Survivors of a Military Suicide Death: Exploring Suicide Bereavement & Postvention Care.

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Survivors of a Military Suicide Death: Survivors of a Military Suicide Death: Exploring Suicide Bereavement & Exploring Suicide Bereavement & Postvention Care Postvention Care

Transcript of Survivors of a Military Suicide Death: Exploring Suicide Bereavement & Postvention Care.

Survivors of a Military Suicide Death: Survivors of a Military Suicide Death: Exploring Suicide Bereavement & Postvention Care Exploring Suicide Bereavement & Postvention Care

“Every Suicide makes this statement: this far, and no further!” ~Edwin S. Shneidman(1972)

The Problem of SuicideThe Problem of SuicideSuicide Global PerspectiveSuicide Global Perspective

• Suicide ranked as 10Suicide ranked as 10thth Leading Cause of Death Leading Cause of Death

• Increase of 60% in last 45 yearsIncrease of 60% in last 45 years

• 15-44 year olds ranked as 315-44 year olds ranked as 3rdrd Leading Cause of Death Leading Cause of Death in all developed and developing countries. in all developed and developing countries.

• 1 suicide/40 seconds = 2,700 deaths per day1 suicide/40 seconds = 2,700 deaths per day

• 1 million suicides/per year globally1 million suicides/per year globally

• Global Mortality Rate: 16 per100,000Global Mortality Rate: 16 per100,000

• Countries of Eastern Europe and descendents (eg., Countries of Eastern Europe and descendents (eg., Russia, Croatia, Poland, Slovenia, Germany) Russia, Croatia, Poland, Slovenia, Germany) Highest Highest RatesRates

• 20 Million individuals attempt suicide each year20 Million individuals attempt suicide each year

The Problem of SuicideThe Problem of SuicideSuicide U.S. PerspectiveSuicide U.S. Perspective

• Suicide ranked as 11Suicide ranked as 11hh Leading Cause of Death Leading Cause of Death• 22ndnd Leading Cause 25-34 year olds Leading Cause 25-34 year olds• 33rdrd Leading Cause 15-24 year olds Leading Cause 15-24 year olds• Highest Rates: 75 years old + 16 per 100,000 Highest Rates: 75 years old + 16 per 100,000

• 34,598 individuals died by suicide 200734,598 individuals died by suicide 2007

• 1 suicide/15 minutes = 96 persons per day1 suicide/15 minutes = 96 persons per day

• Mortality Rate: 11.3 per 100,000Mortality Rate: 11.3 per 100,000

• Men are 4x more likely then Women (79% Suicides)Men are 4x more likely then Women (79% Suicides)

• 376,000 recorded attempts in U.S. annually376,000 recorded attempts in U.S. annually

• American Indians and Native Alaskans age-adjusted death rates for suicide American Indians and Native Alaskans age-adjusted death rates for suicide 190% higher then general population (14.3/100,000). Non-Hispanic Whites 190% higher then general population (14.3/100,000). Non-Hispanic Whites (13.5); Asian/Pacific Islanders (6.2); Hispanics (6.0); Non-Hispanic Blacks (5.1) (13.5); Asian/Pacific Islanders (6.2); Hispanics (6.0); Non-Hispanic Blacks (5.1)

• Firearms are leading method/Hanging 2ndFirearms are leading method/Hanging 2nd

The Problem of SuicideThe Problem of SuicideSuicide Canada PerspectiveSuicide Canada Perspective

• Mortality Rate: 11.1/100,000Mortality Rate: 11.1/100,000

• 1010thth Leading Cause of Death in Canada Leading Cause of Death in Canada

• 3,705 reported suicides per year in Canada3,705 reported suicides per year in Canada

• 10 Suicides per day10 Suicides per day

• Men are 3x more likely to complete then WomenMen are 3x more likely to complete then Women

• Number One Method: Hanging Number One Method: Hanging

• Number Two Method: FirearmsNumber Two Method: Firearms

http://www40.statcan.ca/l01/cst01/hlth66f-eng.htmhttp://www40.statcan.ca/l01/cst01/hlth66f-eng.htm

