals based on role, diverse
skills, and emotional competency
 Create linkages between staff and
community partners
CRT Planning Process
 What types of responses will be made to staff, family, parents,
community, and the media?
 How will we address language and cultural considerations?
 How do staff identify those in need of aftermath intervention?
 Where will they be referred for any psychological trauma?
 Who will review the adequacy of each response and make
appropriate revisions in crises response plans?
 What trainings are needed for staff?
 How will everyone be informed about emergency and crisis
Community Connections
 Work with your community to help better
meet the needs of students and staff
 Involve the community in the planning
 Coordinate crisis plans
Steps to Working with Your Community
Identify resources and referrals
Build connections and develop partnerships
Empower leadership with partners
Disseminate information
Refer out to agencies within the community
and at large (internet)
Utilize Community Resources
 Community Mental Health Centers
 Local Crisis Center
 Police Department
 Mayor’s Office
 Coroner/Medical Examiner’s Office
 Clergy
 Funeral Directors
 Other Schools
Who can help and
what can they do?
Immediate Response Plan
 Step-by-step protocol to guide CRT
 Develop in advance
Immediate Response Plan
Phase 1: Notify CRT
Alert CRT Director of possible situation
Verify the death
Notify agency or workplace leadership
Activate CRT
Phase 2: Assessment and Decision Making
 Assess situation and choose level of response
 Reach out to family of deceased
 Determine what and how to share about death
Immediate Response Plan
Phase 3: Notify Other Key Personnel
 Front office staff
 Workplaces or schools attended by family of the
deceased (siblings)
 Coordinate with external professionals
 Contact your Employee Assistance Plan
Phase 4: Notify Agency or School Community
 Conduct staff meeting to notify staff: provide facts,
guidance, and plans
 Coordinate announcements
 Notification of community (SPRC Guidelines)
Immediate Response Plan
Phase 5: Support Staff and Community
Conduct daily CRT meetings
Present updates to staff
Provide guidance for talking to survivors
Identify, monitor, support and/or refer
Help with emotional regulation
Provide support to staff, family and community
Conduct meetings to share facts and guidance about
helping survivors cope
 Participate and/or advise on appropriate
Immediate Response Plan
Phase 6: Minimize Risk of Contagion with Media
 Work with media representatives
 Monitor reporting of the death and postvention efforts
to ensure objectivity and free of stigma
 Monitor social media
Phase 7: Evaluate Response
 Review and evaluate the crisis intervention activities
(what worked, barriers, etc.)
 Make plans for follow-up actions
 Revise protocol based on lessons learned
Media Communications
Develop partnerships
Designate media spokesperson
Plan ahead for all interviews:
What are the key points to share
with a reporter?
Prepare for Common Questions:
What prevention programming does your
agency/school currently have in place?
Is the agency/school prepared to handle this
particular case?
What impact has the death had on the
community so far?
Media Guidelines: What NOT to do
Don’t sensationalize or romanticize the death by
Report/show pictures of flags at half-mast
Permanent public memorial such as planting a tree, establishing a
scholarship fund, or presenting a plaque
Pictures of the death scene should not be used
Don’t dramatize the impact of suicide through
descriptions and pictures of grieving friends or
Don’t over simplify the problem or present
suicide as a means of coping with personal issues
Don’t talk about method of death by suicide
Media Guidelines: What to do
• Do provide factual info
• Do state concern for the victim and their family
• Do acknowledge the deceased person’s problems and
struggles, as well as the positive aspects of his or her life
• Do provide information on state, local, and school
resources available for suicide prevention and crisis
• Do encourage news reporters to provide info that
increases public awareness of risk factors, warning signs
and community resources
• Do communicate to news professionals the dangers of
suicide contagion and inappropriate reporting
Social Media
Be prepared to manage rumors
Use social media to your advantage
Main goals:
Distribute information and resources
Monitor comments
Collaborate with community
Bereavement Support
 Suicide is unique kind of loss and disrupts
normal functioning
 Be aware of common survivor responses
and how to address them
Active Listening
Be present
Be patient
Recognize the loss and encourage sharing
Provide a safe environment
Offer support
Recognize finality (impulsivity)
Emphasize resources
Follow up
Interaction with Grieving Survivors
Be calm and direct
Give accurate information
Emphasize that no one else is to blame
Talk about emotions
Convey a sense of hope
Build coping strategies
Get students connected
Get students involved
of Bereaved
Bereaved Students
What do you do about issues of depression?
