Verified by 
In the wake of COVID-19, the Well-Being Trust forecasts that the effects of the pandemic may translate to an additional 75,000 deaths from alcohol and drug misuse and suicide. As suicide is already the 10th-leading cause of death in the United States, it is difficult to consider a further increase in mortality rates. In recognition of worsening of suicide risk, the Substance Abuse and Mental Health Services Administration (SAMHSA) just released a call on May 13th for applications to receive emergency grants to equip communities with resources to prevent and deal with suicides.
Current national conversation on COVID-19 and suicide is helpful. However, it currently overlooks a matter requiring the attention of higher education decision-makers: graduate student suicide.
Recent studies have shown around 7-10% of graduate students report experiencing suicidal ideation within the past two weeks, and approximately 1 in 50 students report having made a suicide plan. With the loss of structure and support systems, and in the face of an increasingly uncertain and bleak immediate future, today’s students are at an even higher risk for mental health concerns.
COVID-19 only layers on an array of stressors for students. Research suggests that suicide risk across populations could rise due to the increased isolation, financial stress, barriers to treatment, and anxiety around future prospects – all of which are already factors in failing graduate student mental health. Graduate student concerns are only complicated by an unclear job market due to the coming national economic impacts of COVID-19. Such COVID-19 related stress may increase mental health and suicide concerns.
While continuing efforts to prevent as many suicides as possible, we must prepare for the potential for a rise in suicide. Only through creating postvention plans now can we address the aftermath of likely graduate student suicides.
What is postvention?
Suicide postvention is any set of activities designed to cope with the aftermath of a suicide attempt or death. Effective postvention strategies are difficult to enact.
As laid out by the National Action Alliance on Suicide Prevention, postvention comprises at least one of the following: (1) enable healing after the loss; (2) reducing the negative impacts of the loss, and/or; (3) prevent suicide among exposed persons who may already be at risk.
As of yet there is no standard approach to postvention for higher educational institutions. Unfortunately, our ability to make best practice recommendations is limited by the status of the scientific literature. A recent review of suicide postvention approaches concluded that the level of research support is weak at best. Authors of the review highlighted a number of strategies that may show promise such as educational information, peer or other support models, mental health services, and or structured sessions with a trained postvention facilitator.
Why do we need a postvention plan in advance?
Persons left in the wake of a suicide attempt or death may face negative outcomes themselves, including depression, anxiety, post-traumatic stress, and their own risk of suicidal behavior. For every suicide loss, it is estimated that 135 people are measurably affected by the tragedy; effects ripple out far past immediate connections, and student suicides affect classmates, faculty, and staff alike. These campus community members often suffer from lowered job or academic performance, ultimately decreasing student and employee retention. As institutions assume greater responsibility for the well-being of the student body, postvention infrastructure is needed to mitigate the aftermath of these tragedies.
What would a comprehensive plan include?
The best approach to suicide postvention is a comprehensive one. The Suicide Prevention Resource Center provides a valuable roadmap to holistic suicide postvention. These include:
Planning Ahead
- Design university-wide comprehensive pre- and postvention plans.
- Educate campus leaders: mental health providers, law enforcement, social services, faculty, and staff.
- Prepare programs to proactively reach out to those affected.
- Make public resources available and easily accessible to respond to emotional distress.
Effective Response
- Work with news media to ensure safe reporting practices.
- Provide support to those affected so they can mourn in ways that reduce suicide contagion effects.
- Enhance peer and professional support for long-term care.
- Arrange ongoing access to emotional and educational support.
What would a plan for graduate student suicide postvention look like?
Preparation
- Suicide pre/postvention taskforce. Committees create and maintain suicide pre/postvention plans specific to graduate students. Professionals from mental health, student health, student affairs, residence life, police department, faculty experts, staff liaison, and graduate education should be included, as well as representatives from student groups. The Jed Foundation provides further guidance.