The Problem of SuicideThe Problem of SuicideCanadian Military PerspectiveCanadian Military Perspective

Suicide Rates Across All Military PersonnelSuicide Rates Across All Military Personnel

http://www.forces.gc.ca/site/news-nouvelles/news-nouvelles-eng.asp?id=3799

The Problem of SuicideThe Problem of SuicideSuicide U.S. Military PerspectiveSuicide U.S. Military Perspective

Since 2002, Rise in Suicide Rates Across All Service Since 2002, Rise in Suicide Rates Across All Service Branches Branches

Source: U.S. military branches (2001-09) and Centers for Disease Control and Prevention (latest figures through 2006)

http://www.npr.org/templates/story/story.php?storyId=127860466

The Problem of SuicideThe Problem of SuicideSuicide U.S. Military PerspectiveSuicide U.S. Military Perspective

• 2/3 of military suicides occur outside the war-zone. 2/3 of military suicides occur outside the war-zone.

• Self-inflicted Gun Shot Wound Most Common Self-inflicted Gun Shot Wound Most Common Method, 41% Non-Military issued firearm.Method, 41% Non-Military issued firearm.

• Caucasian Males (17.4/100,000)Caucasian Males (17.4/100,000); Divorced (27.6); ; Divorced (27.6); Under 25 (20.1); E1-E4 (20.1); GED (20.1); 36% Under 25 (20.1); E1-E4 (20.1); GED (20.1); 36% documented mental health dx.documented mental health dx.

• 20% of 30,000 Suicide Deaths in U.S. are U.S. 20% of 30,000 Suicide Deaths in U.S. are U.S. VeteransVeterans

Source: http://www.health.mil/dhb/downloads/Suicide%20Prevention%20Task%20Force%20final%20report%208-23-10.pdf

Suicide Loss SurvivorsSuicide Loss SurvivorsPerspective is Good to KnowPerspective is Good to Know

Who are they?Who are they?

• Definition still unclear Definition still unclear (Jordan, 2008)(Jordan, 2008)

• Anyone impacted by a Anyone impacted by a suicide : self-selection.suicide : self-selection.

• Military: Military: Families, Families, Service Members, Friends, Service Members, Friends, Military Community, Military Community, Community-at-Large.Community-at-Large.

Suicide Loss SurvivorsSuicide Loss SurvivorsThe Ripple of SuicideThe Ripple of Suicide

How Many are there?How Many are there?

• For each person who loses their For each person who loses their life to suicide, conservative life to suicide, conservative estimates are that 6 persons close estimates are that 6 persons close to the deceased are affected (AAS, to the deceased are affected (AAS, 2010).2010).

• 6 million new Suicide Loss 6 million new Suicide Loss Survivors Each Year GloballySurvivors Each Year Globally

• 200,000+ in the U.S. per year200,000+ in the U.S. per year

• Over 10 million in last 50 Over 10 million in last 50 yearsyears

• According to these estimates According to these estimates there are over 2,000 new there are over 2,000 new survivors bereaved by a military survivors bereaved by a military suicide in 2009 alone and 36,000 suicide in 2009 alone and 36,000 bereaved by a U.S. Veteran bereaved by a U.S. Veteran suicide.suicide.

Suicide Loss SurvivorsSuicide Loss SurvivorsResearch – The NeedResearch – The Need

• Despite large number of survivors with elevated risks, Despite large number of survivors with elevated risks, understudied and obscurely understood population.understudied and obscurely understood population.

• Little research about the impact of suicide on survivors Little research about the impact of suicide on survivors and effective Postvention services exists. and effective Postvention services exists.

• What is suicide Postvention?What is suicide Postvention?• ““Postvention is Prevention for future generations” – Edwin Postvention is Prevention for future generations” – Edwin

Sheidman.Sheidman.

• Primary suicide research has been in suicide risk and Primary suicide research has been in suicide risk and suicidal behavior (Prevention) but not in the context of suicidal behavior (Prevention) but not in the context of Postvention.Postvention.

Suicide Loss SurvivorsSuicide Loss SurvivorsWhat is Known?What is Known?

