Postvention: when prevention fails

Suicidal behavior is a complex phenomenon influenced by psychological, biological, social, cultural and environmental factors, which can affect people of any age, gender, culture or social group. This multicausal nature implies that a systemic and transversal approach is necessary for prevention. However, When prevention fails, we have to start talking about postvention.

The postvention consists of offer support to the family and close environment of people who have died by suicide. This process is as important or more important than suicide prevention. People close to you may have feelings of ambivalence due to the strong stigmatization that exists regarding suicide.

In Spain, suicide is the leading cause of unnatural death, even above deaths due to traffic accidents. In our country, between 3,600 and 3,700 people commit suicide a year, which translates into 10 deaths a day and 2.5 deaths every hour.

The WHO reports nearly one million deaths a year from suicide and predicts that, for this year 2020, the rate may increase to one and a half million. Men commit suicide to a greater extent, while women make twice as many attempts.

Suicide prevention

In the presence of suicidal ideation, It is important that the person turn, without shame, to someone they trust with whom they can share what is happening. and let him help you. It is also necessary to put yourself in the hands of professionals who can carry out the appropriate intervention.

Remember that Suicide is a permanent solution to a problem or problems that are almost always temporary. On the other hand, the fact of not finding a solution does not mean that it does not exist, that it cannot be found the next moment.

The person can be helped to identify the situations that trigger crises; That is, to identify the cause of suicidal thoughts in order to recognize when a crisis may occur.

The development of a type of “safety plan” by the affected person, with or without the help of someone close to them or a professional, can help reduce the probability of committing a suicide attempt. This plan may contain the following points (at an indicative level):

Warning signs.Supports. Names of trusted people, along with their contact information so you can call them in case of emergency or imminent suicide attempt.Anchor points. People or reasons why it is worth continuing to live.Protection Guidelines. Search for non-suicidal solutions, elimination of objects with which harm could be inflicted. List of telephone numbers of 24 hour attention services.Reminder call 112, the Telephone of Hope or go to the emergency room from the nearest hospital, in case the previous preventions have not worked and the risk is imminent.

And when everything fails? Postvention

As we have mentioned, postvention consists of offering social, psychological and institutional support to the people in the immediate environment of a person who died by suicide. These people must be helped elaboration of healthy grief and to address risk factors for a complicated grieving process.

The grieving process is different for each person and Suicide grief is very different from any other type of grief.. There are no “right” or “wrong” reactions and any feeling is normal and acceptable (shock, denial, guilt, pain, shame…).

It is common that after death the “whys” begin to appear (why did he do it? Why didn’t I help him?…) and the “what ifs” (what if I had realized? What if I had sought help?…).

As the grieving process progresses, one begins to understand that, although suicide can be prevented in some cases, in others all preventive measures are useless and insufficient. The result will not have depended on the people in the environment. You end up understanding that not all questions have answers and that, sometimes, the reasons will not be clarified.

Acceptance is the best way to integrate loss. No matter how difficult it may seem, you end up respecting the deceased’s decision and stopping blaming him or her for the suffering caused. He is forgiven, but the environment itself is also forgiven. However, feelings of guilt can persist despite having accepted the loss and forgiving the deceased.

Breaking myths about suicide: basic strategy in the postvention phase

Suicide is surrounded by myths and is a taboo subject. For this reason, many times, family members and friends of a person who has committed suicide are involved in ambivalent feelings. Along with sadness, anger and rage may appear. Shame is a common feeling, which often leads to hiding the true cause of death for fear of social judgment.

It is important that postvention include psychosocial support and psychoeducation strategies. These would be strategies related to the reactions and feelings that can be experienced during the grieving process and how to fight against social criticism. It is necessary to let the family and those around them know that they have every right to remain silent, if they want.

First of all, dispelling certain myths can help reduce fear of judgment and ambivalence. Some of these misconceptions are:

Talking about suicide generates a call effect. Suicide cannot be prevented because the person wants to die. Suicide is a cowardly act / it is a very brave act. People who commit suicide do it to get attention. Those who want to kill themselves do not say it. .

A person who wants to commit suicide or makes a suicide attempt is a person who needs and deserves help, as well as the people around them. We must not forget about them, since if a grieving process is difficult and painful by definition, the grieving process for suicide is even more so. It is often accompanied by feelings of guilt and shame that can be long lasting and resistant to interventions.

A duel that is not prepared correctly can become very complicated. It can even lead to a depressive disorder if you do not have the necessary support and resources.

Therefore, it is not only important to focus on the pending issue of suicide prevention, but also the postvention and education of society, to end the stigmatization that so punishes the environment of the deceased.

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