Using the Concept of Using the Concept of Community in Suicide Community in Suicide Research: the RaPSS Research: the RaPSS

StudyStudy

Nicky StanleyNicky Stanley

Psychological autopsyPsychological autopsy

Focus on the ‘psy’ – explores Focus on the ‘psy’ – explores individual motivation and experience.individual motivation and experience.

Clinical – interest in retrospective Clinical – interest in retrospective diagnosis,diagnosis,

focus on pathology, family historyfocus on pathology, family history Forensic, positivist – concerned with Forensic, positivist – concerned with

causes, ‘wotdunnit?’causes, ‘wotdunnit?’ Uses single source – inquest/familyUses single source – inquest/family Not concerned with impact of suicideNot concerned with impact of suicide

Using a community Using a community approach?approach?

Allows a suicide to be understood in its Allows a suicide to be understood in its social contextsocial context

‘‘Here and now’ privileged over historyHere and now’ privileged over history Community – heterogenous Community – heterogenous

explorationexplorationof different perspectivesof different perspectives

Facilitates study of responses to a deathFacilitates study of responses to a deathas well as preventionas well as prevention

Emphasises the role of community in Emphasises the role of community in developing prevention and response developing prevention and response strategies strategies

Multiple PerspectivesMultiple Perspectives

Offers focus on recent events plus Offers focus on recent events plus familyfamily

historyhistory Contrasts formal records and intimate Contrasts formal records and intimate

accountsaccounts Different informants reflect Different informants reflect

fragmentary nature of personalityfragmentary nature of personality

Contradictory accountsContradictory accounts

Male student, aged 21:Male student, aged 21:

Parents convinced that he was Parents convinced that he was enjoying university and was doing enjoying university and was doing exceptionally well academically. exceptionally well academically. His tutor’s impression was that he His tutor’s impression was that he was ‘getting by’ academically but was ‘getting by’ academically but was disappointed at the marks was disappointed at the marks that he was receiving. that he was receiving.

Contrasting discoursesContrasting discourses

Normalising v. pathologisingNormalising v. pathologising

““You can’t say that somebody is suffering a mental You can’t say that somebody is suffering a mental health problem just because they have chosen to health problem just because they have chosen to kill themselves ....this was nothing to do with kill themselves ....this was nothing to do with mental health issues, whatever that might mean, mental health issues, whatever that might mean, you know, it’s quite a complicated issue for me but you know, it’s quite a complicated issue for me but I sort of felt from the outside it seemed like there I sort of felt from the outside it seemed like there was a case to say this was something which this was a case to say this was something which this person....felt in control of.” (student)person....felt in control of.” (student)

““....you could fit the description of manic ....you could fit the description of manic depressive to him if you wanted.” (Parent)depressive to him if you wanted.” (Parent)

Methodology 1Methodology 1Case StudiesCase Studies 20 case studies of student suicide occurring 20 case studies of student suicide occurring

between May 2000 and June 2005between May 2000 and June 2005 HEIs across the UKHEIs across the UK Each case study: 2-6 data sources for each caseEach case study: 2-6 data sources for each case Data Sources:Data Sources:

Family membersFamily members 2929

Students’ friendsStudents’ friends 1212

HEI StaffHEI Staff 1717

Coroners’ and ProcuratorsCoroners’ and Procurators 1515

Fiscal RecordsFiscal Records

Total data sourcesTotal data sources 7373

Methodology 2Methodology 2

SINGLE PERSPECTIVE DATASINGLE PERSPECTIVE DATA

9 Parents’ Perspective Interviews9 Parents’ Perspective Interviews

4 Friends’ Interviews4 Friends’ Interviews

10 Positive Practice Interviews10 Positive Practice Interviews

Methodology 3Methodology 3

STAKEHOLDER CONSULTATIONSTAKEHOLDER CONSULTATION

Expert Seminar on challenges of DataExpert Seminar on challenges of Data

CollectionCollection

Findings - PreventionFindings - Prevention

Context of Transition – ¾ of casesContext of Transition – ¾ of cases

“…“….had no clue what he wanted to do in his life….he .had no clue what he wanted to do in his life….he was very concerned about leaving university, he was very concerned about leaving university, he would have left in the second year, he constantly would have left in the second year, he constantly said to me: ‘what am I going to do?’ “(Student)said to me: ‘what am I going to do?’ “(Student)