• Mixture of personal accounts, clinical observations Mixture of personal accounts, clinical observations and research.and research.

• Suicide Loss is a risk factor for suicide, little research Suicide Loss is a risk factor for suicide, little research into incidence and prevalence of suicidal behavior into incidence and prevalence of suicidal behavior among those affected by a suicide loss.among those affected by a suicide loss.

Exposure to SuicideExposure to SuicideGrowing Body of ResearchGrowing Body of Research

• Crosby & Sacks (2002) sample who knew someone who died by Crosby & Sacks (2002) sample who knew someone who died by suicide in last year, (1.6x more likely) suicidal ideation; suicidal suicide in last year, (1.6x more likely) suicidal ideation; suicidal plans (2.9x); suicide attempts (3.5x).plans (2.9x); suicide attempts (3.5x).

• Hedstrom, Liu & Nordvik (2008) studied workplace suicide Hedstrom, Liu & Nordvik (2008) studied workplace suicide (Sweden) found workplace survivors, 100 employees or less, (Sweden) found workplace survivors, 100 employees or less, (3.5-8.3x) to die by suicide –importance of psychological (3.5-8.3x) to die by suicide –importance of psychological propinquity.propinquity.

• Leo and Heller (2008), examined four large datasets, found Leo and Heller (2008), examined four large datasets, found evidence showing that exposure to non-familial suicide evidence showing that exposure to non-familial suicide increases suicide risk in survivors, particularly young people.increases suicide risk in survivors, particularly young people.

• Large number of studies: that family history of suicidal behavior Large number of studies: that family history of suicidal behavior or suicidal completion – Increased risk for suicidal or suicidal completion – Increased risk for suicidal behavior/completion in survivors (Jordan & McIntosh, 2010) behavior/completion in survivors (Jordan & McIntosh, 2010)

Suicide Loss SurvivorsSuicide Loss SurvivorsWhat is Known? What is Known?

• Vulnerable to increased incidence of:Vulnerable to increased incidence of:• Complicated Grief (CG)Complicated Grief (CG)• Depression (including suicidal ideation)Depression (including suicidal ideation)• PTSDPTSD• Significant Heightened DistressSignificant Heightened Distress• Persistent degree of psychological symptoms after suicidePersistent degree of psychological symptoms after suicide• StigmaStigma• Less Social SupportLess Social Support

Effects appear strongest in familial relatives and non-familial Effects appear strongest in familial relatives and non-familial peers peers

(adolescents- highest)(adolescents- highest)

Suicide BereavementSuicide BereavementIs it Different?Is it Different?

• Jordan (2001; 2008) contends that it is, yet Jordan (2001; 2008) contends that it is, yet recognizes conflict in the data, dearth of research recognizes conflict in the data, dearth of research and need for further research. There are common and need for further research. There are common themes experienced by suicide survivors.themes experienced by suicide survivors.

Suicide BereavementSuicide BereavementGrowing EvidenceGrowing Evidence

• Growing evidence suggests this about the sudden Growing evidence suggests this about the sudden and violent death of a loved one (accident, natural and violent death of a loved one (accident, natural disaster, homicide, suicide) and implications for disaster, homicide, suicide) and implications for survivors: survivors:

• Suddenness has “shock element” – increases distressSuddenness has “shock element” – increases distress• Violence –development of PTSD, depression, anxiety Violence –development of PTSD, depression, anxiety

symptoms. symptoms. • Both can lend themselves to CG.Both can lend themselves to CG.• Greater challenge to assumptive world of survivors Greater challenge to assumptive world of survivors • More time to “Make Meaning”More time to “Make Meaning”• Violent deaths ask for punishment – even to the Violent deaths ask for punishment – even to the

bereavedbereaved• Suicide has stigma = associated with less social supportSuicide has stigma = associated with less social support• Shatter personal invulnerability/loss of innocenceShatter personal invulnerability/loss of innocence

“Survivors of Suicide are the Largest Mental Health Casualty Area related to

Suicide ” ~Edwin S. Shneidman

Suicide BereavementSuicide BereavementInfluencing Issues Influencing Issues

Suicide BereavementSuicide BereavementProminent Themes Prominent Themes

Supported by Supported by ResearchResearch

• Abandonment & RejectionAbandonment & Rejection

• Shame & StigmaShame & Stigma

• Concealment of cause of Concealment of cause of death as death as suicide-stigma/protection of suicide-stigma/protection of memory of deceased.memory of deceased.

