Supporting suicide loss survivors

Supporting people who have been bereaved by suicide requires a compassionate, flexible and culturally safe approach that:

• recognises the diversity of grief experiences
• avoids assumptions about how bereaved people ‘should’ feel or behave.

The appropriate support for a bereaved person will depend on:

• their and their community’s wishes
• their cultural identity
• their access to networks and support services
• their preferences
• your recognition of the right of Aboriginal and Torres Strait Islander peoples to self‑determination, choice, and control in postvention care.

 

• Listen without judgement and allow the bereaved person to lead the conversation. Avoid making assumptions about their emotions, needs, coping style or cultural practices.
• Use validating, respectful, and non‑directive language. In other words, instead of asking direct questions or expressing how you think they should behave, share your observations and thoughts based on what they have told you.
• Avoid minimising their feelings, giving unsolicited advice, or attempting to ‘fix’ their grief.
• Provide space for them to express their cultural identity, community relationships, spiritual beliefs, and family structures, as these not only shape grief, but may also determine why and how they might seek help (or avoid seeking help).
• Work transparently, clearly articulating your role and boundaries, and regularly ask what kind of support they feel comfortable receiving.

 

• Post-suicide grief is highly variable, fluid, and deeply individual. Some people may always appear distressed, others might appear detached or in disbelief, and others might seem to be calm and functioning normally, while struggling internally. A person’s responses can change over the days, weeks and years following a suicide, and they can differ depending on cultural expectations, family roles, and past trauma.
• While it is common for people bereaved by suicide to grapple with feelings of stigma, isolation and difficult questions (such as wanting to understand why it happened), do not assume that everyone will have these experiences.
• Recognise that different family and community members may cope in different ways, and that this can create tension or misunderstanding between them.

Immediately after a suicide, some people might be overwhelmed, traumatised, or unable to seek help on their own. Proactively reaching out to a bereaved person sensitively and respectfully, and seeking their consent, may help them cope with their feelings and thoughts.

Some people might wish to undertake practical tasks such as organising cultural or community ceremonies, or managing administrative processes, but others may not feel ready for this. Suggest these options, without applying any pressure or expectations.

Ask what practical, cultural, and community supports and trusted people would be helpful to them (eg Elders, community leaders, spiritual advisors, Aboriginal Health Workers).

Trauma-informed care

Approach every interaction with an awareness that the bereaved person may be experiencing trauma. Prioritise their safety, empowerment, and choice, and always work to achieve collaboration, and to build their trust.

Supporting wellbeing and safety

People bereaved by suicide have an increased risk of suicide, self-harm, and mental health challenges.

To reduce this risk:

• seek to provide support within 48hrs where possible; but noting that effective wraparound postvention support is ongoing and moves beyond 12 weeks, 3 months and 1 year.
• provide opportunities for open, gentle conversations about their wellbeing, risk factors, and how they are coping
• offer ongoing monitoring, resources, and support pathways (such as counselling, peer groups, culturally appropriate healing supports, or community-led programs), while respecting how ready and able they are to accept different forms of support
• help them to identify protective factors, such as cultural connection, community belonging, relationships, strengths, and coping strategies.

Postvention

The aims of postvention

The main aims of postvention are to support a grieving person, to support the community, and to lessen the impact of suicide.

To support a grieving person:

• Listen, without judgement, and hold space for the person to speak. Do not move into solutions.
• Be sensitive to their cultural, spiritual, and personal beliefs, and help them make sense of the loss, without diluting it to a single ‘why’.
• Help them to move safely through their grief and understand that suicide loss is often complex and may involve shock, guilt, anger, confusion, trauma, shame, relief and other unexpected emotions
• Promote healthy grieving by validating their responses, supporting their coping strategies, and reducing stigma.
• Identify any increased risk they might be experiencing (including risk of suicide, complicated grief, depression, anxiety, and post-traumatic stress), and provide appropriate support.
• Help them to strengthen their protective factors, including social connection, coping skills, cultural identity, community support, and access to ongoing care.
• Provide comfort and stabilisation for those experiencing distress, uncertainty, or trauma.

