Support After Suicide 2020 report: “We were fighting the system as well as the illness"

About this report

This report explores the perspectives of family members of people in Victoria whose loved ones took their own lives. It describes how they viewed Victoria’s complex mental health system, both in how it responded to their loved one and to themselves.

The grief and despair these words express, from a mother whose son took his own life aged 30, is why Jesuit Social Services has produced the current report “We were fighting the system as well as the illness”: family perceptions of how Victoria responds to people at risk of suicide and their loved ones.

Unfortunately, this mother’s experience was not an isolated one. In this report, her voice joins with more than 140 other Victorians who have lost a loved one to suicide and are now calling for significant change to Victoria’s mental health system.

You can hear from the many voices who contributed to this research in the full Support After Suicide 2020 report.

Support After Suicide is a suicide bereavement counselling service established in 2004 and run by Jesuit Social Services. It currently works with about 1000 people each year.

As a result of its work with Victorians who are grieving the loss of a loved one to suicide, the psychologists and counsellors at Support After Suicide have heard both positive and negative experiences of Victoria’s mental health system. Over time, our counsellors noticed a pattern. Families told them over and over again that their loved ones had sought help from the system but had not received it. They told us that they felt the system had excluded them from care plans or had refused to share critical information about what was needed to keep their family member safe. Many families believed that if the mental health system had responded more effectively, the death may not have occurred. And after their loved one died, they felt that the mental health services for themselves were not available or were inappropriate.

We understand that there are a range of contributing factors that may lead to someone taking their life. In this report, we focus on the mental health system and its failure to prevent suicide. We raise the voices of the loved ones left behind – these voices need to be part of the story.

As a result of these stories, Jesuit Social Services decided that we needed to support these family members to contribute to an important conversation about preventing suicide in Victoria – a conversation where those with experience of the mental health system are at the heart of the discussion.

You can read more about family perceptions of how Victoria responds to people at risk of suicide and their loved ones in the full report.

Warning about content

We understand that some of the content in this report might be distressing for some readers.

• The following services provide support. If you are not in immediate danger but you need help, call NURSE-ON-CALL on 1300 60 60 24.
• For crisis support contact the Suicideline on 1300 651 251 or Lifeline on 13 11 14.
• If you are looking for a mental health service, visit betterhealth.vic.gov.au.
• For situations that are harmful or life-threatening contact emergency services immediately on triple zero (000).
• Call Support After Suicide on (03) 9421 7640. Email: aftersuicide@jss.org.au

Purpose of this report

This report explores the perspectives of family members of people in Victoria whose loved ones took their own lives. It describes how they viewed Victoria’s complex mental health system, both in how it responded to their loved one and to themselves.

The report has three research aims:

1. To identify family members’ perceptions of support provided by Victoria’s mental health system to a person before they died, and to identify any gaps in that support
2. To identify what information, support and inclusion of family members was offered by Victoria’s mental health system so they could appropriately care for a person at risk of suicide, and identify any gaps in that support
3. To identify what support was provided to family members after the death, and any gaps in that support.

About the participants we interviewed

We surveyed 142 former and current participants of Jesuit Social Services’ Support After Suicide counselling service whose loved one had died between three months and five years previously. Each respondent refers to a unique suicide and no question was compulsory. As a result, different questions have different sample sizes. From this survey sample, 28 people were interviewed in depth to provide a rich qualitative insight on their perceptions of Victoria’s mental health system.

Many family members reported their loved ones had been experiencing abusive events, such as family violence, abuse and neglect, and bullying. Bullying, especially at work, school or online, was associated with a concerning 41 per cent of the 142 suicides in our survey sample, as reported by a family member. More than one in five of those people who experienced bullying did not seek help, according to their loved one. One third of the people who died were recently separated from their partner. A large majority (89%) of people who ended their lives had a mental illness, as identified by their family member. About half (47%) were experiencing either unemployment and/or financial stress, and one half (47%) were known to have attempted suicide in the past. Almost 70 per cent of those who took their own lives had previously sought help from a health professional, most commonly a GP. Many made several attempts to seek help.

Family perspectives of services provided to the person who died

The 142 people represented in our survey who took their own lives had accessed services 3.5 times before their death (ranging from none to 11 times). Almost 20 per cent of men did not access services at all before they died, while 10 per cent of women accessed no services.