- Suicide prevention training. Suicide prevention trainings enhance campus members’ ability to recognize suicide warning signs, ask questions, and refer students to appropriate resources. Example training programs include Kognito and QPR. We are unaware of research-supported university campus-specific postvention training. However, programs like Connect Training may be a good start.
Response
- Education. Familiarize campus community members on a variety of matters, including negative reactions to a suicide loss (e.g., grief), opportunities for long-term growth (e.g., post-traumatic growth), and the value of local and national resources.
- Expert Availability. Licensed mental health providers specializing in postvention can support affected persons and may be involved in the preparation team.
- Media coverage. This should follow suicide media guidelines developed by a consortium of expert organizations. Irresponsible media coverage can promote stigma or increase risk of suicide contagion.
How can we design our own full strategy?
Surprisingly few resources exist to specifically guide campus leaders in creating essential action plans. However, the perfect should not be the enemy of the good - we need to do the best we can with the information we do have.
Although only the first of the below resources applies to the post-secondary setting, all contain useful materials for creating effective postvention plans for college campuses. We recommend any campus team planning for postvention consult at least the following resources:
- Postvention: A guide for responses to suicide on college campuses. HEMHA’s postvention recommendations include (a) careful planning; (b) forming a postvention committee; (c) identification of roles and responsibilities of committee members; (d) specific criteria for establishing a protocol; (e) preparing for suicide-related communication to the community, and handling of memorials and related events, and (f) guidance on returning back to day-to-day campus operations.
- After a suicide: A toolkit for schools (2nd edition). This approach includes content on forming a crisis response team and helping students cope. Provisions include meeting with students in small groups, structured approaches to supporting student expression of emotions, building practical coping strategies, and dealing with long-term matters.
- Suicide in schools: A practitioner's guide to multi-level prevention, assessment, intervention, and postvention. This seminal work contains handouts and guidance structures, including for helping grieving students, dealing with the media, identifying roles for teachers, and conducting memorials.
Where do we start?
The Community support meetings (CSM) approach provides one potential starting point towards building a comprehensive postvention strategy. Campus leaders provide timely information while engaging in conversation with students and staff. A CSM can be employed after any tragic event. In conducting a CSM, two to four facilitators usually provide the structured session for up to 80 participants.
Authors of the approach lay out 12 steps:
- Opening. Introduction of facilitators and other key persons.
- Brief description of the incident. Authoritative figure (e.g., law enforcement) provides a short factual summary.
- What is a CSM? Provision of the purpose of the CSM (i.e., honest conversation and healing).
- Opening question. A structured approach to developing a common understanding of the person lost.
- Sharing stories. Storytelling focused on beginning grieving and healing.
- Grieving process. Facilitator summary of the individual nature of grief.
- Dealing with “what ifs." Conversation about matters such as self-blame and second-guessing.
- Positive suggestions. Review of a structured list of helpful suggestions for next steps.
- Wrap up. Comments focused on community building and avoiding isolation.
- Community resources. Identification of on- and off-campus services such as mental health, advising, and peer support.
- Memorial gatherings. Planning of a memorial service led by religious leadership.
- Staff availability. Facilitators remain behind for possible one-to-one meetings.
Facilitators should be trained mental health or student services personnel. Sharing stories can be positive and support-building; however, authors of the approach make clear that the CSM is not intended to serve as group therapy. As such, we recommend making this clear at the outset or review of the CSM purpose. Providing access to additional licensed providers at the CSM can fulfill unmet needs and is likely an ethical necessity.
Preparing for the Worst, and Aiming for the Best
We are facing one of the most unpredictable events of our lifetimes. Through suicide prevention education and mental health programs, we can reduce the number of graduate student deaths. By learning about suicide postvention and creating action plans for when they are needed, we can support survivors of these crises when the prevention measures aren’t enough.
This piece is co-authored by Susanna Harris, Ph.D., a science communicator who recently defended her dissertation at the University of North Carolina in Microbiology and Immunology. She founded PhD Balance to promote inclusion, equity, and student wellness in academia.
