"A suicide death is like a pebble in a pond. The waves ripple outward."

I found this simile, which a colleague used in a conversation earlier this week, so immediately illustrative of the effects of suicide and indicative of the importance of what some of us in the field have come to call "postvention." Postvention is the provision of crisis intervention and other support following a suicide. It may involve developing a strategy for crisis response, working to contain suicide clusters, or helping survivors of suicide cope with the loss.

The "pebble in a pond" description helps show how something seemingly small - the death of one person by suicide - can affect an entire community - from family, to friends, to classmates or co-workers, and beyond. A faith community, teachers in a school, service providers, and those who respond first to a death - such as emergency medical technicians or law enforcement - are also impacted by a suicide death.

The way crisis response to suicide has traditionally been viewed, it is the first wave or ripple who usually receives the most attention, and rightfully so - family, friends, and those who are closest in proximity and emotional connection to the person who dies by suicide are acutely impacted by the death. But, the next wave also needs to have crisis resources directed their way, so that the next time a suicide occurs, they are better prepared to respond, both to their own reactions and also in the way they support those closest to the person who died.

One instance of the need for a postvention response occurred recently with Washington, D.C. Metro employees affected by the suicides they witnessed on Metro tracks. Metro employees are requesting training on suicide prevention. The same colleague who shared the "pebble in the pond" description with me said that he had worked with faith leaders in different parts of his state who had completely different feelings about how to respond to suicide deaths. Some were able to confront the topic, while others felt it was best left alone. In my early work in suicide prevention, it felt like an entire school was afraid to utter the word "suicide," even though that's how several of their students had died in the last year.

Postvention is prevention. Supporting a community after a suicide loss and better equipping people in different sectors of a community to respond to suicide helps prevent future suicide deaths. Silence about suicide does not contain the ripple effect - it may just leave people feeling stranded on a wave.

Copyright 2009 Elana Premack Sandler, All Rights Reserved

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