Planning for the Worst: A Commander’s Guide to Suicide Postvention

Soldier in fatigues speaking to a group of soldiers sitting down.
Photo by Sgt. Tiffany Edwards
By Larry Pruitt, Ph.D.
September 9, 2019

When a military suicide or suicide attempt occurs, it clearly has a significant negative impact on those closely associated with the service member. But how far reaching can that impact be and what can those in leadership positions do to foster recovery among those who are affected?

Past estimates have suggested that only six individuals are adversely affected following a suicide, but that may be a massive underestimate. Recent work has demonstrated that closer to 135 individuals are exposed to, and potentially negatively affected by, a suicide. “Affected” means measurable changes in mood, anxiety, stress, relationships, mental health symptoms, and even a person’s own level of suicidal thinking, among other things. This ripple effect of suicide is particularly relevant for the close knit military community which is highly structured in such a way that leaders of both small and large groups are acutely involved with – and often responsible for – the day-to-day activities of their soldiers, sailors, airmen, and Marines.

So, what steps can be taken by first, second, or even third line military leaders following a tragic suicide death to attend to the wellness of a given military unit? This process has come to be known as postvention, the response and support available to affected individuals or the workgroup as a whole, designed to alleviate the negative effects of a suicide or suicidal behavior. In many ways this mirrors the response that a command may have to the death of a service member for any reason), but because suicide carries with it the stigma often placed upon mental health issues, commanders may feel that they need to handle the situation differently than they would if the death were caused by combat, an accident, illness, or any other reason. This is not the case, and military leaders should avoid any communication that portrays suicide as different from any other cause of death.

Below are some general considerations about postvention following a suicide death, as well as some concrete steps that leaders can take in the immediate, short-term, and long-term periods after a death in order to proactively create an environment of recovery, reconstruction, and wellness. These have been adapted from workplace-focused task forces of the American Association of Suicidology and the National Action Alliance for Suicide Prevention.

General postvention considerations

Military leaders with command responsibilities over other service members not only facilitate postvention efforts, but also serve as a role model for those they supervise and for the family members affected by a suicide. First and foremost, commanders need to approach these situations from a point of compassion for those experiencing bereavement. Any discussions, messages, or actions should convey a tone of respect, empathy, support, and should encourage those who are grieving to take steps toward self-care.

Leaders need to listen actively to the needs of their subordinates and the family members affected by the death. They should understand that while the needs of each individual may differ, they are all equally valid. These needs might involve recovery time away from normal duties, or may be expressed as feelings of anger, guilt, regret, sadness, and other emotions. Some needs may be expressed verbally, while others may be more behavioral in nature. If leaders do not feel confident in their ability to process such feelings with their subordinates alone, enlisting the assistance of available behavioral health resources is encouraged. Further, relevant military service policies for offering assistance to survivors, including family members, should be followed as fully as possible.

Leaders who had command responsibility for the individual who engaged in suicide should recognize that they are in a unique position to provide postvention support, broadly. At the same time, they should not neglect their own needs, or the grief they may feel. These leaders should be prepared to handle expressions of anger and/or blame that may be directed at them simply because of their role as an authority figure. This is true in the immediate aftermath of a suicide, but may persist long afterward. These feelings may be amplified by military ceremonies and celebrations, holidays, completion of major tasks/missions that the individual was a part of, anniversary dates of the event, etc. Depending on the circumstances, it can be important to acknowledge the loss of that person or their contribution to the community at these times, in a manner similar to how this would be handled for any individual’s death, regardless of the cause.

10 action-oriented steps when managing postvention efforts

In the immediate wake of the event:

  1. Coordinate – Contain the crisis.
  2. Notify – Protect and respect the privacy of the individual and their family during the notification process, and ask the family if there is anyone they wish to be notified.
  3. Communicate – Reduce the potential for rumors and misinformation by sticking to the facts.
  4. Support – Offer practical assistance to the family.

In the short term (recovery phase):

  1. Link – Identify and connect impacted service members to additional support resources in their community and refer those most affected to trained behavioral health resources.
  2. Comfort – Be empathic and understanding. Provide support, comfort, and promote healthy grieving of those under your command.
  3. Restore – Actively work to restore equilibrium and optimal functioning among those you supervise.
  4. Lead – Build and sustain trust and confidence in your leadership skills and organizational structure.

