Mayo Suicide Liaison Project
Responding to a Suicide A Protocol for Mayo Agencies - May 2013 VERSION 1 MAY 2013
Contents: brother sister mother father son daughter uncle aunt grand-parent cousin partner spouse colleague friend neighbour relative
Page 2:
Introduction
Purpose of Protocol Scope of Protocol
Page 4:
Definitions
Page 5:
Other Things to Consider
Page 6:
Referral Form
Page 3:
Appendix 1 - Breaking Bad News References Page 8:
This protocol was written and approved by the members of the Mayo Suicide Liaison Project Steering Group. Supt. Joe McKenna, An Garda Síochána Mr. Paul Cunney, Deputy Coroner, Mayo East Dr. Stephen Patten, GP, Castlebar Ms. Phil Kilcoyne, Funeral Director Fr. Charlie McDonnell, Westport Ms. Mary O’Sullivan, Resource Officer for Suicide Prevention HSE West Ms. Meena O’Neill, Clinical Psychologist, PCCC Team Castlebar, HSE Mr. James Ryan, Family Advisory Group Ms. Elisha Sweeney, Family Advisory Group Ms. Liz McHale, Reach Out Choose Life Group, Ballina Mr. Cathal Kearney, Director, Family Centre, Castlebar Ms. Máire Ní Dhomhnaill, Counsellor & Project Coordinator
01 Responding to a Suicide A Protocol for Mayo Agencies May 2013
1.0 Policy A significant Introduction: Ireland, as in most other countries, suicide is rare. However, when a suicide does proportion Inoccur, it has a huge impact on the immediate family, relatives and the wider community. findings show that there is a value in providing services immediately following of bereaved Research a death (the active or outreach model). However, this does not preclude the need for services to also be available on a more long-term basis. It is also important to will want support note that not all people who are bereaved will need support. Some are able to move the grieving process with the support of family and friends. Therefore, choice and require through about what services a bereaved person or family receive, and when, are foundational to service. (Best and Promising Practices in Suicide Bereavement Support Services: A support any Review of the Literature, 2009). in the area of suicide bereavement indicates that a significant proportion of outside of Research bereaved will want and require support outside of their close family and social network. addition research indicates that social support after any type of loss appears to be their close Ina crucial factor in determining bereavement outcome and the effect on the bereaved may be more pronounced following a suicide. It is also found that those bereaved by family suicide are at a higher risk of complicated grief reactions, mental health difficulties and potential future suicides. (Petrus Report 2005) and social Over the years in Mayo, one of the gaps identified by families and some services was the need for a dedicated, specifically trained person who would meet families bereaved by network suicide and support them by listening, giving information, and linking them with services. According to Annette Beautrais (Petrus Report 2005) the suicide bereaved require: • Help and advice about practical matters. • Information - with awareness that individuals may be cognitively disorganised in the immediate aftermath of the death and may require the information again at a later time or from a different source. • Support e.g. therapy. • Opportunities to talk with others who are bereaved by suicide. As a result, a number of organisations came together - Family Centre, Castlebar, HSE Community Psychology, Primary Care, Health Promotion and Suicide Prevention to draw up a proposal and were successful in their application for funding to the National Office for Suicide Prevention. The project is called the Mayo Suicide Liaison Project and is co-ordinated by Máire Ní Dhomhnaill. This is a free and confidential service. It is delivered by the Family Centre, Chapel Street, Castlebar.
1.1 Guiding principles for this Protocol: • Ensure the needs of the person(s) bereaved by suicide are central to the response protocol. • Acknowledge that there is a collective responsibility in supporting those bereaved by suicide. Good networking between agencies and organisations is a key to assisting families being offered appropriate and timely support. • Establishing effective communication and discussing and understanding different roles and expectations in advance will help to ensure co-ordinated and clear pathways of support. • Ensure that the self-care needs and welfare of first responders, service providers and other individuals are met. • Recognise the preventative value of sound suicide post-vention practices.
