"Arms Of Support"
(A Survivors of Suicide Attempt, Support Group)
The Mission
“Arms of Support” ( a Survivors of Suicide Attempt Support Group) created by Tuff Services Ministries with the assistance of other organizations by permission, offers suicide attempt survivors a safe, non-judgmental place to talk about their common experience of having survived a suicide attempt. Members are encouraged to share their stories of recovery to support each other and learn new ways to cope with suicidal thoughts. Through peer support, trained and certified guided facilitation, we seek to encourage a supportive community to foster the development of effective coping skills and create hope for the future.
The Purpose of the Support Group
The support group typically has six to eight adult participants (18 years or older) and meets for eight weeks. Each participant must have made one or more suicide attempts. Additionally, participants are required to complete an intake interview with a facilitator prior to attending the group. The group is closed to additional participants once an eight-week cycle begins. Since some participants continue to experience suicidal thoughts and benefit from the support, they and at the group, participants can choose to repeat the eight-week cycle if it is appropriate.
The support group others a unique opportunity for suicide attempt survivors to connect with others with a shared experience. They know that if they are feeling suicidal, they always have someone they can reach out to who will understand their feelings without overreacting, which for many has not been the case when they have told family, friends or even professionals. In fact, in addition to finding support for themselves, participants who repeat the group often provide hope and guidance to new participants.
The support group strives to address both the emotional and practical needs of its members. First and foremost, the group is meant to provide an opportunity for participants to connect with peers who share similar experiences. The initial weeks of the group focus on creating bonds between group participants and facilitators that allow members to feel safe in sharing their thoughts and emotions related to their suicide attempt. Once a safe group environment is achieved, the focus of the group expands to include an emphasis on tools and skills that will help members to stay safe from a future suicide attempt.
The support group is facilitated by two facilitators. One facilitator, a certified suicide facilitator, should have had at least a minimal of 1,000 hours of suicide ideation/mental health training and experience, and the other facilitator should be a mental health professional with suicide prevention training, or as a peer with similar lived experiences. The certified facilitator is responsible for the structure and process of the group. A- second facilitator usually fills the other role, when possible. The role of the mental health and/or peer facilitator is to mirror successes and struggles within the group by modeling their own growth through the process and provides support and insight from their own lived experience.
The support group for suicide attempt survivors was developed based on research and guidelines from the field of suicidology, including:
• The Suicide Risk/Safety Assessment Principles used in the Intake Interview and throughout the group are based on the Risk Assessment Standards for the National Suicide Prevention Lifeline (Joiner et al., 2007).
• The Imminent Risk Guidelines that form the foundation of the group are based on Imminent Risk Guidelines for the National Suicide Prevention Lifeline (Gould et al., 2015).
• The Safety Planning Intervention used in the group is based on the work of Barbara Stanley and Gregory K. Brown (Stanley & Brown, 2008). The support group’s design embodies the core values developed by the Suicide Attempt Survivor Task Force of the National Action Alliance for Suicide Prevention as described in The Way Forward (2014).
The task force participants include suicide attempt survivors and national leaders of this work. The core values are to:
• Inspire hope and help people find meaning and purpose in life
• Build community connectedness
• Engage and support family and friends
• Respect and support cultural, ethnic, and spiritual beliefs and traditions
• Provide timely access to care and support
• Preserve dignity and counter stigma, shame, and discrimination
• Promote choice and collaboration in care
• Connect persons to peer support
**These values continue to guide the implementation of the support group**
Rationale For the Support Group
People who have survived a suicide attempt are often embarrassed or ashamed about their attempt. Frequently, as a result of the crisis or mental health issues that led to their suicide attempt, they have withdrawn from their support systems. It is common for people who have survived an attempt to continue to face thoughts of suicide. While- recent national suicide prevention media campaigns encouraging a public health approach to suicide prevention suggest that “everyone has a role to play in suicide prevention,” it is, unfortunately, still common for individuals trying to share a wish to die with family, friends, significant others, and even helping professionals to be met with fear and alarm.
The rationale for this support group is that freely talking about suicidal thoughts may reduce their urgency and potency, leaving space for new alternatives to be considered. Talking about a suicide attempt within a group of peers can reduce shame and stigma.
If unaddressed, the taboo and secrecy around suicidal ideation and the legacy of having made an attempt could contribute to future suicidal behaviors. When met with empathy and mutual respect, there is important healing potential in allowing an individual to talk about what led them to their suicide attempt, to find acceptance, and to feel more empowered to ask for help should suicidal thoughts return. Members can learn how to- identify when they may be at risk of suicide again and put supports in place to help them cope with their suicidal feelings while staying safe. Having an established space of safety for members to openly disclose suicidal impulses without fear of judgment or overreaction can be very empowering.