Communicate with the family
Provide special support and accommodations
Offer a list of community resources
Link survivors to support services
Self-Care for Survivors of
Take care of yourself!
Encourage your staff to ask for help
Have support systems in place for staff
Develop ongoing support groups
Take advantage of resources
Taking a yoga class
Walk barefoot
on the hot sand at the beach
A bath at the end of the day
Going for bike rides
Watching a movie
Cooking a meal for myself and being really present
Getting up and listening to music
Walking with my dogs
Head out for a hike in nature
Take a road trip and visit a friend
What do you do for
 Survivors often desire service to
remember the deceased
 Can be an important part of grieving
 Inappropriate memorials can lead to
negative consequences
Memorialization “Don’t”s
Don’t treat certain deaths differently
Don’t focus on cause or manner of death
Don’t hold large student assemblies
Don’t dedicate special events to the
Don’t establish permanent memorials
Memorialization “Do”s
Do treat all deaths alike
Do focus on attributes about the deceased
Do offer alternatives to memorials
Hold a day of community service
Put together a team for the AFSP Out of the
Darkness Walk
Sponsoring a Mental Health Awareness Day
Have a Memorial Book for survivors to write
in a give to family
Memorials: Other Considerations
Funeral/memorial service planning should take
everyone into consideration
After hours
Supervised alternatives
Recognize significant dates and be prepared
Focus on education, prevention and living
Online Memorials
Work with survivors to create a page & engage
in social media memorialization appropriately
Monitor content of posts
Monitor the length of time that a
memorialization page is kept active
Be aware of any other online memorials that
may have been created
Suicide Contagion
Be aware of “copycat” behavior
Wanting to mimic the tendencies or behaviors
of one who died by suicide
Changes in environment help to reduce
likelihood of contagion:
Avoid glorifying the suicide
Avoid excessive details
Avoid normalizing
Risk Factors for Suicide Contagion
Make everyone aware of risk factors
Survivors may be at-risk if they…
Identify with or feel responsible for death
Had a relationship with the victim
Have a history of suicidal behavior, significant stressors,
or psychopathology
Show symptoms of helplessness/hopelessness
Lack internal and external resources
Long Term Monitoring and
Suicide Prevention Training
Updates to Response Plan
 Routine re-evaluation of postvention protocol
Changes in staff or structure should be reflected
Improve procedures as indicated by lessons learned during
Modify policies or procedures as research is produced
 Provide copies of protocol action steps
 Explain Immediate Reponses Plan
Train staff in protocol implementation
Communication policies
Policies about memorialization
 Clearly specify rationale behind policies and changes
Long-Term Prevention
Follow-up with at-risk individuals
This should continue for as long as necessary
After allowing time to grieve, implement a
system-wide suicide prevention plan including:
Identification of warning signs
Identification of risk factors
Means reduction and gun safety
Identification and promotion of protective factors
Encouragement of help-seeking and adaptive coping skills
Long-Term Prevention
ERs, Physicians,
Providers, Not
for Profits
& Youth
Gatekeeper Training
Intervention Training
Peer to Peer Training
Family Empowerment
Community Based Services
Community Coordinating
Training Staff and Communities
 Educate about mental health issues underlying suicide and
suicidal behaviors
 Train on how to talk with youth about grief and coping
 Inform and provide a list of available resources in the
 Practice the steps of the protocol
 Model and role play discussions with staff that may be
Staff may feel hesitant and unequipped to respond to concerns
Training staff techniques for responding to questions and support
can increase staff confidence and boost supportiveness of the
workplace climate
Questions and Comments
Melissa Witmeier
Project Training Coordinator
Florida Youth Suicide Prevention Project
Florida Council for Community Mental Health
Thank you for attending today’s training!

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