July 24, 2019
Workplaces Coping With Suicide Trauma
Here are case studies to demonstrate good and bad "postvention"--psychological first aid after a suicide that affects a workplace.
“The workplace is the last crucible of sustained human contact for many of the 30,000 people who kill themselves each year in the United States. A co-worker’s suicide has a deep, disturbing impact on work mates. For managers, such tragedies pose challenges no one covered in management school.”
~Sue Shellenbarger (2001), Impact of Colleague’s Suicide Is Strongly Felt in Workplace, Wall Street Journal
The majority of people who die by suicide are of working age, and almost all of them are employed, previously employed or a family member of someone employed at the time of death; however, workplaces are often ill-equipped to provide grief and trauma support after such a tragedy. Many workplaces, if they provide grief support at all, do not usually take into account the complexities or duration often needed to cope in the aftermath of suicide.
“Postvention” is psychological first aid after a suicide crisis. In the workplace, like many other systems in communities, this response is about both providing hope and community and mitigating the impact of suicide grief and trauma. For this article, 13 people were interviewed about how their employers handled their suicide loss experiences. Here is a case study to demonstrate what happens when postvention is inadequate.
Going through the motions – when suicide postvention is superficial
A federal agency of almost 1,000 people experienced a suicide of a high-level, well-liked, well-known and visible leader. Close to the time of his death, he was seen escorted out of the building among gossip of scandal and failed management. In the absence of information from the executive staff, speculation about contributing factors ensued, and rumors ran rampant. Employees looked to senior management to provide direction during the crisis; the leaders appeared guarded and unwilling to talk about the fact that it was a suicide. In the days that followed, the response seemed like “giving lip service” to the confused and grieving employees. As one said, “We went through the motions but didn’t do the work. People didn’t want to face the fact that a suicide could happen. Shame prevented us from talking about it at all.” The organization attempted to move back to business-as-usual quickly. No plan was created on how to manage roles the deceased person played; the vacuum created led to more speculation, distrust, anger and a lack of closure.
Trauma and Grief after Suicide at Work
Given that the majority of people who die by suicide are working-age adults, most of whom are employed, hundreds of thousands of workplaces around the globe are affected by the suicide death of an employee each year (World Health Organization, 2014; Lytle, 2015; Milner et al, 2014; Paul & Spencer-Thomas, 2012; Spencer-Thomas, 2012). Furthermore, knowing that job loss can be a contributing factor, suicide deaths of recently terminated employees can still have a profound effect on their previous places of employment (Milner et al, 2014; Spencer-Thomas, 2014). When leaders within an organization take their lives, the chaos and trauma resulting from this loss can be immense (Spencer-Thomas, 2011). In addition, suicide deaths of family members of employees, vendors, clients and associates all can take a toll on employees; the number of workplaces affected is very high. Suicide grief support in the workplace often involves two scenarios: suicide of a work colleague or a suicide death outside the work environment.
Unfortunately, most workplaces do not anticipate needing to respond to suicide. Many find themselves reacting in crisis mode, often making decisions that do more harm than good. Models and protocols of how to understand grief, trauma and the impact of exposure to suicide are integral to understanding the way workplaces respond to suicide death. This article creates a framework for understanding and providing effective suicide postvention, provides insight into the way that grief and loss affect workplaces and offers concrete strategies for an effective postvention response at work. [For a full chapter on this topic, please read Spencer-Thomas, S. & Stohlmann-Rainey, J. (2017). Workplaces and the aftermath of suicide. In Andriessen, K., Krysinska, K. & Grad, O. (Eds). Postvention in Action. Hogrefe: Boston, MA.]
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Trauma reactions and grief are often at odds with each other. According to the American Psychological Association, “trauma is an emotional response to a terrible event…. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.” (APA, n.d.). On one hand, the trauma can often result in survivors of loss constantly replaying the events surrounding the suicide in their minds. That is, survivors of suicide loss can’t stop thinking about the death scene (even when they are dreaming), and disturbing images may flash before the mind’s eye when they least expect it. The horror can be overwhelming, and the natural impulse is to stay away from anything that reminds them of the trauma. Sometimes, survivors of suicide loss develop post-traumatic stress disorder (PTSD) in the aftermath of a violent or unexpected death (Young, et al, 2012).
By contrast, the grief journey for survivors of suicide loss is often a “moving toward” experience. As they come to accept the reality of the loss, the tendency is to move toward things that remind them of the deceased, holding close memories, places and mementos that help preserve and honor the life lived. Thus, for coworkers left behind there is often simultaneously a desire to mourn and openly embrace the memory of the deceased and a desire to suppress the thoughts about the deceased because they are too disturbing, such as the often horrifying notion that someone they cared about died in isolation and despair, often in a violent manner.