• BlamingBlaming

• Increased self-destructiveness Increased self-destructiveness or suicidality.or suicidality.

• Mental Mental Illness/Abuse/Substance Illness/Abuse/Substance Abuse in FamiliesAbuse in Families

Supported by Clinical & Supported by Clinical & Personal AccountsPersonal Accounts

• GuiltGuilt

• AngerAnger

• PTSDPTSD

• Search for Explanation/Why?Search for Explanation/Why?

• ReliefRelief

• Shock & DisbeliefShock & Disbelief

• Family System Effects/Social Family System Effects/Social Support Issues/Social IsolationSupport Issues/Social Isolation

• Obsession with Suicide Obsession with Suicide Activism (Positive & Negative Activism (Positive & Negative Outcomes)Outcomes)

Complexities of Military DeathComplexities of Military Death

• Circumstances: Sudden/Violent DeathsCircumstances: Sudden/Violent Deaths• Condition of Bodily RemainsCondition of Bodily Remains

• Young Adult Deaths (18-40)/Younger SurvivorsYoung Adult Deaths (18-40)/Younger Survivors

• Geography of DeathGeography of Death

• Military Casualty & Burial Rites /RitualsMilitary Casualty & Burial Rites /Rituals• Casualty OfficerCasualty Officer

• Media InvolvementMedia Involvement

• LOD/Death InvestigationsLOD/Death Investigations

• Benefits/Entitlements/Paperwork/Bureaucratic Systems of CareBenefits/Entitlements/Paperwork/Bureaucratic Systems of Care

• Secondary and Multiple Losses – Disenfranchised GriefSecondary and Multiple Losses – Disenfranchised Grief

Military Death-Influencing Military Death-Influencing Factors:Factors:

Additional ChallengesAdditional ChallengesMilitary Suicide Loss SurvivorsMilitary Suicide Loss Survivors

• Dishonorable Death: Shame & StigmaDishonorable Death: Shame & Stigma

• Violence of the DeathViolence of the Death• WitnessingWitnessing• Finding the BodyFinding the Body

• Media Involvement (Can be exploitive) Media Involvement (Can be exploitive)

• Memorials & RecognitionsMemorials & Recognitions

• Line of Duty & Death InvestigationsLine of Duty & Death Investigations

• Pensions/Insurance/EntitlementsPensions/Insurance/Entitlements

• Mental Illness/Help-Seeking (Where to go?)Mental Illness/Help-Seeking (Where to go?)

• Anger & BlameAnger & Blame

Military Suicide Loss-Influencing Factors:Military Suicide Loss-Influencing Factors:

Military Suicide LossMilitary Suicide LossCompounding IssuesCompounding Issues

252525

Post-Traumatic Growth After Post-Traumatic Growth After SuicideSuicide

• Changed identityChanged identity• SurvivorSurvivor• Worthy of self-careWorthy of self-care

• Changed relations with othersChanged relations with others• More priority on relationshipsMore priority on relationships• More expression of love/ affectionMore expression of love/ affection• More compassion for othersMore compassion for others

• Ending dysfunctional relationshipsEnding dysfunctional relationships

• Changed outlook on lifeChanged outlook on life• Purpose – sometimes a new purposePurpose – sometimes a new purpose• Greater appreciation/ gratitudeGreater appreciation/ gratitude• Deeper spirituality/faithDeeper spirituality/faith• Hope Hope

• GrowthGrowth

Postvention NeedsPostvention NeedsWhat does the literature tell us?What does the literature tell us?