To support the community:

• Reduce the risk of further suicidal behaviour in the community, especially in families, schools, workplaces, and close social groups, by reducing access to means, implementing a buddy-system to check-in on family and friends etc.
• Support the restoration of community functioning, including strengthening connections with practical, social and cultural supports.
• Use the experience as an opportunity to educate community members effectively and safely about suicide and on postvention-specific services such as Standby Support After Suicide, to reduce risk to others affected by or exposed to the death

Postvention interventions you might use

Individual clinical interventions

Name and description of intervention	Why use this intervention?
Psychotherapy (first-line response) This includes grief counselling, trauma-informed therapy, CBT, ACT, narrative therapy, and culturally informed healing approaches	It helps the bereaved person process complex emotions, rebuild safety, make meaning, and reduce the risk of complicated grief or trauma responses.
Short-term pharmacological support (as needed) This may address acute insomnia, severe anxiety, intrusive thoughts, and overwhelming physiological distress.	It provides stabilisation during acute grief periods. Caution: Medication is not a treatment for grief and should be used cautiously and only when clinically indicated.
Longer-term medication (selected cases) Consider using this when depressive syndromes, PTSD, or severe anxiety persist.	It supports people whose grief has progressed into a diagnosable mental health condition.

Social and peer support interventions

Name and description of intervention	Why use this intervention?
Support groups (in-person or online) This includes general suicide bereavement groups, as well as groups that are youth-specific, LGBTQIA+-specific, First Nations-led, and culturally aligned groups.	A major 2024 review found peer support is a core component of suicide bereavement services. A 2024 scoping review led by researchers from the University of Melbourne examined implementation of suicide bereavement support internationally. The review noted that people bereaved by suicide frequently seek support groups, online forums, and peer-led programs to make sense of their experiences and reduce feelings of isolation. Peer support was identified as a common and important component of postvention.
Family outreach and family-based support These may involve family meetings, SEWB teams, ACCHO workers, social workers, or postvention coordinators.	Because suicide affects family systems, interventions that strengthen communication, safety, and connections in the family can help prevent intergenerational and cumulative distress.

Community-level interventions

Name and description of intervention	Why use this intervention?
Community healing responses These include cultural ceremonies, memorial activities, community gatherings, and trauma-informed collective healing practices.	Suicide can affect whole communities, so facilitating connection and helping people and communities to make meaning of the death can reduce the risk of further suicides in the community.
Education and gatekeeper training For schools, workplaces, sporting clubs, health services.	It helps communities recognise distress and respond safely and reduces the risk of further harm.
System-level supports Coordinated postvention programs (eg StandBy), ACCHO-led SEWB responses, multicultural organisations, veteran services.	It ensures continuity of care, cultural safety, and skilled early intervention.

GPs and postvention

Postvention is not the responsibility of any single person or service, but a shared, community-based effort. Nonetheless, GPs have a critical and often central role, for two reasons:

• many people turn to their GP as a first point of contact for support during and after bereavement
• GPs contribute to community resilience, by providing education with a focus on suicide prevention.

A solid GP relationship provides a stable, trusted healthcare anchor during a highly destabilising period, and enables the bereaved person to understand that their grief responses are normal.

In addition to coordinating referrals, medications (if needed), and ongoing supports, you can also:

• provide continuity in a system that can often feel overwhelming, particularly after trauma.
• detect complicated grief, new and developing mental health issues and suicide risk.

When supporting someone who has lost a person to suicide, adhere to the principles listed below.