Organizations are often ill-equipped and ill-informed to handle grieving employees; this is particularly true for the suicide-bereaved, who experience the double silencing of workplaces ill-equipped to cope with grieving employees and stigma related to the type of loss.
One of the people interviewed for this article was a mother whose son died by suicide the day after he was discharged from his military service. She shared, “I had only been at my present position for 90 days, my probation period. I was given some money, they had collected. Other than that, nothing. I was hurting very much. When the holidays came, I put a candy cane and a note asking for prayers in everyone’s mailbox. Nothing. No words, no notes, no nothing. One day I was walking down some steps, and I just wanted to let go of the railing [and fall to my death]. I talked to my supervisor and asked if I could just come in a little later on the Saturday mornings. I said I would stay late and be the last one to leave. She said to me, ‘I thought you were already over that.’ I wanted to ask her which one of her three sons she would ‘be over’ in less than two years.”
Sometimes, bereaved employees believe they can return to their previous level of functioning at work and do not want to take time off because work provides structure, social support and a sense of purpose. Thoughtful employers help their grieving staff members find creative ways to balance these competing demands. One interviewee who was a teacher at the time of her teenage daughter’s suicide shared, “The principal called me into his office [the day after the suicide]. The two assistant principals glared at me as I walked in. The principal told me that they did not want me to come to school the next day or when school began. I was very insulted. I argued and told them that I had shown up every day, I had done my job and I needed to be in the classroom for the children. They just listened stone-faced. Finally, one of the assistance principals told me that no one could bear to look at me because the pain in my face and eyes was so terrible. That shocked me. I had no idea that my grief showed. (I guess I had not really looked in the mirror). So then I gave in, and I told them I would stay home for one week. They assured me they would get a professional retired teacher for my class and to stay home as long as I needed. I assured them I would be back in one week. I left school then and drove home very upset. After I got home, though, I suddenly felt a great relief, and I ended up staying home for seven weeks. It turned out that they knew best after all. After I returned to work, there were days I could not make it, so I called in sick. They never complained about me staying home too much. There were a few times I’d look at a little girl in class who reminded me of [my daughter], and I’d break down. If I sent word to the office, they immediately sent a substitute teacher down so I could go home.”
Another interviewee shared how his son’s suicide affected his work performance, “I returned to work one week after [my son’s suicide]. I was under the illusion that I could suppress my pain and go on with my life as if nothing happened. The day I was placed on involuntary leave, I was facilitating a class of about 100 people. Someone interrupted me with an off-topic question. Rather than gently deflect and move on, I went into an uncontrollable rage, comparing that person’s inane question to my pain over my son’s suicide. I was replaced in the classroom immediately. When I went to the corporate offices, they acknowledged my loss; however I was told to take a month off and see if I could return to full performance. Oddly, now that I’ve ‘cleaned up my act,’ there is a bit of empathy from management.”
Because grieving will happen in the workplace, it is important that the culture in the workplace is supportive of reintegrating bereaved people with compassion and flexibility. In the case of an employee who is bereaved by suicide, all of the same recommendations apply. One of the major pitfalls in organizations is to treat an employee bereaved by suicide differently from other bereaved employees. For example, when an employee dies from cancer, a workplace’s common practice may be to circulate a sympathy card and attend the memorial service, but, when someone dies by suicide, the grief support is often neglected. Consequently, the person bereaved by suicide who would likely need additional support coping with grief, trauma, guilt and shame that may accompany this taboo form of loss will actually get less support.
NAMI New Hampshire (2006), a U.S. leader in suicide postvention indicates that although suicide postvention includes principles of critical incident response and stress debriefing, it has a larger scope with a narrower focus. While critical incident response and critical incident stress debriefing is designed to support workplaces in managing the crisis phase of a workplace incident, suicide postvention is a long-term strategy that addresses the needs of the workplace as a system. Elaine DeMello of NAMI New Hampshire shared (personal communication August 15, 2015) after responding to many workplace postvention cases, “[Because of the intensity, complexity and duration of the grief and trauma reactions] loss survivors are at risk for losing job; what helps is an advocate or conduit who can pave the way for the person to come back to work.”
Tensions in Postvention in the Workplace
The goals of suicide postvention in the workplace is really not that different than other crisis responses (Carson J Spencer Foundation et al, 2013), i.e., to support people through the trauma and help restore functioning to a disrupted system (Suicide Prevention Resource Center, 2010). The process is about managing the inherent balance of needs and safety components that can sometimes be at odd with one another. On one hand, workplaces acknowledge something really significant happened, while on the other hand leaders are pressured to get back to business as usual. On one hand, grieving employees need to share stories to grieve and honor a life that was lived, while on the other hand workplaces practice safe messaging seek to minimize glorification of the deceased and the divulgence of too many details about the death. On one hand, employees need information that is quick and accurate, while, on the other hand, privacy and investigation concerns can slow the process.
