Postvention Toolkit: Phase 2

While we hope that children never have to experience tragic events, at times these can occur. Drawing on current consensus, these key messages explain how to talk to a child about suicide loss[1].

We present this information as a guide. There are a lot of different ways of doing this, and this document highlights some considerations while acknowledging that each family will decide what’s right for them, given their comfort levels, where the child is at, given the family’s culture and their personal circumstances.

We encourage you to reach out to community mental health organizations, cultural leaders or elders for support in planning how to let a child know about a suicide loss (see postvention resources below).

Before the conversation:

• One of the best ways to take care of a young person in the wake of a suicide loss is to take care of yourself. By practicing self-care, you serve as a role model and provide reassurance that children don’t have to take care of you. Seek your own help as needed, by reaching out to personal, peer or professional supports (see postvention resources below).
• Before having the conversation, ascertain the wishes of the deceased person’s family about how they want to refer to the death.
• If the person who died was close to the child, letting the child know about the suicide will not be one single event, but a process of communicating over the child’s lifetime.

Setting up the conversation

• Tell all children, even younger ones, the truth about the death-as soon as possible; telling children the truth using developmentally appropriate words is the best way to help them begin to process and adapt to the reality of the loss and to build trust. The risk in waiting, or in withholding parts of the story, is that they may hear adults talking, or find out from other children, the internet, or the news. Another risk is that if a child does not have the whole picture, they will try to fill in the gaps with guesses — and what they imagine may be more upsetting than the truth. If you didn’t follow this guideline and wish to, it’s okay to go back and tell the child the truth now.   
• Choose the most appropriate person for the conversation. Ideally, they will be the primary caregiver, or someone delegated by the primary caregiver who has a strong relationship with the child/children. Refer and reach out to mental health organizations that can support with this phase (see postvention resources below).
• Find a quiet place to talk that feels safe and familiar to the child/children where you will not be interrupted;
• Deliver the message to small groups, and if possible speak to children one-on-one;
• If speaking to a group, consider the group dynamic- who is in the group, group size, age and development of children.
• In a group context, consider having minimally 2 adults involved, so that one person can provide one-on-one support if needed throughout the discussion. In a group, try to contain the conversation as much as possible. The purpose of the conversation is to provide the facts, limit contagion, provide support and inform children of what additional supports are available (see postvention resources below).
• Reassure the child/children that they can leave the group and talk one-on-one with someone if they are more comfortable;

Having the conversation

• Details about the death may be upsetting and can increase the risk of imitative behavior.
• Start with an honest explanation of what happened with minimal detail, and without providing graphic information. Keep it simple and brief, while letting children’s questions guide the discussion.
• If the child asks, it is okay to give basic facts, but use common sense and avoid unnecessary details.
• It is important to use the words death or died to help children understand the permanence of the loss. Don’t use terms like ‘asleep’, ‘passed on’, ‘passed over’ or ‘gone on a journey’ to describe death. Children can take such words literally and get confused about what’s actually happened.
• The central message when talking about why the person died by suicide is to explain that they were not well. Their brain was sick and that caused them to feel sad, angry, frustrated, scared… and they thought there were no other options. Point out that there are always other options, but the person could not see them.
• Another key point to get across when informing a child about a suicide is that they are safe and loved—and they will be taken care of and supported.
• Reassure children that it is not their fault in any way at all—that nothing they did or didn’t say or do caused this. (This message needs to be repeated over and over again.)
• Remind children that it’s okay to talk about the deceased person and to ask questions.
• We strongly suggest that you conclude any conversation about an individual’s suicide by encouraging the child to seek help and reminding them there is always someone willing to help.

How will my child react?

• Every situation and every child will be different.
• Recognize that early reactions, though sometimes difficult to witness, allow a child to begin to process what’s happened. They may range from acute distress to complete numbness, withdrawal or even seeming disinterest. Be understanding, try not to overreact to their reactions.
• Be aware of the shock factor. Repeat key information later. Check understanding.
• Children learn through repetition so they may need to immediately ask questions, or they may be silent at first and wish to revisit the subject again later. It’s normal for young children in particular to ask the same questions repeatedly. Death is a hard concept for anyone to understand, especially for a child who hasn’t experienced a loss before.
• Expect them to process what’s happened over a long period of time. As they grow and mature they are likely to understand what’s happened in new ways. They may want to ask questions days, weeks and even years later.