• Provide safe, culturally sensitive consultations.
  • Provide a safe, non-judgmental space where they can be listened to, talk about the death, including its emotional, cultural, and practical impacts.
  • Embed cultural humility into discussions (eg ask, rather than assume, how they understand grief and death, how their family understands grief and death, and what kind of support would best help them).
  • Sensitively screen for significant distress, including suicidal ideation, while normalising a range of grief responses.
• Support the use of other services and networks.
  • Help them stay connected to protective support, such as family, cultural and spiritual groups, peer networks, and community leaders.
  • Provide information about available support, such as local bereavement services, crisis support, multicultural services, and online communities.
• Support families and children.
  • Provide guidance, monitor their wellbeing, and make early referrals where appropriate.
  • Offer help/pathways for social determinants such as housing, food, etc.
• Consider their long-term needs.
  • Offer regular follow-up appointments, acknowledging that their needs may change over time and distress may return.
  • Assist their health maintenance (eg sleep, nutrition, chronic conditions, substance use, and stress-related physical symptoms).
  • Be mindful that, while some people may report little or no reaction initially, grief responses may emerge weeks or months later, and patients can still benefit from support.

The therapeutic role of the GP

For many bereaved people, the GP relationship is one of the most protective interventions. Even brief check-ins have therapeutic value.

Practical action you can take

• Maintain a non-judgemental, compassionate presence.
• Validate the person’s grief and pace (‘There’s no right way or fixed timeline’).
• Suggest coping strategies, including sleep, safety, support networks, and cultural needs and connections.
• Provide practical guidance and connection to specialised services.
• Schedule regular, gentle review appointments.

Proactive contact

Proactive contact is an important element of postvention, particularly because some people may not seek help due to shame, cultural beliefs, stigma, trauma, or a lack of awareness of available services and how they might help.

Proactive contact is usually made by a GP, peer worker, postvention coordinator, or community-based team. If the bereaved person has Aboriginal or Torres Strait Islander status, do not make proactive contact before seeking guidance from an Aboriginal Health Worker, Elder, SEWB clinician, or someone known to the family.

Postvention frameworks (eg the Australian Institute for Suicide Research and Prevention Postvention Australia Guidelines, the StandBy Support After Suicide model and the National Suicide Prevention Strategy 2025–2035), emphasise that services must not passively wait for people to contact them, but instead offer gentle, timely, culturally safe contact that respects the diversity of bereaved people. This means that proactive contact must always be ethical, culturally safe and trauma-informed.

Before contacting a bereaved person

To avoid causing distress, always consider the following before contacting a bereaved person:

• the circumstances of the suicide, including any exposure to trauma
• the impact of the death on the bereaved person’s community
• the relationship between the bereaved person and the deceased
• cultural, spiritual, or kinship protocols that may shape the person’s communication preferences
• how familiar the bereaved person is with you and your practice.

Before contacting Aboriginal and Torres Strait Islander peoples who are bereaved

• Seek guidance from local ACCHOs or SEWB teams about cultural protocols.
• Check whether naming the deceased is appropriate.
• Listen to and follow family or community guidance.
• Respect Sorry Business, which may temporarily limit the bereaved person’s availability or affect the timing of your contact.

When making contact

Ideally, gentle contact would be made from someone known by the deceased or the bereaved.

Depending on your relationship, you might consider writing a card expressing your condolences and an offer to support them through their bereavement.

When making contact:

• acknowledge the loss
• offer compassionate presence
• provide information and options, not pressure.

When contacting Aboriginal and Torres Strait Islander peoples who are bereaved

Ensure that the form and timing of your contact is culturally safe and considers the context of the death and bereavement.

Where appropriate, offer home visits, community-based contact, or yarning-style conversations, which may be more culturally appropriate.

Offering practical support

When talking to a bereaved person, offer as much practical support as possible. For example, you could:

• ask if they would like information about coronial and other formal processes
• explain how to access crisis or counselling supports
• talk about what they can expect during the period of early grief
• help them navigate health systems.

Connecting the bereaved person to appropriate services

Evidence shows that, when people are struggling with a suicide loss, timely connection with appropriate services can reduce isolation and strengthen safety (eg reduce complex grieving, reduce likelihood of substance abuse, and reduce suicide risk). These services include:

• grief counselling
• peer support
• community-based support
• crisis services.

How to answer ‘Why?’

Bereaved family members commonly ask, ‘Why did this happen?’, ‘Why didn’t I see the signs?’ or ‘Could I have done more?’

These questions often reflect deep distress, guilt, and a search for meaning, rather than a literal request for a definitive explanation.