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• Ensure we ‘do no harm’ to those who come to us for support.
Responding to a Suicide A Protocol for Mayo Agencies May 2013
2.0
Purpose of Protocol
3.0
Scope of Protocol
The purpose of this protocol is to set out a co-ordinated, integrated response for a family following a suicide in Co. Mayo. It was developed as part of the Mayo Suicide Liaison Project. It aims to support a family by having a dedicated liaison person who would arrange to meet the bereaved and offer them a menu of services and supports within and outside the County. In order for this to happen a protocol is required which includes all first responders working together with the liaison person to achieve this goal. The protocol also requires co-operation and co-ordination between services including HSE Psychology, Counselling Services and Individual Practitioners, and other statutory and voluntary groups within the county so appropriate referrals can be made by the liaison person in supporting the family.
This protocol is intended to be used in the immediate hours and days after a suicide, and possibly over a longer period (weeks and months) as is required. The Mayo Suicide Liaison Project is not time limited. The family must be broadly accepting that the death is a suspected suicide. As research has demonstrated the role of natural support mechanisms e.g. family and friends, is particularly important in the early days in the aftermath of a suicide. This protocol and the introduction of a liaison person is to compliment and support those natural support systems. The organisations, agencies and groups involved in the development of this protocol include: • • • • • • • • •
Families bereaved by suicide Family Centre, Castlebar An Garda Síochána GPs Funeral Directors/Undertakers Clergy Coroner HSE Principal Clinical Psychologist & Resource Officer for Suicide Prevention Choose Life Reach Out Community Group
We also have consulted and will continue to consult with the following groups: (This list is not exhaustive) • • • • • • • •
All the diocese within Mayo Mortuary Team/ Pathologist Coroners & Deputy Coroners Ambulance Service/Fire Service/ Coastguard/ Search & Rescue (Second Responders) Mayo Suicide Prevention Alliance HSE Primary Care Teams, Psychology Dept., Social Work Dept., A&E Dept., Adult Mental Health Services, Child & Adolescent Mental Health Services Voluntary Groups/ Local Networking Groups Console, Living Links, Counselling Services
03 Responding to a Suicide A Protocol for Mayo Agencies May 2013
4.0 Definitions The purpose Family: the purpose of this protocol family will be defined as next of kin who could be of this For spouse/partner, children, parents, and siblings. It may also include grandparents, aunts, uncles. protocol is to and We refer to families throughout this document. However, this also includes individuals may or may not be connected with a family network. This protocol is available to set out a who those who are grieving the death of a colleague, a neighbour or a friend. co-ordinated, First responder: integrated A trained or certified individual who is the first emergency person to arrive at the scene a traumatic or medical situation. For the purpose of this protocol we include Gardaí, response ofClergy, Funeral Director / Undertaker, GPs. for a family following a Second Responder: In this category we include those services that may be called to a scene of a suicide suicide in to assist the first responders. For the purpose of this protocol we include ambulance services, fire services, coastguards, search & rescue. Co. Mayo. Post-vention:
The definition of Post-vention is “actions directed to intervene in a crisis, support and assist those affected by a completed suicide”. (National Quality Standards for the Provision of Suicide Bereavement Services, 2012).
4.0 Roles and Responsibilities: An Garda Síochána is the Coroner’s representative at the scene of a suicide. They have to carry out the following duties: • Assist the Coroner in arranging the formal identification of the deceased person • Inform the next of kin/family of the death • Investigate the circumstances of the death • Prepare and forward an investigative report to the Coroner • Attend and give evidence at the Inquest • Liaise with the next of kin/family • Take a lead role by informing the family of MSLP and forward a referral if appropriate A GP has to attend a scene to pronounce a person dead, the deceased may be their own patient or the GP may be on call or the nearest available medical doctor. • They may be required to give medical attention to individuals or family members on the day. • They may be asked to take a lead role in informing the family about the MSLP if they know the family well and are the best placed person on the day. A Funeral Director within the county has a contract with the Coroners to attend the scene of all sudden deaths including suicide. It is the responsibility of the Funeral Director to remove the body from the scene and take it to the Mortuary where a Post Mortem will be carried out. The family have the option of asking a funeral director/undertaker of their own choice if they so wish.
