Suicide Bereavement Support Service: final evaluation report

5. Experiences and outcomes of people receiving longer-term support

Prior to the pilot extension into a third year, the evaluation had engaged with people who had been receiving support from the service for periods ranging from three months to nine months to explore their experiences and the outcomes that had been generated. The findings and evidence from this have been detailed in the previous evaluation reports. In summary, the evaluation up to the end of Year 2 found that:

• People have a positive experience and receive responsive person-centred support from the service, that is delivered with sensitivity and compassion.
• People receive support that is led by them and provides the flexibility required to respond to changing needs.
• The service has a positive impact on the emotional and mental well-being of the people it supports,
• as well as the extent to which they feel they can cope with and return to day-to-day life and activities. For some people, the impact is profound, with feedback suggesting that it has been the difference between living and dying.
• Wider support and service options aligned to their needs are explored with people, and support required to access them is provided as required and appropriate.

During this extension period, the evaluation was tasked with understanding the needs, experiences and outcomes of people receiving support over a longer duration. This was explored with 13 people who have been receiving support from the service for over 12 months. The findings are presented in the following sections.

5.1 Format of support

All but two of the 13 people supported by the service that we engaged with during this phase of the evaluation reported that all their support sessions had been carried out by phone. They stated that this had been their preference at the outset, and they had continued with this format because it had worked so well for them, even when the option to have face to face sessions was introduced.

“I’ve kept going with the phone calls, and well, it's really worked for me. In the early days it’s all I felt I could manage, but now, as I say, it’s worked really well and it’s just really convenient, easy.”

“It's all been over the phone because that's my preference. The first, I suppose, nearly first year, I didn't really want to meet up with anybody, I didn't want to look at anybody, if that makes sense. Even now that I’m back to, well closer to my old self, I don’t feel the need to change it. I know I could meet up with [practitioner] but this gives me what I need.”

One person reported that they had moved to a mix of face to face and telephone support. They explained that as the brighter months of the year came around, the option of meeting for a walk and receiving support appealed to them, while telephone sessions still provided convenience when their work made it difficult to meet up. Another person explained that they had met up for a face-to-face support session once, and another reported that they wanted to have an in-person session before they finished their support completely. In both instances this was borne from a desire to meet the person that had been supporting them and express their gratitude

“I've often thought to myself, you know, do you know I'd like to meet [name, anonymised] before the session's totally finished, you know, just to let them know how much they have helped me. It’s something I’m going to mention in the next session.”

5.2 Changing frequency of support and influencing factors

People supported by the service commonly reported that support sessions were weekly when they first accessed the service. All of those we spoke with struggled to recall the early periods of engagement with the service in detail, describing it as a blur and as a time in their bereavement journey where they struggled to understand and process what had happened. The higher frequency of support during those early stages had been essential in helping them get through that period.

“At the beginning it was just getting through a day, getting through a couple of hours in a day. I can’t really explain how important it was to have [practitioner] there whenever I needed them.”

Most of the supported people explained that there had been periods when they had started reducing the frequency of the support they received from the service, which coincided with a feeling of being better equipped to cope, better able to get by day to day and feeling less reliant on the support.

“I won't use the expression 'moved on' because you'll never move on, especially losing a daughter, losing a child. But I suppose I could see progress, I wasn’t feeling the same way between calls and felt that I didn’t need to be having them so often.”

“I was back to work, I had a routine again, and just managing better in myself.”

However, people also described how circumstances in their lives and different events had set them back and heightened their need for support again.

“I’ve recently had some really bad news that I’m finding it hard to deal with. She would be my, yeah, the person I would always turn to for support I suppose, and I can’t. So I'm just very much feeling the loss I suppose at the moment, finding stuff a bit harder and yeah, needing a bit more support than I thought I would at this moment in time, but I'm sure with time that will get better.”

There was a wide variety of circumstances and factors that had influenced people’s increased need for support, with examples including:

• Ongoing reviews by statutory agencies of the bereavement with certain points in the review process creating heightened feelings of distress and bringing back painful thoughts and memories.
• Isolation and lack of a wider support network.
• Re-engaging with activities that the person would have done with the loved one they had lost.
• Strained relationships and traumatic events with other family members, partners or ex-partners.
• Moving house and leaving memories behind, or selling the home of their loved one.
• Returning to work, where roles mean that people face situations that can trigger memories and be re-traumatising (e.g. healthcare workers).
• Death or serious illness of a family member or friend.
• Trying to support other people affected by the bereavement who are not yet ready to access support for themselves.

“I’m in the middle of trying to sell the house, and you know, that’s the house that we had together, and when I do move there will be stuff I need to get rid of. But everything is memories and it’s hard because it’s part of bad memories but also so many good ones. I’m just finding it really really hard just now.”

The reassurance that the frequency of support can be increased again was reported to be highly valued. Having this option gave people the confidence to test how they would manage with less support. Several people reported that they would have been more hesitant about reducing the level of support they received without the reassurance that they could increase it again if needed. Related to this, that there is no time limit placed on support was also seen to be critical by those who have accessed support.

“So at the moment I check in with [practitioner] sort of once a month, but I also know that I can, if I want to, you know, between that sort of once a month, that I can get in touch if I need to. I could even go back fortnightly or even weekly sessions, that was always made clear. And that’s like, a sort of safety, that lets you go OK let’s try monthly or whatever and you know you can go back if you’re not ready.”

“Yeah I think it's very important to not feel that you're rushed or you've got a time limit because as I said you can think you're doing okay yourself maybe after six months, but then sometimes after that you know, you find yourself in a bad place again, something can trigger it off or a memory or just how you're feeling yourself, so I think it's very important not to have a time limit, if I'm honest.”