Age specific explanations:

• Children may be emotionally and cognitively older or younger than their age; please adapt the guidelines and examples below to the child’s maturity level.
• Pre-school age 3-5- infants and toddlers experience loss and grieve when a person important in their life is no longer physically present, particularly their caregiver or persons close to them. However, they may not have the words to describe certain emotions or the ability to understand what death is or that it is permanent. They will ask lots of questions. Answer their questions as directly and consistently as possible.
• Early school aged 6-8-Many children at this age understand death is permanent, and the person who died is not coming back. They may worry that they somehow caused the death so it’s important to reassure them that they are not responsible, that they will continue to be loved and cared for.
• Late elementary school age (9–12 years old) – At this age, most children understand death is permanent. They may also have an interest in how the body works, and have questions about what specifically caused the death.

Moving forward from here

• Try to keep up your typical daily routines as much as possible.
• Handling strong emotion can be hard for children. They may struggle with several thoughts and feelings; guilt abandonment, numbness, sadness, confusion, anger, overwhelmed, loneliness, fear and denial.
• While some children may need time to process the loss and thus seem unfazed by it, others may have a wide range of reactions such as changes appetite, aggression, “clinginess”, short term regressive behaviours like bedwetting or seeking the attention of adults.
• While there may be natural consequences for these behaviours, focus on empathy and support. These new, or increased behaviours are your child’s way of asking for help. If they could manage on their own, they would!
• At the same time, be assured that children don’t have to talk about the death in order to heal.

When to seek support

• If you feel that your family needs support to process what has happened speak to a community-based agency like Crossroads Children’s Mental Health Centre, or the Youth Services Bureau (see the postvention resources below).
• While children may come to some resolution/bounce back, they may have more questions or experience their grief differently as they move through the developmental stages or confront new experiences. Plan for milestones like birthdays or holidays as these may trigger difficult feelings.
• A child’s family can be a resource as they grieve. It is a good idea to do regular ‘wellness checks’ as a child moves forward.
• Providing truthful information, encouraging questions and offering reassurance to children can support young people and their families to find strength and cope with suicide.

Speaking to youth about suicide loss

Young people respond to suicide in unique ways and a wide range of reactions is possible. Your child may feel: confusion, anger, aggression, withdrawal, fear, guilt, denial, blame, betrayal, abandonment, hurt, sadness.

Parental understanding, reassurance and attention are very important at this time. Make it clear that you are available to talk whenever they need you.

Youth may have a lot of questions and want to know exactly what happened – it is important to steer discussion towards positive help-seeking actions that young people can take. It is important to encourage young people to tell an adult if they are worried about a friend.

Supporting a youth through a suicide loss

• Refer them to reach out to an adult they trust or contact [xx] if they are experiencing thoughts of harming or killing yourself (see postvention resource list below)
• Help them identify sources of support around them including: friends, family, teachers, and share your experiences and feelings with them
• Affirm for them that people manage their grief in very different ways – there is no right way to grieve the loss of a friend and it is important to respect each other’s differences
• Remind them to keep to their usual routine as much as possible – ensuring they eat as regularly as possible, maintain some physical activity, and get adequate rest
• Encourage them to consider limiting their exposure and activity on various social media platforms during this time until formal death notification is made to surviving family and the community.