““He was packing all his things up to go to university the He was packing all his things up to go to university the day before he took his own life and he just couldn’t day before he took his own life and he just couldn’t tell me what was really happening to him….he was tell me what was really happening to him….he was going through all the things that had gone wrong in going through all the things that had gone wrong in his life that he wanted to put right.” (Parent) his life that he wanted to put right.” (Parent)

2/3 diagnosis of mh problems – 9 diagnosed as 2/3 diagnosis of mh problems – 9 diagnosed as studentsstudents

Findings - PreventionFindings - Prevention

PerfectionismPerfectionism Disrupted academic careersDisrupted academic careers

“…“….his worst thing was failure, he hated .his worst thing was failure, he hated failure, and I suppose failing first year at uni failure, and I suppose failing first year at uni was obviously a massive trigger…” (Student)was obviously a massive trigger…” (Student)

Relationship break-ups and difficultiesRelationship break-ups and difficulties

“…“….the girlfriend situation….made him start to .the girlfriend situation….made him start to say to himself: ‘are you not any good at say to himself: ‘are you not any good at relationships? I’ve got a social problem’.” relationships? I’ve got a social problem’.” (Parent)(Parent)

Findings - PreventionFindings - Prevention Services perceived as stigmatised:Services perceived as stigmatised:

““That bothered him hugely, the fact That bothered him hugely, the fact that he was going to be tarred with this that he was going to be tarred with this brush of mental illness that, you know, brush of mental illness that, you know, shouldn’t be happening to him….but he shouldn’t be happening to him….but he didn’t really seem to want to be didn’t really seem to want to be helped.” (Student)helped.” (Student)

Co-ordination between community and Co-ordination between community and HE ServicesHE Services

Suicide transmissionSuicide transmission

Suicide transmission – 4/20 casesSuicide transmission – 4/20 cases

When I thought about killing myself, I When I thought about killing myself, I was feeling the most excruciating pain was feeling the most excruciating pain you could possibly imagine and I you could possibly imagine and I thought the way out of this is to kill thought the way out of this is to kill myself, how will I do it? Oh, I’ll hang myself, how will I do it? Oh, I’ll hang myself, that’s what he did…. I wanted myself, that’s what he did…. I wanted to stop feeling the pain….to stop feeling the pain…. (Student)(Student)

Findings – HE ResponsesFindings – HE Responses Proactive approach welcomedProactive approach welcomed

““The thing is this isn’t the first student ever to kill The thing is this isn’t the first student ever to kill themselves….it’s happened before for them [the themselves….it’s happened before for them [the university], it hasn’t happened before for us [the university], it hasn’t happened before for us [the friends of the student who died], so the university friends of the student who died], so the university should…. be a little parent-like perhaps about it, should…. be a little parent-like perhaps about it, and you know at least understand and try to help.” and you know at least understand and try to help.” (Student)(Student)

Including students in private accommodation in Including students in private accommodation in responseresponse

Acknowledging impact of suicide on friends’ Acknowledging impact of suicide on friends’ academic progressacademic progress

““Academically not doing so well but not wanting to Academically not doing so well but not wanting to be seen to use the death as an excuse …. obviously be seen to use the death as an excuse …. obviously you were struggling ….(but) you wouldn’t want it to you were struggling ….(but) you wouldn’t want it to be seen that way … so I think if they’d approached be seen that way … so I think if they’d approached me … I’d tell them.“ (Student)me … I’d tell them.“ (Student)

Findings – HE ResponsesFindings – HE Responses

Families valued signposting to sources Families valued signposting to sources of supportof support

Staff needs for support infrequently Staff needs for support infrequently met:met:

““What would have been really helpful What would have been really helpful would have been if someone had would have been if someone had turned around to me and said go find turned around to me and said go find yourself someone to talk to …. we’ll yourself someone to talk to …. we’ll pay for it….” (Student Services)pay for it….” (Student Services)

RecommendationsRecommendations

►Emphasis on policy interventions Emphasis on policy interventions within HEIs’ remitwithin HEIs’ remit

►Role for HEIs in suicide preventionRole for HEIs in suicide prevention►Harm limitation task for HEIs Harm limitation task for HEIs

following a suicidefollowing a suicide►Highlight relationship between HEI Highlight relationship between HEI

and other systemsand other systems