In the long term (reconstruction phase):

  1. Honor – Prepare for anniversary reactions and other milestone dates. Be aware that these can be triggers for additional grieving.
  2. Sustain – Transition from postvention back to suicide prevention.

No one wants to think that a suicide could happen to someone they know, care for, and work with every day.  But in the event that a suicide does occur, being prepared to support those affected can help to manage the pain and loss in effective and healthy ways. And remember, if you or someone you know is thinking about hurting themselves, having thoughts of suicide, or becoming self-destructive, there are trained responders ready to help at all times. Contact the Military Crisis Line immediately for assistance by calling 800-273-8255 and then press 1.

Dr. Pruitt is a licensed clinical psychologist. He serves as the director for suicide prevention at the VA Puget Sound Healthcare System, and the lead VA suicide prevention coordinator for a four state region including Washington, Oregon, Idaho, and Alaska. Dr. Pruitt is also an associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine.


The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


Comments

  • The thoughts of this is going around in my friend's head. He had 5 of his Afghanistan Tour buddies who have died by suicide. He acts like he now has 3-4 different personalities but tells everyone that everything is "fine".

    • Please encourage your friend to contact the Military Crisis Line by calling 800-273-8255 (press 1), texting 838255, or chatting online at https://www.veteranscrisisline.net. If you feel he may be in immediate danger, please call 911 or accompany him to the nearest emergency room.

      -- Dr. Pruitt

       

       

  • Thank you very much for this follow-up by discussing postvention strategies, after the DoD annual report discussed suicide-prevention efforts in the various branches, but "postvention" could not be found anywhere in the report of many, many pages.

    I'd also suggest that suicide-prevention resources, especially for those in acute mental-health crisis, be noted at the top of the article. That way, the offer of help is indeed immediate, not several minutes later, at the article's end. Every minute counts for those enduring an acute mental-health crisis. Those struggling with mental-health challenges usually present with a lack of motivation and energy. One may open an email, but read only what is seen in the rendering email window.

    Suicide is not a cause of death; it's a manner of death.

    Local Commanders now have a great and informed resource in this list of action items. The military is real big on checklists, especially in aviation, and this is one of the best I've seen in all my years as a Soldier and an advocate for Federal employees with disabilities, especially those with targeted disabilities.

    There was no protocol for my supervisors to follow in 2013, when an FPS Security Guard went to the rooftop of the GSA building in Washington, DC and completed suicide with his service weapon. I had a rather marked and devastating reaction to this incident of completed suicide and workplace violence. Sadly, my father, Leland Cogdell, completed suicide on Christmas Day 1969. My beloved sister, Margaret Rose Grant, completed suicide on September 11, 2004. I've also lost many friends from childhood and military service to completed suicide. I try to honor their short lives by helping others.

    Thank you to everyone who works to care for those who live with some form of organic brain dysfunction. You are indeed angels of mercy, and I sincerely appreciate what you do in your vital vocation.

    Fly Army!

    Best,

    Ted Cogdell
    Washington, DC

  • Both TAPS and the Air Force Resilience Office have very tangible suicide postvention resources, guidelines, recommended messaging to unit and others, engagement with family, etc: https://www.taps.org/suicidepostvention; https://www.resilience.af.mil/Postvention-Tools/

  • Was wondering if leaders are aware of Traumatic Event Management assets available to them to assist?

    • Thank you for your comment and for letting us know about this.  

      -- Dr. Pruitt

       

       

  • While the content of this message is great, we start to fail around step 5. Command teams truly struggle with postvention. We tend to rely too heavily on Inside the Wire resources. It would benefit to update the article with specific resources in suicide postvention that are beneficial such as the Tragedy Assistance Program for Survivors.

    • Thank you for your comment. Our understanding of postvention as a key step is relatively new in the field of suicide prevention, and stems from work conducted by the Military Suicide Research Consortium. However, it's been a long standing part of other areas that deal with tragedy, including how military and civilian agencies inform families that their loved one lost their life in combat (military) or a catastrophic accident (police). We're just now at a stage where those models are being adapted to cases of suicide. The Tragedy Assistance Program for Survivors is a good example of how that work is being done.

      -- Dr. Pruitt

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