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• They too may be asked to take a lead role in informing the family about the MSLP if they know the family well and are the best placed person on the day.
Responding to a Suicide A Protocol for Mayo Agencies May 2013
A Member of the Clergy may be invited by the family to attend and to give the deceased the last rites, pray for the deceased and with the family. • They too may be asked to take a lead role in informing the family about the Mayo Suicide Liaison Project (MSLP) if they know the family well and are the best placed person on the day. Máire if invited by the family will contact them and meet with them at a time and place of their choosing to talk about all the different services within and at times outside Co. Mayo. • Máire will meet with the family individually or as a unit and try and answer any questions they may have and discuss any issue that may be concerning them. • Máire will listen and if necessary carry out an informal assessment on any family member and refer onwards. Máire will also refer those that request it to the most appropriate service/s. On occasions she may link the individual to a particular service and help put that in place. • In the case of children seeking support an agreement has been made with the PCCC Psychology Service that the Liaison person can refer directly to the Principal Clinical Psychologist. • She will check in on different occasions with the family and have on-going contact if needed. • This service is available in the Irish language. Is féidir an seirbhís seo a fháil trí mhéan na gaeilge.
5.0
Other Things to Consider Everyone who is bereaved experiences grief in their own way. We will endeavour to respond to groups from different cultures and traditions, nationalities and all age groups as part of this project. We will give consideration to: • Where the death has taken place will affect who responds (for example, at home, within Ireland, abroad). • Acknowledging different values by considering religious beliefs, disability, diverse groups, speaking a language other than English, etc. • To ensure that we do not disempower families by unintentionally excluding them from key conversations or decisions in our efforts to protect them. This can be done by many people, including the extended family, neighbours, first responders, etc. It is important that all service providers are mindful and sensitive to the trauma families are going through e.g. see Appendix 1 on Breaking Bad News.
05 Responding to a Suicide A Protocol for Mayo Agencies May 2013
6.0 The Protocol (The Working Piece)
Referral to Mayo Suicide Liaison Project The main aim of the Mayo Suicide Liaison Project (MSLP) is that following a suspected suicide a liaison person will be available to the family if they so wish to discuss with them the menu of supports and services available to them, linking them with and/or referring them to the most appropriate service within and outside the county. One of the first responders (Gardaí, GP’s, Clergy or Funeral Director) will take the lead in asking the family if they would like a liaison person to meet with them. It is VERY IMPORTANT that ALL the family are accepting it is a suicide. If they agree; the liaison person will be informed, she will contact the family directly and set up a meeting (See Option 1). If the family does not wish to meet the liaison person, a family information pack will be given to them by the lead first responder, containing contact details for MSLP and other relevant information. If for any reason the Gardaí are deemed not to be the best placed first responder to explain this service to a family, another first responder will take the lead in this situation (See Option 2). There will be no time limit to avail of this service.
OPtION
1
OPtION
2
OPtION
3
Investigating Garda
GP, Clergy, Funeral Director
FAMILY OR FAMILY MeMbeR
No to MSLP
Family Info Pack
Yes to MSLP
Form MSLP1 to Máire
No to MSLP
Family Info Pack
Yes to MSLP
Form MSLP1 to Máire
No to MSLP
Family Info Pack (Máire)
Yes to MSLP
MSLP (Máire)
FAMILY
FAMILY
MáIRe
06 Responding to a Suicide A Protocol for Mayo Agencies May 2013
6.0
The Protocol (The Working Piece)
Form MSLP 1 to be Completed by the Investigating Garda (GP, Clergy or Funeral Director) if a family would like a liaison person to contact them about the supports and services available to them following a suicide. This form to be completed as soon as is practicable following the death and forwarded to MĂĄire NĂ Dhomhnaill, Mayo Suicide Liaison Project, Family Centre, Chapel Street, Castlebar, Co. Mayo or mairenidh@thefamilycentre.com. Telephone: 094 9025900. Mobile: 087 2172866. 1. Name of person who has agreed for the Family to be contacted by the MSLP Liaison Person? ....................................................................................................................................................................................................................................................................................................................
