Suicide bereavement support, Denmark

CYP Now has teamed up with the Churchill Fellowship to publish a series of articles summarising key findings from studies undertaken worldwide by Churchill Fellows (see below). This is an abridged version of Time to Count: Supporting children after a parent dies by suicide by Anna Wardley.

Anna is an award-winning communications professional who lost her father to suicide when she was nine years old. In adulthood, she has used a range of therapies to help deal with unprocessed grief and has trained as a practitioner of trauma release exercises to help others affected by trauma.

In 2019 and 2020, Anna visited leading experts and organisations in Australia, Denmark, Sweden and the USA doing pioneering work that could potentially be replicated in the UK. Here, she looks at provision from Denmark, where she visited the Danish National Center for Grief, the Danish Research Institute for Suicide Prevention, and academics and practitioners in bereavement response in the country.

UK CONTEXT

Suicide-bereaved children remain overlooked, fuelled by the myth that children are not affected by suicide, or indeed any death, to the same extent as adults. The fact that no data is collected on how many children lose a parent to suicide each year highlights this oversight.

In the UK it is estimated that many thousands of children lose a parent to suicide each year and, according to international research carried out by Johns Hopkins University in 2010, these children face increased psychological and social problems, a two-fold risk of hospitalisation due to depression, and three times the suicide rate compared with those who have not lost a parent to suicide.

By improving how we support these children with complicated grief, we can mitigate the long-term damage in the aftermath of a suicide. I wanted to find out how our international counterparts were working to avert mental health crises in young people affected by suicide and break the devastating chain of those bereaved by suicide in childhood going on to take their own lives.

SCALE OF THE ISSUE

We don’t know how many children lose a parent to suicide in the UK each year as there are no statistics collated so we can only make guesses based on the number of suicide deaths reported in the age groups where people are likely to have children.

Given the age profile of people who die by suicide, it is likely that many are parents of dependent children. According to the statistics for suicide deaths published by the Office for National Statistics in 2019, a total of 3,596 men and women who died between the age of 20 and 49 died by suicide in the UK in 2018. It is likely many of the people in this age range were parents, so it is clear that many children in the UK are losing a parent to suicide. The problem is that nobody is counting them.

We count the number of children admitted to hospital due to knife crime or the number of young people with special needs requiring extra support in school so that we can evaluate what resources are required to provide the necessary support. Without that vital information, it’s hard to make a case to support an unquantified or invisible group.

Things are different in other countries including Scandinavia where a national register of data is held on each individual, which can be interrogated to produce statistics on all areas of life.

In Denmark, researchers can use the national register data to quantify the scale of the issues faced in society. This system is underpinned by a more open approach to sharing personal data with the state and relies on a high level of trust in public bodies holding such information that can be accessed in an anonymised form for research.

B-PLANS

Bereavement response plans (B-plans) in Danish schools play a major role in planning and delivering bereavement support for children and young people. Dr Martin Lytje, based at the Danish Cancer Society in Copenhagen, has worked to evaluate and develop the system of B-plans that help teachers support grieving students in Danish schools.

First introduced in the early 1990s, B-plans (Sorgplan in Danish) were inspired by the pioneering work of Norwegian researchers to develop support in schools for bereaved children. Based on practical experience rather than scientific research, the plans are created from a template by the teachers themselves to ensure that they cater for the different needs of each individual setting. Although every plan is unique, they mainly focus on the practical aspects of responding to different scenarios of bereavement. This often includes themes such as who should contact the family, who should be notified about the bereavement, and how to inform other students.

While little scientific research has been undertaken to evaluate the effectiveness of the B-plans, the system has one of the highest implementation rates in the world and interviews with teachers suggest that the Danish model has been successful as a support mechanism for teachers. However, a survey of 967 teachers conducted in 2016 found that the plans would benefit from being updated to incorporate the perspectives of the students they are designed to support.

PEER-TO-PEER SUPPORT

One theme that unified all the organisations I visited was a steadfast belief in the value of peer-to-peer support after suicide. This shared kinship allows children and young people to express their complicated grief surrounded by others who have experienced the same sort of loss, helping them understand that they are not alone in dealing with complex emotions following a suicide.