Family members expressed mixed views on the quality of services provided to their loved one. Public psychiatric hospitals, Victoria Police, public psychiatrists, hospital emergency departments and Crisis Assessment and Treatment (CAT) teams received the most “poor or very poor” ratings in percentage terms, while private general hospitals, relationship counsellors, GPs and private psychiatric hospitals received the most “good to very good” ratings. It should be noted that the services that received the lowest ratings were also those most likely to be encountering people in acute or crisis situations.

In interviews, 27 of 28 family members expressed concerns that mental health professionals did not appear to have the skills to recognise that their loved one was at risk of suicide or to complete an adequate treatment plan. Five family members reported positive experiences with the mental health system, specifically in their dealings with the CAT teams, Victoria Police, psychologists and psychiatrists. Nineteen family members reported repeated negative experiences across one or more of the five following areas:

• Admission and discharge from hospitals or psychiatric units
• Support and treatment while in care, including communication between services
• Follow-up care and support
• Staff skills and knowledge
• Medication error or misunderstanding of medication.

Family perspectives of support to help them care for their loved ones

Seventy-nine per cent of the 142 family members surveyed said they felt the mental health system put up barriers to accessing information or help in caring for their family member. More than half stated that health professionals cited privacy as the reason for excluding families while more than one quarter said they were not told of their loved one’s level of suicide risk.

Of the 545 individual services accessed by a family member (many people accessed more than one service), no information or support was received on 375 (68%) of those occasions. For those who did receive support, responses were mixed. For example, of the 85 family members who visited a GP, 63.5 per cent reported they received no information or help relevant to the care of their loved one. Consistent with this finding, of 50 family members who approached a hospital emergency department, almost 63 per cent said they received no information or support and were excluded from the care of their loved one.

Every one of the 28 family members interviewed identified at least two ways they felt the mental health system failed in helping them provide the best care for their loved one. Families also consistently reported that they found the mental health system complex and difficult to negotiate, and several felt this factor alone put their loved one at risk of substandard care. Twenty-seven of the 28 family members interviewed told us they were often left uninformed or under informed about how best to care for their loved one, even when the mental health system had diagnosed them with a psychiatric illness or identified them as being at risk of suicide.

Some family members felt the system treated them as playing no role in the care of a suicidal person, even when they were the primary carer or had the most significant relationship with them.

Family members reported that:

1. They did not know how to navigate the mental health system
2. They felt elements of the mental health system did not listen to them
3. They felt they were not supported in caring for their loved one
4. They experienced negative attitudes
5. They felt they were not informed about their loved one’s care, especially in relation to diagnosis, treatment plans and/or discharge.

Some family members were concerned that a seriously ill person was being released into their care. They felt that while they were loving family members, they lacked professional skills and so felt unsupported and uninformed in caring adequately for their loved one.

Family members reported that:

1. They did not know how to navigate the mental health system
2. They felt elements of the mental health system did not listen to them
3. They felt they were not supported in caring for their loved one
4. They experienced negative attitudes
5. They felt they were not informed about their loved one’s care, especially in relation to diagnosis, treatment plans and/or discharge. Some family members were concerned that a seriously ill person was being released into their care. They felt that while they were loving family members, they lacked professional skills and so felt unsupported and uninformed in caring adequately for their loved one.

Services provided to family members after death

Prior to contact with Support After Suicide, families reported difficulties accessing information and support. Overall, 80 per cent of the 129 family members who responded had been offered some kind of help after a loved one took their own life. They reached out commonly to GPs (who mostly offered condolences), and psychologists (who mostly offered a meeting), as well as Victoria Police. Other services contacted were: psychiatrists, welfare agencies, hospital emergency departments, telephone crisis lines, relationship counsellors, community health centres, the CAT team, drug and alcohol counsellors, and a school counsellor.

Twelve of the 28 family members interviewed highlighted how a lack of support in the time after their loved one’s death contributed to a decline in their own mental health. Thirteen family members told us services were available but not helpful. Eight told us services for family members were not available at all, while six reported a positive experience with post-suicide support services. All 28 reported that services such as Jesuit Social Services’ Support After Suicide program were helpful.

Implications and next steps

The findings from our survey and interviews suggest the mental health system is not providing the level of service required to move people away from suicide. The report also highlights systemic problems that result in the exclusion of family members from knowing about a loved one’s mental state.