Postvention Resources

Crisis Lines/referrals

Youth Services Bureau (YSB) for caregivers and youth under 18: 613-260-2360

Good2talk for post-secondary students: 1-866-925-5454

Distress Centre for all ages: 613-238-3311

Kids Help Phone for young people: 1-800-668-6868

Post suicide support

Post Suicide Support Team (PSST) group sessions for non-family after a suicide: 613-737-7791

Support for caregivers and adults impacted by the death

Parent Lifeline’s of Eastern Ontario (PLEO) bilingual, confidential helpline for parents and caregivers of a child or youth who has mental health or addictions issues: 613-321-3211

Bereaved Families of Ontario, Ottawa Peer support groups offering safe, supportive spaces to be in grief, to share and to learn:  (613) 567-4278

Mental Health Walk-in Clinics in Ottawa support for life’s challenges, free counselling services, no appointment needed, trained professional counsellors: www.walkincounselling.com

Mental Health Caregiver Guide, Ottawa Public Health

Understanding Loss and Grief, Canadian Mental Health Association

References

Andriessen, K. (2014). Suicide bereavement and postvention in major suicidology journals. Crisis.35, 338-348. doi: 10.1027/0227-5910/a000269

American Foundation for Suicide Prevention. (2014). Talking to children about suicide. Retrieved from: www.afsp.org/copingwithsuicide

Aron, E.J., Bostic, J.Q., Grumet, J.G., and Jacobson, S. (2018). Assisting the school in responding to a suicide death: What every psychiatrist should know. Child Adolescent Psychiatric Clinic, 27, 607-619. doi: https://doi.org/10.1016/j.chc.2018.05.007

Brotherson, S., Anderson, A. (2016). Talking to children about suicide. Retrieved from https://www.ag.ndsu.edu/publications/kids-family/talking-to-children-about-suicide/fs637.pdf

Conversations Matter. (2013). Conversations matter when telling a child about suicide. Retrieved from: http://www.conversationsmatter.com.au/

Dyregrov, K. (2011). What do we know about needs for help after suicide in different parts of the world? A phenomenological perspective. Crisis, 32, 310-318. doi: 10.1027/0227-5910/a000098

Mitchell, A.M., Wesner, S., Brownson, L., Dysart-Gale, D., Garand, L., and Havill, A. (2006). Effective communication with bereaved child survivors of suicide. Journal of Child and Adolescent Psychiatric Nursing, 19, 130-136. doi: 10.1111/j.1744-6171.2006.00060.x

National Alliance for Grieving Children. (2013). About childhood grief. Retrieved from https://childrengrieve.org/resources/about-childhood-grief

Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., O’Brien, M. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis, 34, 164-182. doi: 10.1027/0227-5910/a000168

Rossetto, K.R. (2015). Bereaved parents’ strategies and reactions when supporting their surviving children. Western Journal of Communication, 79, 533-554. doi: 10.1080/10570314.2015.1079332

Skylight. (2007). Explaining suicide to children and young people. Retrieved from https://www.mentalhealth.org.nz/assets/ResourceFinder/Explaining-Suicide-to-Chidren-and-Young-People.pdf

Szumilas, M., and Kutcher, S. (2011). Post-suicide intervention programs: A systematic review.  Canadian Journal of Public Health, 102, 18-29. Retrieved from https://pdfs.semanticscholar.org/ad05/c9d06c6dc0d7bf76f1793830063fd0c8ce44.pdf

The Dougy Centre & The American Foundation for Suicide Prevention. (2017). Children, teens and suicide loss. Retrieved from https://afsp.org/american-foundation-suicide-prevention-dougy-center-join-forces-launch-new-education-resource-families-young-suicide-loss-survivors/ 

The Sharing Place. (1996). Explaining suicide to children. Retrieved from: https://www.crisissupport.org/wpcontent/uploads/2015/03/EXPLAINING_SUICIDE_TO_CHILDREN.doc.pdf

Waterloo Region Suicide Prevention Council & Canadian Association of Suicide Prevention (nd) After a suicide attempt, a guide for families and friends. Retrieved from: http://www.togethertolive.ca/sites/default/files/waterloo_after_a_suicide_attempt_for_family.pdf

[1] This checklist is part of postvention guidelines being developed by organizations working to prevent suicide in Ottawa. These guidelines will be distributed in 2019. To learn more: Andrea Poncia, Coordinator of Suicide Prevention Ottawa, aponcia@ysb.ca.