A complicating issue for workplace suicide postvention is that getting fired, laid off, humiliated or disciplined at work can be a precipitating event for some suicidal employees. When this occurs, residual bitterness, anger and mistrust for leadership can have a profound effect on the intensity and duration of the employee’s response.
One interviewee shared this story, “My husband, an employee for 18 years, and supervisor for the last 15, was let go from his position the day before he died by suicide. While this was the third suicide with the company, there was no crisis plan in place. Employees were notified when his death was posted on the lunchroom TV. Management chose not to attend the visitations or funeral to ‘keep the peace,’ but quite frankly I would have preferred to see them there. There was a lot of hostility because he was let go from his position as a supervisor, and, when word of his death got out, there was more hostility from the people who worked with him in the plant. Management let the dust settle over time with no comments.”
Few workplaces plan for a suicide by having access to a postvention guide like the Manager’s Guide to Suicide Postvention, because too often the daunting nature of suicide throws people into reactive or avoidance mode. As a first step, managers benefit from reflecting on the question, “What do you usually do when there has been a trauma or death in this workplace?” Usually, there are already cultural norms and policies in place to address grief and trauma, and any deviation from this cultural standard is likely to cause confusion and additional hardship.
When an Employee Loses a Family Member to Suicide
“I am a pharmacist at a grocery store and had been there eight years when my teenage son died by suicide. I knew all my customers by name, and many of them knew my son. When word reached the store, my store manager called everyone together to break the news. With tears streaming down his face, he explained that my son was dead. Work was suspended, people were allowed to go home or take the time they needed to pull themselves together. For a grocery store, this is huge, as we are all about customer service in a community where the competition is fierce. By the afternoon, I had cards, a gift basket and messages from so many of my workplace family. Many of the staff were able to take the day off to attend my son’s memorial, and the store was generous in their contributions. Since my return to work, I have been given free rein to cry when I need to, hug when I need to and talk with others when I need to. My store management and fellow staff continue to be a source of support and comfort.
The Suicide Postvention Process
Postvention is psychological first aid, crisis intervention and other support offered after a suicide to affected individuals or the workplace as a whole to alleviate possible negative effects of the event (Smith, Romero, & Cimini, 2010). In the center of the response are often managers who are guiding bereavement support, trauma reactions and a transition back to work. Effective managers in these circumstances communicate empathy and respect and offer permission for people to take care of themselves. They offer a range of support options and know not everyone will need the same types of resources in the same timeframe. Many managers find themselves in the middle of complex and competing factors. Just like other employees, leaders are often affected by the tragic loss and in need of support, but sometimes become targets of anger and blame by other employees. Leaders may feel overwhelmed and immobilized by the shock, and yet they are charged with returning the workplace to health and productivity.
“A Manager’s Guide to Suicide Postvention in the Workplace: 10 Action Steps for Dealing with the Aftermath of Suicide” organizes recommendations to guide employers in the immediate aftermath of a suicide death, in the short-term, and in the long-term, sometimes over months and years. The duration of these recommendations was intentional because, in many workplaces, immediate needs may be considered, but, often within just a couple of weeks, bereavement support drops off. For example, one of the interviewees for this article reported, “… there was no ‘return to work plan’ that I know of…The employee assistance program I found worthless. I contacted them one evening very stressed and received a lukewarm response. There has been no follow-up contact from them at all to see how, or if, I am managing.”
Immediate: Acute phase
- Coordinate: Having the right point person coordinating the efforts around suicide postvention. This person should be decisive and compassionate, knowledgeable about crisis response and suicide grief and able to juggle many high-stress demands at once.
- Notify: Communication after a suicide is difficult. On one hand, those left behind have a strong desire for facts, so quick and accurate communication regarding, “here is what we know, here is what we don’t know and here is what is going to happen moving forward,” can do much to quell anxiety and damaging speculation. On the other hand, workplaces must be mindful to protect and respect the privacy rights of the deceased employee and the loved ones during death notification.
- Communicate: As communication regarding the suicide is disseminated, spokespeople should be mindful of the safe and effective messaging guidelines (National Action Alliance for Suicide Prevention, n.d.) to reduce the risk that people who are already vulnerable to suicide might become more at risk for suicide contagion.
- Support: In the immediate aftermath, most people do not benefit from counseling in its traditional format. Instead, what is often needed more is practical assistance. Many grieving families can benefit from the practical support of transportation, food and everyday life tasks.
Short-term: Recovery phase
- Link: After the initial intensity of the crisis has passed, a smaller group of affected individuals usually surfaces. Workplace managers need strategies to identify and link these employees to additional support resources and refer those most affected to professional mental health services.
