LOSSteam Postvention Training -- Postvention as Prevention

Overview of the Circular Model of Suicide Reduction

The arrows of this model represent services that are unique to that section of suicide reduction. When all arrows exist in a community then it is likely to reduce the impact suicide may have on all those inside these inter related services. Click on each arrow for a brief example of how each area of services can reduce suicide and reduce the need in the next section for services in order to have a tipping point toward reduced suicide in that community. The services described are not intended to be all that are known or needed in a given but representative of how such services can be joined together in this model to contain and reduce suicide for those living in that community. Click the name of any stage in the process to learn more about how it fits in to the big picture, or simply scroll down to read all.

Prevention
	This section would include those programs that provide awareness on suicide and help those attending programs of prevention gain insights into the basic facts of suicide along with history of suicidology as a field of practice. Also programs that address risk factors and means restriction efforts would also be included. For example as depression screening programs help individuals prior to thoughts of suicide they in effect take that person from future risk to safety without the individual or community knowing such prevention has occurred. This sets up a paradoxical challenge for such programs when proving they are reducing suicide because the person is a statistical non-event and a challenge many prevention programs face is demonstrating their effectiveness regarding suicide reduction. What makes sense is to be sure these programs are in each community because as long as someone can be helped before symptoms become significant the safer each community becomes. Consider the community where medical treatment includes immunizations against polio and measles is available and widely consumed it is predictable that fewer cases of each will occur. This same concept can be used for mental health concerns as well. With the result that fewer mental health intervention services will then be needed just as fewer hospitalizations for polio and measles will occur.
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Intervention
	There are few suicide intervention-training programs for mental health caregivers and professional training including Psychiatry fall short on this area of training due to limited space in curriculums that are competing to provide basic competencies in mental health professional training. Although most community members assume that mental health professionals will know what to do and how to help, this seems an expectation that is doomed to be disappointing to families seeking help with suicide intervention. More realistically it is first responder, family and friends who are dealing with suicide thoughts and behavior. Most who are asked who would they tell if they were having thoughts of suicide will pick an informal resource such as a close friend, co-worker, family member before selecting anyone representing the formal resources represented by mental health service providers. This is a valid reason to insure all community members have a basic set of skills regarding suicide intervention just as we hope most in a community will know CPR to assist someone having a cardiac event we need more trained in suicide first aid. A program I have been impressed with since 1985 is the ASIST (Applied Suicide Intervention Skills Training) program from a global provider of many programs aimed at reducing suicide Livingworks Education, based in Canada. In the sense of full disclosure I have been a contracted trainer for this organization for over twenty-five years and I know first hand the programs keep up with new understandings in the field suicidology and utilize adult education methods to deliver their skills training programs. So I can endorse what I know and expect the reader to appreciate my bias is transparent but sincere regarding the content of these courses. I think when any community reaches a tipping point of ASIST trained members more will be helped to live and not die by suicide. I have seen first hand communities like Ft. Bliss, Texas achieve positive indicators in all preventable areas when they have over 10 % of their US Army members trained in ASIST. Reductions in domestic violence, suicide, drinking while driving accidents, etc. can be credited to a community that cares when a person is showing signs of change and distress which may lead to suicide. Early intervention is more likely when a community is sensitized to these invitations for help and reaches out when thought of suicide have not lead to behavior by an attempt. A caring and supportive community that is trained can make a measureable difference with intervention efforts. When that happens the intervention arrow suggest a drop in post intervention services because fewer attempts to die will occur. Therefore relieving overutilization of mental health services and less of a challenge for individuals to reenter their world safer from thoughts of suicide. I have sought to introduce a new term from the original three areas of suicide services for the past ten years and that is post-intervention. We have not had a term in suicidology that delineates those who attempt from those bereaved by suicide and as such have lumped both groups into the area of postvention (meaning after intervention). This is a confusing term then for both groups and less than helpful for communities who wish to support each with appropriate services. I propose post-intervention is a more accurate term for those who survive a suicide attempt (a newer term for this population is “lived experience”) and finally their voices are being heard at the national and international levels. It is a disservice to those who suicidology sought to help that we have been so delinquent in recognizing the obvious differences in services for both those who have lived experience and those who are bereaved by suicide. I hope the reader can appreciate that in all too many cases we have community members who can claim membership in each of these divisions. So when intervention is achieved now we have services to offer to those wanting to be safe from suicide in the future and those services I hope will be referred to as Post-Intervention to reduce future risk of attempts.
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Post-Intervention
	these have been based on the concepts of symptom reduction in the past and often suicide was not a topic for examination by mental health providers due to lack of training in the field of suicidology by their professional programs who expected on site supervision and field training to support the limited class room knowledge that was being provided. I have been privileged to provide both pilot, field trail and now community training on a new Livingworks Education Program called suicide 2 Hope (s2H for short) since 2014 and I must confess it will fill a gap in training for those who wish to enhance recovery and growth that can also address suicide history. In my experience many who take the risk to seek help end up with no one to help them stay safe in the future or vouch that they are ready to return to duty, work, the role they have been in prior to getting help that really helped them. If we can roll out such post-intervention training and high risk groups see that suicide is not a forever appointment and like other illnesses recovery and growth are possible we will have succeeded in reducing the need for postvention (bereaved by suicide numbers will go down as well) services.
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Postvention
	this is the area of the model I have invested my energies in since 1986, it has been the most rewarding work I could have ever hoped for and still I find myself a voice in the wilderness at times. My mentor and the founder of the American Association of Suicidology, Dr. Ed Shneidman, once told me that the struggle with Postvention (those kind acts that are extended after a suicide) is that those who attempt and live and those bereaved are placed in this section and both have unique and very different needs. That is why I can suggest post-intervention be designated for those who live after an attempt be identified in that arena of services and postvention (no hyphen) be given to those bereaved by suicide. I have met some of the most wonderful people I have ever encountered who share this experience of having someone they love die by suicide. The devastation and danger they face in the aftermath of such a death is impossible to describe and is unique to each person and prescribed by their relationship to the deceased. The complicated bereavement process is often without help from anyone who is skilled in negotiating their journey and they routinely deal with stigma from this cause of death. I wanted to devise a way to encounter survivors of suicide as soon as possible so they would know that 1. They are not alone and 2. Where help is available in their community that other survivors of suicide had benefited from and had agreed was helpful after their loss. The Lossteam concept grew out of this desire and today is unique to each community where it has been adopted. LOSS in Lossteam stands for Local Outreach to Suicide Survivors and the team is made up primarily of those who have had a loss and got help and now want to be a resource to the newly bereaved. More information on the site can give the reader deeper appreciation of the effectiveness of this concept.
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Please note: the LOSSTeam website is not intended to provide help in a crisis. If you are feeling suicidal or need help for yourself or someone you know, please consult IASP's Suicide Prevention Resources to find a crisis center anywhere in the world. In the US, call toll-free 1-800-273-TALK (8255) for a free suicide prevention service or visit SuicidePreventionLifeline.org.