①① Professional Help –Grief Counseling/Trauma CounselingProfessional Help –Grief Counseling/Trauma Counseling

②② Suicide Specific Peer Support and Support GroupsSuicide Specific Peer Support and Support Groups

③③ Psycho-education – Books and Bibliotherapy (Suicide Bereavement/What Psycho-education – Books and Bibliotherapy (Suicide Bereavement/What to Tell the Children)to Tell the Children)

④④ Thana-technology – internet support (practical & emotional/24 hr access).Thana-technology – internet support (practical & emotional/24 hr access).

⑤⑤ Sleep TherapySleep Therapy

⑥⑥ Legal and/or Financial CounselingLegal and/or Financial Counseling

⑦⑦ Practical AssistancePractical Assistance

⑧⑧ Social SupportSocial Support

⑨⑨ Active Outreach: 1 in 4 survivors seek help. Why?Active Outreach: 1 in 4 survivors seek help. Why?• Shame, stigma, isolation, exhaustion, trauma, lack of Shame, stigma, isolation, exhaustion, trauma, lack of

information regarding access (barriers), care is not helpfulinformation regarding access (barriers), care is not helpful

(Wilson & Marshall, 2010)(Wilson & Marshall, 2010)

Counseling Issues Counseling Issues – Suicide Loss– Suicide Loss

• Recognize potential for disenfranchised and/or Recognize potential for disenfranchised and/or complicated griefcomplicated grief

• Recognize that grief is experienced differently Recognize that grief is experienced differently across the lifespanacross the lifespan

Always assess for suicide potentialAlways assess for suicide potential Consider risk factors, plan, etc.Consider risk factors, plan, etc.

Appreciate the search for the “WHY??”Appreciate the search for the “WHY??”

Once a suicide survivor, always a suicide survivorOnce a suicide survivor, always a suicide survivor

Never forget to instill hopeNever forget to instill hope

Potential for Potential for Disenfranchised GriefDisenfranchised Grief

Grief that is experienced when a loss is not or Grief that is experienced when a loss is not or cannot be:cannot be: Openly acknowledgedOpenly acknowledged Publicly mournedPublicly mourned Socially supportedSocially supported

Doka, K (1989). Disenfranchised Grief: Recognizing Hidden Sorrow.

Potential for Disenfranchised Grief Potential for Disenfranchised Grief (Cont.)(Cont.)

Examples of Examples of relationshipsrelationships NOT recognized: NOT recognized: Service buddiesService buddies Military familyMilitary family Counselors, chaplains, casualty officersCounselors, chaplains, casualty officers Partners, ex-spouses, siblings, fiancesPartners, ex-spouses, siblings, fiances

Disenfranchised grief may occur when the relationship is not recognized (society defines “legitimate” grievers as primarily familial (Doka, 1989)

Potential for Disenfranchised Grief Potential for Disenfranchised Grief (Cont.)(Cont.)

Examples of Examples of grievergriever NOT recognized: NOT recognized: Young childrenYoung children Mentally disabled individualsMentally disabled individuals Aged individualsAged individuals

Disenfranchised grief may occur when the griever is NOT recognized (griever not socially defined as capable of grief)

Disenfranchised grief may occur by virtue of Disenfranchised grief may occur by virtue of the death circumstances: Suicidethe death circumstances: Suicide

Doka, K. (2002). Disenfranchised Grief: New Directions, Challenges and Strategies for Practice

Support Strategies for Support Strategies for Suicide SurvivorsSuicide Survivors

Utilize active listeningUtilize active listening

Allow the ongoing search for Allow the ongoing search for the “WHY??”the “WHY??” May get partial answers, may May get partial answers, may

get noneget none

Assess for suicide potentialAssess for suicide potential Thoughts of joining loved one Thoughts of joining loved one

are not uncommon; requires are not uncommon; requires careful assessmentcareful assessment

Watch for social isolationWatch for social isolation

Avoid simplistic explanations Avoid simplistic explanations or clichésor clichés ““It was her time”It was her time” ““You have to be strong for You have to be strong for

others”others” ““Only the good die young”Only the good die young”

Respect the pain; you cannot Respect the pain; you cannot take it awaytake it away

Support Strategies for Support Strategies for Suicide Survivors (Cont.)Suicide Survivors (Cont.)

