Suicide grief: Postvention in healing, managing impact

THE World’s Health Organisation (WHO) estimates that more than 720,000 people globally die by suicide every year, and it is the third leading cause of death for those between the ages of 15 and 19.

Suicide causes are multifaceted as well as influenced by social, cultural, biological, psychological and environmental factors present across the life-course, according to the organisation.

In Malaysia, suicide is a growing public health crisis with alarming statistics showing an upward trend in recent years.

The National Health and Morbidity Survey (NHMS) 2022 showed that one in eight adolescents had experienced suicidal thoughts, while one in 10 had attempted suicide.

The report highlights a significant increase in suicide among adolescents, with 13.1 per cent having suicidal thoughts and 9.5 per cent attempting suicide in 2022, compared to 7.9 per cent and 6.8 per cent, respectively a decade ago.

Deputy Prime Minister Datuk Seri Ahmad Zahid Hamidi revealed that 1,087 people died by suicide in 2023 alone, which is an increase of 106 cases compared to the 981 reported in 2022.

These figures underscore the urgent need to address the country’s mental health crisis and provide adequate support to those affected by suicide.

While prevention efforts focus on identifying and helping those at risk, the importance of postvention, which means supporting the loved ones left behind, should not be overlooked.

Although there has been much focus on raising awareness about suicide prevention and identifying warning signs, far less attention has been given to postvention.

Postvention is essential not only for healing and recovery but also to prevent further suicides a survivors of suicide loss are at a higher risk of experiencing trauma, depression and having similar thoughts.

Addressing both prevention and postvention is crucial for breaking the cycle of loss and promoting mental well-being across the community.

Kathy’s story: Coping with the loss of her brother to suicide

Kathy (not her real name) had always looked up to her older brother David (not his real name). They were only two years apart and she was very close to him. However, when David reached his early 20s, Kathy started noticing changes in her brother that she could not fully understand.

“I was busy with school and my friends, so I did not pay much attention to the changes in his behaviour. My parents were concerned about him initially, but they thought it was just a normal part of growing up,” she said.

As Kathy was getting ready for school one Monday morning, at around 6am, she heard a scream coming from David’s room on the first floor. Recognising her mother’s voice, she rushed upstairs to find out what was wrong.

“It was the most shocking moment of my life. I felt like my heart had been ripped out of my chest. I could not believe that my brother was gone,” she recalled.

In the aftermath, Kathy’s grief consumed her and her relationship with her parents became strained.

She said that she felt overwhelming guilt that sometimes she could not sleep at night. Eventually, she found the courage to open up to her parents about her emotions.

“We finally talked, even though it was hard at first because I feared their reactions and I was embarrassed to talk about it. There was still guilt, but talking about it eventually allowed us to start healing,” she said.

Shortly after, Kathy’s parents suggested if she was willing to go for counselling to help process her emotions better.

She was reluctant in the beginning, but after some persuasion from her parents, she began seeing a psychiatrist and started counselling.

The sessions helped her process her grief and manage her emotions, guiding her through the healing journey.

“I thought I was alone in the dark and I didn’t know how to ask for help, but when I finally opened up, my parents supported me. They helped me find the care I needed,” she said.

Rina’s story: Navigating grief after losing a best friend to suicide

Rina’s (not her real name) journey through life had always been deeply intertwined with her best friend. Though they became close in secondary school, it was not until they both moved to Kuala Lumpur for work that their bond truly deepened.

Living in the same apartment building but in different units, they found solace in each other especially during the Covid-19 pandemic restrictions which kept them from returning to their hometown, Kuching.

“Having her around made our lives in KL feel less lonely,” Rina recalled, adding that they would spend their free time at their favourite café and enjoy doing fun activities on weekends.

However one day, tragedy struck when Rina received news that her best friend had gone missing.

“She was later found dead in her unit, in the very apartment building we lived in. Her family had initially reported her missing but when they found her, it was already too late,” she said.

Rina added that at first, she could not believe the person they had found was her friend.
“I was in denial, thinking they had the wrong person. But when the authorities confirmed it was her, my emotions shut down. I could not even cry because everything felt empty,” she said.