- Comfort: Usually, what most people need during the short-term phase of suicide postvention is support, comfort and an environment that promotes healthy grieving. This can be done within the workplace through professionally facilitated debriefing sessions, or managers can find community resources for employees in the form of suicide grief counselors or suicide loss peer support groups.
- Restore: While providing support, managers also must restore equilibrium and optimal functioning in the workplace. Returning to the familiar schedule can be healing for some, but the timing needs to be sensitive to individuals who may not have the capacity to perform their jobs at the levels they did before the tragedy.
- Lead: Leadership messaging is critical during both the immediate and short-term phases of suicide postvention at work. Effective leaders build and sustain trust and confidence in organizational leadership by acknowledging the impact of suicide – on the company, and on them personally, by offering compassion to employees and by helping the team move from an immobilization state to a state that returns to or even supersedes previous levels of functioning. Effective leaders are “visible, vocal and visionary” during this time and are able to successfully pull people together to draw upon the collective resilience of the work team culture (Spencer-Thomas, 2014).
Workplace postvention practices should also take into account the fact that leaders need support, too. One interviewee who worked at a large school where there were multiple suicide losses reported, “The top leadership went from being ‘Principal of the Year’ to not coming to work because of trauma and depressed [after the cluster of suicides]. She was not able to get out of bed and go to work. Our crisis team leader couldn’t quit crying and was told, ‘If you can’t get yourself together, we’re going to have to reassign you.’”
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Longer-term: Reconstructing phase
- Honor: With many deaths, the honoring rituals that usually happen at the funeral or memorial service help provide structure as people mourn. For suicide, this intense period of grief and trauma is often protracted (Jordan & McIntosh, 2010), and workplaces are advised to prepare for anniversary reactions and other milestone dates. For example, milestone dates might include when a work team completes a major project in which the deceased played a role. Again, this level of response may be just for a handful of employees most affected, but managers are better off preparing for these days than reacting without a plan. Honoring practices for suicide loss are best if they are integrated into the company’s overall grief practices. One interviewee shared how this experience was successful in bringing together family members and employees most affected by a suicide death of a long-term employee: “While she was working for this company, she had started a plant exchange. On her birthday they dedicated a memorial garden and built a beautiful deck for all employees who had died. Her plaque added to others who had died at this company. The family was invited, and together with the employees they shared memories and the importance of workplace friendships at the dedication service. The project gave employees a sense that they could do something. The process helped turn a negative into a positive event. Now, every year the workplace conducts a butterfly release in September. The company president says a few words for people (employees and family members) who we have lost. New butterfly bushes are planted to attract new butterflies in honor of those who have died.” A large mental health provider in Canada reported on an annual “Celebration of Life” ritual to honor the grief process of clinicians whose clients had died – from all causes — over the previous year, “We celebrate the life that was lived and the work we provided to help them. We walk along individuals in their journey, practice rituals of remembrance, sing inspirational songs and pray together.”
- Sustain: Finally, managers are charged with providing guidance in moving the workforce from a postvention state to suicide prevention. Sometimes, in an acute grief reaction, employees might want to put together an awareness event or start a suicide prevention training. Thoughtful managers navigate this need to “do something” with encouragement to create space to move through the oscillating experiences of grief. When an appropriate time has past, and the workforce is less reactive and more reflective, managers can help them build a comprehensive and sustained strategy to make suicide prevention a health and safety priority.
When Postvention in the Workplace Works
In contrast to the opening story of a leadership response of “shutting down,” in the aftermath of a leader’s suicide, the following story of an insurance company of over 50,000 employees demonstrated a far more compassionate response.
Like in the opening example, the suicide death was of a senior-level manager – a man running a 500-700-person division of company. In the weeks leading up to his death, he became distraught and reclusive. “Leaders didn’t say much, but they lived every word,” one employee said. “Their response was value-driven, not just checking a box.” Immediately after the death, executives pulled together all of the managers and briefed them on concrete information about what happened and said that the first priority in the aftermath was to insure the health of all staff. They then assigned Employee Assistance Program staff to specific managers to support all managers and make sure they had what they needed to follow up to provide resources to the employees. The leaders communicated through a press release that was straightforward and honoring of the man who died, using words like “long and distinguished career” and “provided excellent service to customers.” “They didn’t glorify suicide, but they didn’t diminish person,” one employee recalled. “This organization was a family, and we became closer through this experience. It was a teachable moment on how we support one another.”
Workplaces are often not well-prepared to respond with a compassionate, long-term strategy of grief and trauma support to employees and surviving family members in the aftermath of a suicide affecting the workforce. New practices and policies are needed to give employers a better plan so the survivors of loss can better manage the oscillating grief and restoration processes that are frequently disruptive to work performance demands and overall health.