2. Name of Main Contact Person: (if different from above) ....................................................................................................................................................................................................................................................................................................................
3. Address: ................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................................................................
4. Mobile No: ............................................................................................................................................................................................................................................................................ 5. Landline No: ....................................................................................................................................................................................................................................................................... 6. Relation to the Deceased: ................................................................................................................................................................................................................................ 7. Name of Family GP:................................................................................................................................................................................................................................................... 8. GP Contact Details: (if available) .............................................................................................................................................................................................................
Information on the Person who has died: 1. Name: ......................................................................................................................................................................................................................................................................................... 2. Age/DOB: ............................................................................................................................................................................................................................................................................... 3. Married/Single/Separated: ............................................................................................................................................................................................................................. 4. Name of Spouse/Partner/Next of Kin:.............................................................................................................................................................................................. 5. Date of Death: ................................................................................................................................................................................................................................................................. 6. Any other relevant information: ............................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................................................................
7. Name of Investigating Garda: ..................................................................................................................................................................................................................... 8. Contact number for Investigating Garda: ...................................................................................................................................................................................
Signature of Person Referring:................................................................................... Garda
GP
Clergy
07 Responding to a Suicide A Protocol for Mayo Agencies May 2013
Date: .................................................................................... Funeral Director
Appendix 1 Breaking Bad News A Process for Breaking Bad News The standard by which we should assess the quality of how we have broken bad news to patients is to ask ourselves: If the person was my relative would I have been happy with how the news was given? (Faulkner, 1998)
Summary Adapted from Jennifer Barraclough’s Do’s and Don’ts (1999) DO
DO NOT
• Allow time • Ensure privacy and confidentiality and respect both • Ensure honest and simple language is used • Let the person talk • Listen to what the person says • Be sensitive to the non-verbal language • Gauge the need for information on an individual basis • Allow for silence, tears and other patient reactions • Document and liaise with the multidisciplinary team
• Overload with information • Distort the truth • Give false reassurance • Feel obliged to keep talking all the time • Withhold information • Assume that you know what is concerning the person • Criticise or make judgements
Recommended Manner of Breaking Bad News Elicit Person’s Understanding No “Fire Warning Shot” Break News at Person’s Pace in Manageable Chunks
Yes Does the Person Know or Suspect the Truth?
Acknowledge Immediate Reactions
Explore Level of Knowledge Confirm News at Person’s Pace
Allow Person Time for Initial Shock Deal with Emotional Reactions and Questions
Faulkner A BMJ 1998; 316:130-132
References: Flexhaug, Monica & Yazganoglu, Erdem, (2009), Best and Promising Practices in Suicide Bereavement Support Services: A Review of the Literature, Alberta Health Services, Canada. Hospice Friendly Hospitals Programme in Partnership with the HSE, How Do I Break Bad News? Dublin. Petrus Consulting (2007), Review of General Bereavement Support Services and Specific Services available following Suicide Bereavement for the National Office for Suicide Prevention. National Office for Suicide Prevention, HSE, Console & Tural le Cheile, National Quality Standards for the Provision of Suicide Bereavement Services: A Practical Resource, 2012.
Offer Support as Appropriate
08 Responding to a Suicide A Protocol for Mayo Agencies May 2013
Funded by the National Office for Suicide Prevention
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An Garda SĂochĂĄna