Support Strategies for Support Strategies for Suicide Survivors (Cont.)Suicide Survivors (Cont.)

Recognize the potential for disenfranchised Recognize the potential for disenfranchised and complicated griefand complicated grief Was the suicide acknowledged as such?Was the suicide acknowledged as such? Was there some type of service held?Was there some type of service held?

Encourage survivors not to make major Encourage survivors not to make major decisions for 6 – 12 monthsdecisions for 6 – 12 months Realistically, this is not possible for many Realistically, this is not possible for many

survivors so additional support is neededsurvivors so additional support is needed

Support Strategies for Support Strategies for Suicide Survivors (Cont.)Suicide Survivors (Cont.)

Assess carefully for increased drug/alcohol use as Assess carefully for increased drug/alcohol use as a coping mechanisma coping mechanism

Address unfinished businessAddress unfinished business PicturePicture Empty chairEmpty chair Visit to cemeteryVisit to cemetery LetterLetter

Support Strategies for Support Strategies for Suicide Survivors (Cont.)Suicide Survivors (Cont.)

Utilize different therapeutic modalitiesUtilize different therapeutic modalities Journaling, bloggingJournaling, blogging BibliotherapyBibliotherapy Support groupsSupport groups

Be prepared to tolerate a wide range of emotion – Be prepared to tolerate a wide range of emotion – flat affect to rageflat affect to rage

Support Strategies for Support Strategies for Suicide Survivors (Cont.)Suicide Survivors (Cont.)

• Recognize that the period immediately after Recognize that the period immediately after the death may not be the most difficult timethe death may not be the most difficult time• 9-18 months later reality hits 9-18 months later reality hits • Grief “attacks”Grief “attacks”

• Recognize that individuals respond to loss Recognize that individuals respond to loss differently:differently:• Intuitive patternIntuitive pattern• Instrumental patternInstrumental pattern• Blended patternBlended pattern

Support Strategies for Support Strategies for Suicide Survivors (Cont.)Suicide Survivors (Cont.)

• Life will never be the same but “different” can be Life will never be the same but “different” can be OKOK

Tasks of Mourning & The Tasks of Mourning & The Companioning ModelCompanioning Model

To accept the reality of the lossTo accept the reality of the loss

To work through the pain of griefTo work through the pain of grief

To adjust to an environment in which the To adjust to an environment in which the deceased is missingdeceased is missing

To emotionally relocate the deceased and move To emotionally relocate the deceased and move forward with life.forward with life.

Jordan (2008) suggests that practitioners should Jordan (2008) suggests that practitioners should resist the urge to try and “fix” a survivor’s grief, resist the urge to try and “fix” a survivor’s grief, but rather adapt to an “expert companion” model but rather adapt to an “expert companion” model with survivors who often may take years, with survivors who often may take years, navigating through a lengthy complex navigating through a lengthy complex bereavement process bereavement process

Worden, W. (2002). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Professional (3rd ed.)

Importance of Importance of TerminologyTerminology

Avoid “grief resolution” or “closure”Avoid “grief resolution” or “closure”

Stress the importance of continuing bonds, if Stress the importance of continuing bonds, if appropriate*appropriate*

Use “integration”Use “integration” ““Integrate the loss throughout life”Integrate the loss throughout life”

Peer Support Peer Support What is it?What is it?

• Concept and DefinitionConcept and Definition• Simple, yet powerful and based on belief that Simple, yet powerful and based on belief that

people who have faced, endured and overcome people who have faced, endured and overcome adversity in their lives can offer hope, adversity in their lives can offer hope, encouragement, advice and counsel to others encouragement, advice and counsel to others facing similar life circumstances.facing similar life circumstances.

• Social emotional support, often joined with Social emotional support, often joined with practical support which is mutually offered by practical support which is mutually offered by peers to bring about a desired social, emotional peers to bring about a desired social, emotional or personal change (Solomon, 2004).or personal change (Solomon, 2004).