For many survivors, asking ‘Why?’ can be an important part of their grieving process, and you can help by responding with compassion and honest answers about what can and cannot be known.

Sitting with the question rather than attempting to answer it

You might feel pressure to provide answers or ‘fix’ the unfixable, however, the goal is not to offer a complete explanation (which may not exist), but to make space for the bereaved person’s pain.

To help make this space and let the bereaved person ‘sit’ with their questions, you could:

• acknowledge the impossibility of fully knowing the deceased person’s inner world at the time of their death
• acknowledge that suicidal thinking is often driven by overwhelming psychological pain, emotional tunnel vision, or impaired judgement, rather than rational decision making
• normalise their search for meaning, while gently reinforcing that you cannot provide a definitive answer.

A possible response

‘I wish I had a simple answer. What I can say is that when someone is in emotional pain, their ability to see options or reach out can become very limited. It doesn’t mean you missed something, or that you should have known.’

Responding to ‘Could I have done more?’

Self-blame is common after suicide. To help ease this feeling, you can:

• validate the survivor’s feelings without reinforcing guilt
• emphasise that suicide is complex and can have many reasons behind it, and that families often do act with love and care, even if it doesn’t feel that way afterwards
• reassure them that many warning signs are subtle or short-lived, and that sometimes there are no such signs.

A gentle way to frame this response could be:

Many people ask themselves that. Often the signs are not easy to see, and even when something feels different, it can be challenging to understand what’s going on or how best to help.

Balance openness and confidentiality

If the deceased was a patient of yours, their family might seek detailed explanations from you about their medical history, such as their mental health before their death. However, as your confidentiality obligations remain after death, you must navigate this carefully.

Without breaching your obligations, you can:

• acknowledge the family’s need for information and connection
• explain why confidentiality still matters and what can reasonably be shared
• respond with empathy and non-defensive openness within the limits of the law.

Providing grief education and support

Most people have never experienced suicide bereavement before, and many are unprepared for the intensity and range of emotions that follow. Providing gentle education about what grief can look and feel like helps survivors understand their reactions and can reduce their confusion, shame, and fear.

Monitoring a person’s grief

GPs also have an important role in recognising whether a person’s grief is progressing in a healthy, adaptive way or whether additional support or intervention might be needed. This requires a solid understanding of the different ways grief can present.

Grief responses

Grief responses vary widely between individuals and across different losses. Some people show only subtle outward signs of grief, while others experience profound emotional, cognitive, physical, or functional disruption. The intensity and duration of a person’s grief can be influenced by many factors, including the nature of their relationship with the deceased, individual personality and coping style, age, health, spirituality and cultural identity, the support available to them, and whether the loss was sudden and unexpected or gradual and anticipated.

People experiencing suicide bereavement describe:

• shock
• anger, directed at the world or at times at the person who has died by suicide
• guilt and regret (eg ‘Why didn’t I notice something?’, ‘Why didn’t I do something?’, ‘I did do something, but it didn’t work – why not?’)
• loss and loneliness
• fear
• anxiety and depression
• intrusive images
• disassociation
• feeling overwhelmed.

In addition, these feelings can be intermingled with relief, joy, peace and happiness, making the grieving process feel like a roller-coaster, particularly as these ‘positive’ emotions can also cause distress and guilt.

It is also not uncommon for people to dream of the deceased, half-look for them in crowds, sense their presence, or feel them watching out for them.

The grief process over time

In the early period of acute grief, the bereaved person’s thoughts and feelings about the loss may feel constant and overwhelming.

However, over time, most people begin to move towards integrated grief, where the person who died is no longer at the centre of every thought, and can be remembered without the same level of acute distress. Sadness and longing may remain, and the deceased person may still be easily called to mind, but the grief becomes more manageable. This shift commonly begins a few months after the death.

Even when grief is fully integrated, people do not ‘get over’ the loss: the connection remains, and they can experience feelings of sadness and of missing the person for the rest of their life.

