The suicide postvention SOP project was designed to develop a guideline or template that would be useful to fire service broadly. We are aware that suicide prevention is preferred, but the statistics show that suicide has not yet been completely prevented in any nation or any profession, so postvention is necessary as well. We aim to have a document that fire departments of various sizes could use to create their own procedures and perhaps policies for best practices after a suicide death of a firefighter. We started the project with an SOP drafted by the New York City Fire Department Counseling Service Unit. The document you are reading today is the end result of those groups.
Suicide postvention is the suggested course of action individuals and groups can take after the tragic loss of someone to suicide. Postvention can include individual and group support, peer support and professional counseling. Early studies demonstrate that postventions help with the grieving process and decrease the incidence of complicated grief, suicidal ideation and poor adjustment to the loss. In a sense, postvention is secondary or tertiary prevention.
A Standard Operating Procedure (SOP) Guideline for Suicide Postvention in Fire Service: A Suicide Postvention Protocol for Fire Service
Preparing for the possibility of suicide and having a pre-established SOP for postvention ready is critical to helping individuals cope in the aftermath of a suicide. While every Fire Department’s SOP may need to be modified in order to remain in compliance with existing departmental policy, the following protocol was designed to serve as a general guide for suicide postvention within Fire Service. This first document is intended to be a “how-to” SOP, and it is supported by an educational document with “Do’s and Don’ts”, suicide myths, and online resources.
Purpose/Objectives for Suicide Postvention
The goals and objectives for suicide postvention for department members include the following:
- Ease the trauma and related effects of the loss
- Prevent the onset of adverse grief/complicated grief, defined as feelings of loss that are debilitating and do not improve over time
- Reduce stigma and social isolation that can result from suicide loss
- Minimize the risk of new suicidal behavior
Suicide Postvention Steps
- Notification Procedure
- The notification procedure should follow existing chain-of-command and have protocol instructions for who is required to be involved. The suicide death should be precisely in keeping with any other death in fire service, and notification procedures would follow existing policies (Reference policy #___, LODD).
- There are no universal rules for who should do what, as each department will differ with respect to what types of individuals are available and willing to be involved in the postvention process. It is recommended that a company meeting be called as soon as possible (within 24 hours, certainly) where firefighters can be briefed and provided resources, referrals, directions as to how they can help family members and fellow co-workers, and time to process the information.
- With the permission of the family, the facts of the suicide should be stated as clearly as possible so as to limit the incidence of rumors; however, this information should be provided in a respectful and unglorified manner (see Do’s and Don’ts in educational materials).
- The announcement to the department should be accompanied with a phone number or helpline for firefighters to call for help.
- Determine protocol regarding social media. Decide what is acceptable for the department to post and what is acceptable for individual firefighters to post.
- Determine Who Will Be Involved
- Designate a team leader to coordinate the response to the suicide in the fire department, perhaps someone with counseling experience or a long history in fire service.
- Physicians, counseling units, Employee Assistance Programs (EAPs), chaplains, officers, police, union officials, safety, and other key departmental teams should be assigned specific roles and given directions for what activities they should be involved with as part of the development of each specific Department’s SOP.
- Designate a department liaison for responding to the families.
- Designate a team of support or peer counselors for liaisons and firefighters where they can get help if needed.
- Responding After a Suicide
Response to suicide will depend on where the suicide took place and the characteristics of the member involved. For example, although it happens rarely, the procedures will be very different if the suicide took place in quarters by an active member than if they took place out of quarters by an active member or a retiree.
- In Quarters – Response to suicide death in quarters will be treated similarly to response to any other type of emergency situation. Firefighters will call 911, assess vitals, and attempt resuscitation if possible.
- Out of Quarters – Response to an out of quarters suicide death will involve notification procedures and protocols for response at the department, hospital or victim’s home.
- Responding to the Family
- Financial questions – The identified liaison person should have a document prepared that outlines benefits the family will receive after the death of their loved one. Insurance and line of duty benefits are often a source of stress after a suicide and having clear information at hand will help to dispel anxiety and provide family members with clear expectations. Because suicide is not consistently ruled a LODD, certain benefits may be limited.
- Funeral Details – Turnout following a suicide death would ideally be no different than other types of death for firefighters. However, the funeral is an extremely critical time for grieving both for the family and for members of the department, and special care to respect the feelings of family needs to be taken. Funerals are opportunities to provide social support and reduce stigma if handled well. Although isolation for the grief stricken is ill advised, care must be taken to ensure that vulnerable grieving family members are not intruded upon. If possible, provide ceremonial options to the family that they can choose from and encourage members of the department to attend.
- Departmental Help – The protocol established at FDNY following 9/11 was to assign one or two members to be liaisons or contacts for grieving families to help meet the needs of the family from the department. This wisdom led to better adaptation to loss for both family and brother/sister firefighters. Departments including this in an SOP should set boundaries and expectations so the liaisons can maintain balance in their own lives and establish protocols to deal with any difficult interactions (e.g., when and where to recommend that family members seek mental health treatment if they are having a particularly difficult time adjusting to the loss).
- Responding to Department Members
– short term vs. long term support
- Short term – Officers go out to the firehouse with a chaplain, ceremonial officer, and peer counselors and do an umbrella overview of what is going to transpire over the next couple of days and check in with the members and captain.
- Longer term –
- Match a peer counselor to the firehouse. During the first week the peer checks in with the members of the firehouse regularly, in an attempt to touch base with as many affected members as possible. Over the next several months they go once a week or every two weeks to do outreach. There may be a critical time period between 2-4 months when clinical symptoms develop.
- Determine the “family tree” within the department – the network of those who were closest to the firefighter who committed suicide. This could be the current house or the shift of the firefighter. It could also be a previous station. Establishing this list will aid in connecting those who may be the most vulnerable following the suicide with resources and support.
- Establish methods of follow-up after the suicide. There are several means that can be used to check-in with firefighters following a suicide in order to evaluate how they are doing. Using self-assessment handouts, leaving business cards for peer counselors at the firehouse, displaying resources for emergency hotlines or telephone therapy or websites for online help can all be useful. If the results of any questionnaires or assessments indicate a potential behavioral health problem, there must be the appropriate support in place for connecting that firefighter to treatment. In all cases it is essential to maintain a connection with firefighters after suicide loss. The more that peer counselors and other mental health support staff engage with firefighters after a suicide, the more likely it is that the affected firefighters will get help if they need it.
- Prepare for and address potential emotions, behaviors, and beliefs that may arise after a suicide (all of the following are normal and to be anticipated):
i. Anger and shame
ii. Frustration/Lack of understanding;
v. Self-medicating behaviors
vi.Belief that suicide is a sign of weakness
- Responding to Firefighters At-Risk
There are times when the signs of a behavioral health problem after a suicide are more difficult to handle. For example, a positive drug screen, an act of aggression, alcohol abuse, or demonstrating poor work performance all suggest that a firefighter may be having difficulty coping with the loss. Responding in these situations with the knowledge that such behaviors could be related to the firefighter’s difficulty coping with the loss can potentially deter unnecessary disciplinary action and instead connect a firefighter to treatment that he or she may desperately need.
- Concluding the Postvention
After several weeks (or as determined by the department), phase out the postvention process.
- Set up meetings with firefighters and family members to have a closing discussion and provide resources if they need help in the future.
- If desired by firehouse or family, plan future check-in times by peer counselors or team leaders on a periodic or monthly basis between 6 months and a year after the suicide.
- Reinforce the fact that grief following suicide can take a longer time to process, and help will be available at any time.
- Have postvention coordinator continue to record and track any follow-up services to the family provided by the department.