Peer Support Peer Support Underlying TheoriesUnderlying Theories

• Mutual Aid (root of peer support, reciprocal process):Mutual Aid (root of peer support, reciprocal process):• ““All-in-the Same Boat Phenomenon”; Taboo Areas (stigma); All-in-the Same Boat Phenomenon”; Taboo Areas (stigma);

mutual support-installation of hope; problem-solving; sharing mutual support-installation of hope; problem-solving; sharing data; dialectical-sounding board process; mutual demand; data; dialectical-sounding board process; mutual demand; rehearsal; universal perspective; strength in numbers rehearsal; universal perspective; strength in numbers (Shulman, (Shulman, 2009).2009).

• Social Support Social Support (Cobb, 1976; Cassel; 1976)(Cobb, 1976; Cassel; 1976): Buffers distress, : Buffers distress, reduces psychological morbidity. Isolation/loneliness harms.reduces psychological morbidity. Isolation/loneliness harms.

• Experiential Knowledge Experiential Knowledge (Kolb, 1984).(Kolb, 1984).

• Social Learning Theory: learn and model behavior, coping Social Learning Theory: learn and model behavior, coping skills, self-efficacy skills, self-efficacy (Bandura, 1977).(Bandura, 1977).

• Helper-Therapy Principle Helper-Therapy Principle (Riessman, 1965).(Riessman, 1965).

• Social Comparison Theory Social Comparison Theory (Festinger, 1954). (Festinger, 1954).

( Salzer & Shear, 2002)( Salzer & Shear, 2002)

Peer Support Peer Support Literature Review – Brief OverviewLiterature Review – Brief Overview

• Began with Self-Help Movement and linked with 1935 Began with Self-Help Movement and linked with 1935 founding of Alcoholic Anonymous (A.A.). Burgeoned in the founding of Alcoholic Anonymous (A.A.). Burgeoned in the 1970’s and 1980’s (Katz & Bender, 1976; Davidson, 1999)1970’s and 1980’s (Katz & Bender, 1976; Davidson, 1999)

• Recognized as an acknowledged basis of recovery and Recognized as an acknowledged basis of recovery and helpful for disenfranchised groups (LGBT, Suicide, Cancer, helpful for disenfranchised groups (LGBT, Suicide, Cancer, Addictions).Addictions).

• First Bereavement Peer Group in U.S. was “Compassionate First Bereavement Peer Group in U.S. was “Compassionate Friends”, Fall 1972. Since then all relationship types and Friends”, Fall 1972. Since then all relationship types and circumstances of death to meet specific needs of survivors circumstances of death to meet specific needs of survivors with like-circumstances have been created (9-11; Suicide; with like-circumstances have been created (9-11; Suicide; Mass Trauma;Police; AIDS; Trauma)Mass Trauma;Police; AIDS; Trauma)

• Current bereavement literature under systematic review, Current bereavement literature under systematic review, yielded few reliable treatment guidelines – however peer-yielded few reliable treatment guidelines – however peer-support groups noted strong benefits of participation (Forte, support groups noted strong benefits of participation (Forte, 2004).2004).

Peer Support Peer Support Suicide Loss-Brief OverviewSuicide Loss-Brief Overview

• First Suicide Loss Peer Support Group, 1980, First Suicide Loss Peer Support Group, 1980, Atlanta, Iris Bolton, a mother who lost her son Atlanta, Iris Bolton, a mother who lost her son to suicide in 1977. to suicide in 1977.

• Clinically observed to be widely-utilized and Clinically observed to be widely-utilized and helpful for suicide survivors for postvention helpful for suicide survivors for postvention support.support.

• Current research has begun to demonstrate Current research has begun to demonstrate value and efficacy (Barlow, et al., Feigelman & value and efficacy (Barlow, et al., Feigelman & Feigelman, 2008), but continue research is Feigelman, 2008), but continue research is needed (Cerel, et al.), especially with sub-needed (Cerel, et al.), especially with sub-populations with special needs.populations with special needs.

Question: Question:

Why should we even try and help military Why should we even try and help military families and service members who are suicide families and service members who are suicide loss survivors?loss survivors?

Answer: Answer:

Because doing nothing Because doing nothing is not acceptable and is not acceptable and there is evidence we there is evidence we can make a can make a difference….difference….