Providing practical support

When someone loses a loved one to suicide, you may be one of their first and most trusted points of contact. Your role can extend well beyond clinical care and may include emotional, practical and procedural support. For example, you can:

Provide immediate emotional and clinical support

• Offer compassionate, non-judgmental space for the bereaved person to talk about what happened and how they are coping.
• Assess them for acute distress, including suicidal thoughts, self-harm risk, substance use, or symptoms of complicated or traumatic grief.
• Create a safety plan if needed.
• Arrange follow-up appointments proactively rather than waiting for the patient to book.

Facilitate access to mental health services

• Prepare a Mental Health Treatment Plan.
• Refer to psychologists or grief counsellors.
• Refer to specialised suicide bereavement services, such as postvention programs, support groups or trauma-informed clinicians.
• Provide information about helplines, peer groups, and community resources.

Assist with coronial matters

Because reading a coronial report can trigger trauma and guilt, sensitive support from you can help to reduce confusion, fear and rumination.

• Explain the purpose of a coronial investigation.
• Advise them that the report may cause harm and/or re-traumatise them, receive consent to proceed.
• Help them read and understand the coroner’s report.
• Clarify the coroner’s findings in plain language.
• Support them emotionally if reports are distressing.
• Encourage them to ask questions and to take time to process the information in the report.

Provide documentation

• Medical certificates.
• Letters for employers, schools, and insurance companies.
• Reports explaining the mental health history of the deceased (if appropriate and legally permitted).

If working in a rural or remote area

If you are working in a rural or remote area, you might also need to:

• identify the deceased, if no other local authorised person is available
• confirm the death, if emergency services are limited or distant
• communicate with police and other first responders
• notify or liaise with the coroner’s office, if there are no local coronial staff.

Providing culturally safe support

Grief is a universal human experience, but the ways people understand, express, and cope with loss are profoundly shaped by culture. Cultural identity influences beliefs about death, acceptable emotional expression, family roles, spiritual practices, and help-seeking behaviours.

Some people from other cultures, and Aboriginal and Torres Strait Islander peoples, may not use the word suicide. This is due to factors including stigma, as suicide is still criminalised in some countries. They may use other words for suicide or speak indirectly about suicide. It is important to note that this is not avoidance, and for many people indirect language is the only safe way they know how to talk about suicide. In these cases, simply listen to the words the person uses and follow their lead when providing support.

Additionally, western models of grief do not fully capture the collective, cultural and ongoing nature of grief as it is experienced by many Aboriginal and Torres Strait Islander peoples, for whom grief is shaped by cultural identity, kinship responsibilities, connection to Country, spirituality, and community obligations. Sorry Business involves cultural, spiritual and community governance processes, including extended mourning, ceremony and collective decision making. These practices are central to healing and wellbeing, and clinical systems need to adapt to them, rather than expecting cultural obligations to fit western models.

Because each person’s cultural identity is shaped by race, language, gender roles, religion, migration, and community ties, best practice involves approaching grief with cultural humility: asking, not assuming, and recognising that cultural variations are unique and deeply personal.

Avoid assumptions

• Avoid making assumptions about your patient’s cultural identity or practices: ask respectfully what is important to them and who they want involved.
• Invite them to guide you as to how their cultural practices, rituals and community supports need to be acknowledged or incorporated.

Providing culturally safe support to Aboriginal and Torres Strait Islander peoples

Understand that cultural safety is determined by Aboriginal and Torres Strait Islander peoples themselves and is shaped by relationships, power, trust and systems, not solely by a person’s clinically observed behaviour.

To do this, ask:

• ‘Are there cultural or community practices you would like me to be aware of?’
• ‘Would you like support from your ACCHO, SEWB team, Elders, or Aboriginal Health Worker?’
• ‘Is there anyone from your community you would like present when we talk about this?’

Supporting cultural connection is an important protective factor in recovery and postvention.

Providing culturally safe support to people from other cultures

Adopt cultural humility

Ask questions that align with recommendations that emphasise cultural humility in grief care. For example:

• ‘Are there any cultural or spiritual practices that are important for you in this time of grief?’
• ‘How does your family or community usually support someone after a loss?’
• ‘Is there anything you would like me to understand about the way you grieve?’