I met with organisations providing peer-to-peer support in a wide range of settings including meetings in a family home, in group sessions for children facilitated by a specialist psychotherapist, in residential youth camps in the countryside and in purpose-built play and drama therapy rooms where children and young people could interact with their peers under expert supervision. I also found out about examples of online peer support for suicide bereaved children and young people in Sweden, and how they were attracted to the anonymity and round-the-clock accessibility such platforms offered.

An example of an effective peer-to-peer support model is Nefos, the primary provider of suicide bereavement support in Denmark (see box). Another is the Danish National Center for Grief (Sorgcenter in Danish) which provides psychological treatment to those who have developed, or who are at risk of developing, complicated grief and as a result experience reduced daily functioning following the death of a loved one.

FINDINGS AND ACTIONS

Bereavement by suicide is different to other forms of bereavement, and children and young people express grief differently to adults. A significant amount of stigma and many myths persist that hinder the provision of support following suicide bereavement and people are particularly fearful to discuss the topic of suicide with children and young people.

Peer-to-peer support from others bereaved by suicide can be extremely helpful for forming relationships of mutual support and preventing isolation. Storytelling and creative expression can help children and young people form their own narrative, and by forming their own meanings they can move from victims to active agents.

Since completing my Fellowship, I have already started to work towards implementing my recommendations. Key progress to date includes:

Established a social enterprise called the Luna Foundation (www.teamluna.org) focused on improving the support for children and young people after parental suicide

Developed an online suicide bereavement training workshop for people working with children and young people, piloted in Wales in 2021 and now delivered in several regions

Worked with Portsmouth City Council to produce resources to support children and young people after suicide bereavement and a suicide bereavement protocol for education settings

Selected as a Shackleton Leader by the Shackleton Foundation, a leadership investment programme supporting social entrepreneurs who embody the spirit of Sir Ernest Shackleton, supporting the development of the Luna Foundation

Appeared as a panelist during a discussion on “grief following suicide” as part of the Grief Festival 2020 where I spoke about my Churchill Fellowship research

Co-chaired a workshop focused on support for children and young people after suicide on behalf of the Portsmouth Suicide Prevention Board

Met representatives from councils in South Yorkshire to share the initial findings from my Fellowship research to help inform their support provision

Became a founding member of Hampshire County Council’s People with Lived Experience of Suicide Group, where I advocate for the needs of children and young people.

• Time to Count from www.churchillfellowship.org/ideas-experts/ideas-library/supporting-children-bereaved-by-parental-suicide
  
  

HOW NEFOS DELIVERS PEER SUPPORT FOR PEOPLE BEREAVED BY SUICIDE

I was lucky to be able to attend a Nefos peer-support group in Denmark. The evening meeting for parents who had lost a child to suicide, was held by volunteer Lotte Holmen at her home in Valby on the outskirts of Copenhagen.

A total of eight suicide-bereaved parents attended the group, plus two trainee facilitators, and I was impressed by the warm and welcoming atmosphere that allowed the bereaved parents to freely express their feelings among others who understood their complex grief.

Parents had been invited to bring an artefact, photo or video to share memories of their child, prompting some highly emotional disclosures and exchanges.

The group sharing was expertly facilitated by Lotte, who also incorporated a guided breathing exercise and provided refreshments creating a calm and homely atmosphere throughout the session. By sharing memories in a safe space, the setting provided a rare opportunity for these parents to express their overwhelming grief.

Nefos also offers the opportunity for those bereaved by suicide to take part in a series of one-to-one therapy sessions with a counsellor. There is no charge for any of the support they provide.

Nefos is also committed to training volunteers to carry out the vital role of group facilitator. The two trainees present at the group I attended were being mentored by Lotte, one of the organisation’s most experienced facilitators, and took part in a debrief after the meeting as part of their preparation to run groups themselves.

ABOUT THE CHURCHILL FELLOWSHIP

The Churchill Fellowship is a national network of 3,800 inspiring individuals whose mission is to find the world’s best solutions for the UK’s current challenges.

Up to 150 Churchill Fellows are funded each year to visit the world’s leading practitioners and projects on a topic of their choice – from social policy to healthcare to education and more – and bring back new ideas for their communities and sectors across the UK.

Any UK adult citizen can apply, regardless of qualifications, background or age. Fellows are chosen for their potential as change-makers, not their past track record or status.

• Find out about fellows and their ideas at www.churchillfellowship.org