Four significant implications for Victoria’s mental health system arise from the report:

1. There may have been situations where weaknesses in Victoria’s mental health system failed to prevent a person taking their own life
2. These weaknesses may still be affecting Victorians currently at risk of suicide
3. There may be Victorian families currently feeling a lack of confidence to advocate for their loved one in the mental health system because they don’t feel supported or informed enough to do so
4. There may be hundreds of family members currently not receiving the support and information they need as they experience the significant grief and trauma that comes when a loved one takes their own life

Jesuit Social Services envisions a simpler and more family and person-centred mental health system, where people at risk of suicide and their family members are communicated with respectfully and in a way that preserves their human dignity. Family members and carers must receive support and be informed of strategies to reduce the risk of suicide occurring.

As importantly, the needs of families bereaved by the suicide of a loved one can no longer be overlooked. They should be referred to post-suicide support services – and those services need to be properly funded.

It is time for the family members of people who have taken their lives to be allowed to join the conversation about how to make Victoria’s mental health system as strong and as effective as it can be.

We need a well-functioning mental health system that truly meets the needs of those at risk of ending their lives and supports families in helping them reduce the risk of suicide occurring.

With this in mind, we make the following ten recommendations, derived from the experiences of family members who participated in our study and by Jesuit Social Services’ own professional practice and insights.

Recommendations

The safety and care of people at risk of suicide must be at the heart of any response. To achieve this, we recommend:

• More training, resources and targeted support for health practitioners to extend their knowledge and skills in relation to conducting risk assessments, and caring for and supporting people at risk of suicide.
• Ensuring the outcome of risk assessments results in an appropriate level of care that is also communicated to family members and primary carers.
• Strengthening community responses to ensure an integrated continuum of care for people at risk of suicide that matches their clinical need. More responsive and accessible care in the community would provide more appropriate responses for people at risk of suicide and reduce pressure on emergency care settings. Such responses might include:
  • Welcoming and easily accessible entry points to mental health support services across the spectrum of response – prevention, early intervention and treatment. Such a model, which might be an expansion of current community health centres, must be effectively promoted, be co-designed with people with lived experience, and may include:
    • immediate crisis support and coordination of longer term support, including assessment and triage with multiple agencies
    • risk and needs assessments and direct assistance, including GPs, counselling and case coordination for people at risk of suicide and their carers
    • co-location of services and links to other health services, social service providers and schools
    • client and family case managers to act as advocates with other parts of the mental health system
    • engaging personal networks around individuals at risk of suicide, especially compassionate support and guidance for family members supporting loved ones.
  • Therapeutic residential care for people who are at risk of suicide and in need of intensive treatment and support. Such care would provide relationship-based support and counselling and connect to family and peer support.

Families must be empowered and supported to advocate for loved ones at risk of suicide and, wherever appropriate, to be involved in treatment and support decisions. To achieve this, we recommend:

• A review of how confidentiality practices and protocols may be preventing professional staff from providing families with information and guidance on appropriate care, and may also prevent families from providing relevant information to professional staff. Any review must include a consideration of how these barriers might be overcome.
• Specialised training for mental health and other health practitioners working with people at risk of suicide to ensure families form part of a holistic and continuing care response team and are not inadvertently excluded due to misunderstandings of existing privacy legislation. Recent training initiatives related to family violence and child information sharing schemes, as recommended by the Royal Commission into Family Violence, could serve as useful models in this regard.

Suicide-bereaved people are at a higher risk of suicide themselves and can experience complex grief and trauma. To support them, we recommend:

• That the Victorian Government provide secure, long-term funding for statewidepost-suicide services for suicide bereavement, including the Support After Suicide service provided by Jesuit Social Services. This would also include increased access to suicide bereavement services for people in regional and rural areas.
• That the Federal Government increase its current funding to Support After Suicide and streamline funding arrangements.
• Establishing consistent reporting and evaluation requirements across Primary Health Networks, as recommended by the Productivity Commission. Jesuit Social Services has built strong relationships with the various Primary Health Networks (PHNs) that fund Support After Suicide to deliver services in Victoria. The PHN model works well to enable organisations to deliver key services to meet local needs. However, each PHN has different reporting and evaluation requirements, which places a sizable administrative burden on Support After Suicide. Consistent reporting requirements across different PHNs would help ensure greater efficiency for service providers with limited resources as well as comparable data across PHN catchments.

Any system that seeks to intervene in a person’s health care must be underpinned by a strong evidence base. To help achieve this we recommend the Victorian Government provide dedicated funding to develop an evidence base on:

• The impact and effectiveness of the suicide prevention and intervention services in the Australian and Victorian contexts.
• The impact of suicide and the effectiveness of post-suicide services in the Australian and Victorian contexts.

Download the full report

Learn more about the Support After Suicide program