Evidence of the impact on and views of NHS staff following a colleague's suicide to inform postvention guidance: a multi-methods study.

Abstract

Background: Healthcare professionals are 24% more likely to die by suicide than the general population. The impact of such deaths on National Health Service colleagues is unclear. Early post-suicide support (postvention) is beneficial for those affected, yet little is known about how to offer this support within the National Health Service.

Objectives: We set out to: (1) review existing research on suicide impact and postvention interventions in workplace settings; (2) explore the impact of colleague suicide on staff well-being; (3) examine staff perceptions of contributing factors to their colleague's suicide; (4) identify what supports or hinders bereaved colleagues in seeking help, and gather staff preferences for future support; (5) explore how managers currently support workers following a death by suicide; and (6) use the findings to develop evidence-based postvention guidance for National Health Service organisations.

Methods: This study had four work packages: (1) an integrative review of primary research to review the impact of suicide in the workplace; (2) a qualitative interview study with National Health Service staff affected by a colleague's suicide or involved in supporting others (n = 29 affected staff, n = 22 supporters). Data were analysed using grounded theory and thematic analysis; (3) a co-production workshop with key stakeholders to review research findings and generate recommendations; and (4) a synthesis of all findings and recommendations to develop evidence-based postvention guidance.

Results: The integrative review revealed that existing postvention guidance often lacks empirical support and does not address how workplace culture affects staff after a suicide. Those tasked with delivering postvention face stigma and complex challenges, and current support does not fully meet the needs of affected staff. In the interview study, two theories were developed. First, staff affected by a colleague's suicide faced cultural and behavioural barriers to accessing support. Some devised strategies to overcome these barriers, while others fell through the gaps. Second, those providing postvention support also encountered barriers and required emotional and practical backing to effectively support others. Thematic analysis generated key recommendations for National Health Service trusts: (1) promote staff mental health and encourage open discussions about suicide; (2) establish trained teams to deliver timely support; (3) share information swiftly and compassionately, giving staff space to reflect together; (4) offer ongoing emotional support and staff-led activities like memorials and (5) ensure support teams also receive emotional and practical assistance. All findings and recommendations were discussed during our co-design workshop. Stakeholder attendees supported the recommendations. Findings informed our guidance, which emphasises the need for postvention teams within National Health Service trusts and integrated care boards, and the need to be ready to respond to colleague suicide before it happens.

Limitations: The integrative review was limited to English-language papers. Most interviewees were White British women, meaning the findings may not represent the experiences of all National Health Service staff. Furthermore, many 'supporters' interviewed were already offering high-quality support, potentially leading to an overly optimistic view of the postvention currently provided.

Conclusions: Our guidance recommends the following: that skilled and trained individuals must actively offer immediate and ongoing postvention support to National Health Service staff; that those offering postvention must be supported so they can support others; and National Health Service trusts and integrated care boards must foster a suicide-aware, supportive culture that enables supporters to implement our recommendations.

Future work: We recommend that further research be undertaken to explore the impact of colleague suicide on minoritised and global majority health workers. In addition, we suggest a robust evaluation study to report on implementation of the guidance and to ascertain what works in practice.

Study registration: This study is registered as IRAS: 291050; HRA 21/HRA/4450.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129341) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 40. See the NIHR Funding and Awards website for further award information.