Ask about their preferred type of support

• ‘Would you prefer support that involves family, community leaders, or would you prefer a private individual approach?’

Ask about their cultural rituals

Invite your bereaved patient to talk about any rituals that support their coping (eg lighting candles, making offerings to ancestors, gatherings such as funerals, memorials and wakes). Acknowledging and talking about these rituals can foster resilience and help your patient make meaning of their loss. You can ask:

• ‘Are there any rituals that are important to you and your community?’
• ‘Are there any rituals that are important to you that you’d like to do today?’

Maintain a list of culturally responsive referral options

Develop and maintain a local list of:

• culturally specific grief services
• multicultural mental-health practitioners
• community leaders or faith-based supports.

The symptoms of grief, such as low mood, sleep disturbance, difficulty concentrating, or withdrawal from others, can resemble those of mental health disorders, such as depression, anxiety, and post-traumatic stress. Grief can sometimes also cause the development of mental disorders like the above.

For these reasons, it’s important to focus on the bereaved person and their lived experience of grief and mourning, rather than assuming their responses indicate a clinical diagnosis.

Grief is a natural, adaptive process, and while it can be intense and prolonged (especially after suicide loss), it should be understood within the context of the person’s relationship, circumstances and meaning-making.

The following table summarises the symptoms of complicated grief, and the symptoms of other mental health disorders.
 

Disorder	Symptoms
Complicated grief1 About 10% of bereaved people experience complicated grief2 (also referred to as prolonged grief disorder and persistent complex bereavement-related disorder). This is a syndrome of prolonged (ie well beyond six months) or intense grief, resulting from a failure to transition from acute to integrated grief. Complicated grief is associated with substantial impairment in work, health and social functioning.	Difficulty accepting the death. Separation distress (recurrent pangs of painful emotions with intense longing for, and preoccupation with, the deceased, and over-involvement in activities related to the deceased). Traumatic distress (eg disbelief, anger and bitterness, pronounced avoidance of reminders of the loss).
Depression3 Grief and depression share some of the same symptoms (low mood, sadness, and social withdrawal), making clinical depression sometimes difficult to diagnose in the context of bereavement.	Mood and ideation are almost constantly negative. Difficulty in experiencing positive feelings. Recognisable and stable cluster of debilitating symptoms. Feelings of worthlessness and self-loathing.
Post-traumatic stress disorder4 Approximately one-third of PTSD presentations are the result of ‘interpersonal-network traumatic experiences’, which include the death of a loved one. Most bereaved people will have an emotional reaction when remembering or thinking about the suicide, however those with PTSD will experience marked cognitive, affective and behavioural responses, which lead to considerable social, occupational and interpersonal dysfunction.	Intrusive thoughts. Nightmares and flashbacks of past traumatic events. Avoidance of reminders of trauma. Hypervigilance. Sleep disturbance.
Suicidal thoughts in bereaved patients5 Although it is appropriate to have a case-finding approach to suicidal thoughts and behaviour in bereaved patients, there is no data to show that the use of a diagnostic screening tool alone in primary care reduces mortality. Additionally, it is difficult to accurately predict which patients with suicidal thoughts will go on to attempt suicide. Assessing suicide risk involves direct and unambiguous questioning about suicide ideation, planning, and intent. Although some patients may be reluctant to mention their thoughts of suicide, someone with suicidal ideation will generally tell their clinician about such thoughts when asked.	passive thoughts of death (e.g. “I wish I wouldn’t wake up” or “life is not worth living”) active thoughts of harming themselves or ending their life thinking about methods, plans, or timing of suicide feelings of hopelessness, helplessness or being trapped perceptions of being a burden to others intense emotional pain, distress, or inability to cope withdrawal from family, friends, or usual supports increased use of alcohol or other substances sudden changes in mood (including unexpected calmness after distress) giving away possessions, settling affairs, or saying goodbye reduced concern for personal safety or engaging in risk-taking behaviour