5.3 Changing needs

People supported by the service described the period after their bereavement as a time of confusion, when they experienced a wide mix of intense feelings and emotions, usually combined with questions they did not have answers to. Several explained how bereavement by suicide is different from other bereavements they had experienced in terms of the nature and intensity of the thoughts and emotions they were experiencing.

“It was a feeling of guilt that I’ve never known before, guilt that I wasn’t there for him, that I wasn’t there to help him. You don’t think it’s ever going to go away.”

In those early stages following their bereavement, people supported by the service spoke about the importance and value of having someone to speak to and who would listen to them with empathy and compassion. Those supported by the service reflected on the support they had received and how it helped them understand and accept that their feelings were normal and to come to terms with the questions they would never have answers to.

“At the very very start it was just someone who listens without telling you what everyone was telling you at the time. You know, "everything will be okay, blah blah blah blah blah." Someone who just listens and don't provide those ready-made phrases that you get tired of hearing and someone you can just cry in front of, which I did a few times. Someone you can be very honest with, that was really important at the very start. At that time, it was a phase where actually I wasn't right at all mentally, and I had very dark thoughts.”

“Sometimes you just need to know, you just need that reassurance that what you are feeling is normal. There’s so much your feeling, and thoughts your having, and you wonder if it will ever stop. [Practitioner] just helps you work through it, it’s OK to feel those things, it's OK to be thinking that way.”

“All the why’s and the what if’s that go round and round. I’m not saying that I don’t still think those things, but there’s an acceptance that I’ll never know and that is sort of OK.”

Supported people described how over time and with the support of the service the intensity of the emotions and feelings related to the bereavement reduced, and the impact of those emotions and feelings subsided. The support helped them to understand and process their emotions and feelings but also gave them strategies that helped them to cope better day to day. Some supported people spoke about support sessions becoming more future and solutions-focused rather than predominantly being related directly to their bereavement. However, the ongoing need for support was acknowledged, the need to still have that person they can speak to openly without judgement or expectations about how they should be feeling by now remains. Supported people explained that they can be caught off guard by something that can set them back and catch them unprepared.

“It just started me questioning what were all these years about, you know? And, yeah, it really got me down. So, yeah, that's where I find that checking in with [practitioner], I think just talking to her, I sort of figure it out myself, you know? She doesn't give me any answers, but she does help me figure it out for myself.”

“I mean, my feelings maybe aren’t quite so acute now. I don't know, I just get general troughs and crests of life. And it's depending on how I'm feeling about the other things, will then also be how well I'm able to deal with things.”

“There's days when I think, when I'm having a really good time and I think, do I really need this? And then there's just something will happen that trips me up and I think, no, do you know what, I still do need this. It’s the things that just come up and bite you in the bum. That’s the only way that I can describe it.”

“And usually by the end of the conversation I think, right, okay, I've come up with that solution. That's what I'm going to do.”

5.4 The difference that support has made

The support that people have received from the service was consistently reported to have positively impacted on their mental and emotional wellbeing, which was attributed to a reduction in the intensity and frequency of emotions that had a negative impact.

“I do feel a bit stronger now, I do, I definitely do. I don't think my mental health would be as good as it is now.”

“I definitely feel that [practitioner] helped me get the power back.”

“In fact, some people say to me, my boss said to me, she says you're happier now than, she's known me for 14 years, through that was my marriage and my son, and she says this is the happiest I've ever seen you in 14 years, it's unbelievable. So she says you’ve got a bit of your spark back.”

“It was really important for the emotional side initially and then it's sort of support with you as you sort of change slightly or are able to adapt more than that support sort of goes with you. So it's made a massive difference emotionally. Mentally, yes, the support was there.”

“I think I'm making some really good progress and I'm beginning to be more happier in my life, but [support worker] being there definitely helps me.”

The service was also reported to have supported people to feel better equipped to cope with day-to-day life and finding a new normal. A variety of different examples were given by people supported by the service to demonstrate the progress they had made, which included getting back to participating in social activities and hobbies, going back to and remaining in work, and generally having a more positive outlook and hope for the future.

“When I first went back to work, the first day was not so great as we had a child protection workshop. But they switched the format and they just launched into it, and it was suicide and things like that. And I just stood up and ran out the room, and I thought I was gonna pass out. And I just felt as if I was right back there in the moment, and had it not been for [practitioner] that night I don’t think I would have ever gone back.”

“I've got nothing but praise for it because it's changed my life completely, completely changed my life and I've got a life now, whereas before I'd be like, I didn't want to continue, you know what I mean?”

“Well I don't think I'd be working, I wouldn't be back at my work, I wouldn't be out and about and socialising, I would just be like hiding.”

“I couldn't speak any higher of the service in terms of, I genuinely don't know if I would have functioned in work and stuff without the support that I've had so yeah it's pretty huge.”

“So I suppose I've gone out more and I've certainly gone for coffee and lunches by myself. So I find that that's a big step forward.”

“I’ve started doing mindfulness stuff, I've gone along to a pilates group and I also go along to a relaxation yoga class.”

For a few, the difference the support of the service has made was reported as potentially having been the difference between life and death.

“And [support worker] was very very supportive and very, oh god he doesn’t even know sometimes I did get upset about it but no, I probably wouldn’t have carried on if it wasn’t for [support worker] to be honest.”

“I think I could honestly say that that if I hadn't had the service there's a chance I might not be here today.”

“I wouldn't have known what I needed at that point. I was just in abject gut wrenching pain and loss and feeling suicidal and my world was upside down. So I don't know that I knew what I needed, but what I now know, looking back, was how much it really helped me.”