While it is strongly recommended that group participants have an individual therapist, it is not a requirement. After an attempt, people often report feeling vulnerable and raw. It may be that some members don’t have the energy or will to complete tasks that could be related to their healing, such as traditional individual therapy. A support group can be a less demanding atmosphere where members can be among others who understand their experience and take small steps toward healing as they choose. In some cases, suicide attempt survivors may have worked with past therapists that they didn’t and helpful when it came to suicide. Others may feel betrayed by professional helpers if they were hospitalized as a result of their suicidal thoughts or attempt. That being said, it is important that group facilitators assess the readiness of each group participant during the intake interview. While the hope is that the support group may connect attempt survivors to further supports, it is important that participants have support beyond the group as well. The group can be an intense experience for some and having a place to process that experience can be crucial. Additionally, is important for the facilitators to establish boundaries with group members so that participants don’t rely on them for needs that are beyond their role.
In previous support groups, when asked what they hoped to get out of the group, some participants have stressed the need for emotional support and relief such as:
• Connecting with peers who have had similar lived experience of a suicide attempt in order to find a safe, nonjudgmental environment where they can talk about their experiences
• Letting go of a sense of failure
• Lessening the isolation that preceded their suicide attempt and that often continues after their attempt because those closest to them are uncertain how to respond
• Being able to trust
• Having a place of “no shame”
• Letting go of the “big red label” of having made a suicide attempt
• Finding self-acceptance
• Developing a sense of hope other participants have expressed fear of being in a suicidal state again or of acting impulsively when feeling depressed or overwhelmed.
These participants have expressed the desire to receive tools and learn skills to equip them to feel that they have more control over their behavior and ultimately their lives.
Goals For the Support Group
The Tuff Services Ministries support group serves the unique needs of survivors of suicide attempts. In offering a time-limited support group, there is a focus on short-term goals, one of the most important being reducing internalized stigma. An individual who feels fragile and vulnerable after an attempt may be more willing to make the first tentative steps of “opening the door” to their internal world with others who have been there too.
In contrast to a time when participants may have felt most isolated leading up to their attempt, the group offers a timely experience of belonging, relating and being understood.
The group environment, focused on the common experience of having survived a suicide attempt, helps survivors feel more connected, a key component in reducing suicide risk. Because the suicidal state can lead a person to withdraw from others, the group offers a corrective experience of reaching out, opening up and encouraging connectedness.
Short-term goals of the group include:
• Maintaining participant safety and managing risk
• Reducing internalized/perceived stigma
• Increasing comfort with and ability to speak about the thoughts and feelings that led to their suicide attempt
• Decreasing the likelihood of another attempt by learning how to recognize and cope with thoughts of suicide
• Increasing coping skills as they relate to suicidal thoughts
• Increasing knowledge about, and the likelihood of using, safety planning tools and resources
• Increasing connectedness, including access to peers who can support each other in times of crisis
• Creating a “built-in” safety net where members are comfortable sharing thoughts/risk for suicide without fear of how others will react
• Managing and reducing lethal means
• Increasing hopefulness
Longer-term goals can be met as participants return for future cycles or as the group process starts to move in a forward direction with greater gains made over time. The seeds may be planted for growth and progress on a slower timeline than the initial eight weeks.
Long-term goals include:
• Reducing suicidal desire
• Reducing suicidal intent
• Increasing protective factors
• Preventing future attempts
• Creating a peer support network
• Increasing in individual’s ability to plan for the future
Some individuals may also choose to increase involvement in advocacy and community service, particularly in the area of suicide prevention. Many participants have reported that using their experiences related to their attempt to help others provides a sense of meaning and connectedness.
Suicide prevention efforts must address the needs of attempt survivors. Individuals who have attempted suicide form a significant high-risk group for both repeat attempts and death by suicide. Interventions can reduce this risk and keep attempt survivors from reattempting or dying by suicide. Yet services for attempt survivors are limited and often ineffective.
Studies show that as many as 50 to 70 percent of people discharged from a psychiatric hospital or emergency department following a suicide attempt do not keep their first scheduled outpatient session for on-going care (Knesper, et. al., 2010). This may stem from a sense of shame or dissatisfaction following their initial treatment in the hospital. The people who do attend therapy often drop out after a few sessions and do not complete therapy. Many people who go to an emergency department for suicidal crises are discharged without mental health assessments.
In addition to suicide attempt survivors who are seen in emergency departments, hospitals, or doctors’ once, a number of individuals who attempt suicide do not seek treatment and remain unknown to any health or mental health provider. There exists a gap of services for people recovering from a suicide attempt. While it is commonly agreed that therapy and support services are vital after a suicide attempt, there are very few programs devoted specifically to this population.
Many attempt survivors don’t seek any mental health treatment after their attempt, often discouraged by previous experiences in therapy where they may not have benefited. Some look for services specifically for suicide attempt survivors and are disappointed to find few exist. Other suicide attempt survivors may feel embarrassed that they let their therapist down by making a suicide attempt. Still others might be angry with the mental health system because when trying to talk about their suicidal thoughts and feelings, they were involuntarily hospitalized by the outpatient mental health provider, thereby precluding their ability to explore this issue in therapy on an ongoing, outpatient basis.
For suicide attempt survivors facing significant barriers to mental health services, support groups may provide an alternative option or a first step that leads to treatment and recovery.