Rina shared that the first night was unbearable, that she had to move to her friend’s place for the night just so she could sleep and rest.

Looking back, she said that the first week after her friend’s passing was an unforgettable nightmare.

“I lost my appetite and laid on the sofa all day. I would burst into tears at any moment and felt angry at myself for not being able to save her. I probably fit all the symptoms of depression, but it was actually intense grief.”

Thankfully, her family and friends made her feel less alone.

“They had food delivered to my house and constantly checked on me. My colleagues, who are mental health professionals, also supported me. When I could not function at work, they helped cover for me,” she said, adding that she felt blessed to have a strong support system.

It took Rina three years to regain emotional stability.

“As a mental health professional myself, I found it particularly difficult. I kept thinking how can I help others prevent suicide when I could not even save my own friend? That self-doubt was hard to overcome,” she said.

What helped her most, Rina said, was hearing from trusted friends that her friend’s death was not her fault.

“Sometimes, you need someone else to tell you what you cannot tell yourself,” she said.

As a Muslim, Rina also faced additional emotional conflict as suicide is considered a sinful act in Islam. Through religious counselling, she found peace with her internal struggles and became an advocate for suicide postvention.

“Postvention is prevention – without that support, the risk of further suicides is too high. We need to dispel the myths about suicide and engage the community to stop it.

“In my healing journey, I found AWAS (Awareness against Suicide). Although I got to know them from social media, it somehow helped me because I now know that there are people out there who had similar experiences like I did,” she said.

Rina added that she also found Maristan, a non-profit organisation dedicated to Islamic Psychology that provides helpful resources in regards to the religious dilemma of suicide.

Role of suicide postvention

Both stories illustrate the importance of postvention – they show how those left behind after a suicide struggle with grief, guilt and emotional trauma, and how seeking support whether through counselling, peer groups or family helps in the healing process.

Postvention, in their cases, became essential for recovery and for preventing further emotional damage or suicidal ideation.

Suicide leaves a profound impact on those closest to the deceased, as well as the wider community.

According to Dr Ravivarma Rao Panirselvam, a psychiatrist at Miri Hospital, postvention refers to any activity that supports people bereaved by suicide and helps them with the aftermath of suicide, which often involves traumatic grief.

In some cases, he said that the bereaved may face similar risk factors as the deceased, or the trauma they experience increases their own suicide risk.

“Postvention provides early identification and support, helping reduce the risk of further suicides in the community,” he said, emphasising that grieving after a suicide is intense and often deeply traumatic.

“In high-income countries, it is believed that a suicide death affects about 135 people. In Malaysia, mental health experts suspect the impact may be even greater,” he said.

Dr Ravivarma said that grief following a suicide is sudden, traumatic and often disenfranchised, meaning it is unsanctioned and unrecognised by society.

This isolation, he added, can deepen the grief experienced by survivors.

“Survivors may feel overwhelmed by emotions like denial, anger, guilt, blame and shame, which can lead to social withdrawal and difficulty processing their loss,” he said.

These feelings, he said, can evolve into pathological grief or psychiatric disorders such as depression or anxiety, with lasting effects on community resilience.

“When suicides are not addressed, their risk factors persist and may spread, leading to more pain and suicidal behaviour.

“Hence, it is crucial that postvention services are made known to the general public, especially survivors of suicide,” Dr Ravivarma said.

Services available

In Sarawak, Dr Ravivarma noted that government and private hospitals, as well as non-governmental organisations (NGOs) and local peer support groups, offer support to those affected by suicide, adding that mental health professionals and peer support groups play complementary roles in postvention efforts.

“Professionals assess and treat psychiatric disorders that may arise from suicide bereavement, while peer support groups provide a space for survivors to share their experiences. These groups help survivors feel validated and understood, which is crucial for healing,” he explained.

At Miri Hospital, Dr Ravivarma said that they provide counselling to those who are referred to them or willingly come to seek support, along with an active outreach to the bereaved.

Despite the availability of services, he said many people remain unaware of them.

“When someone is affected by suicide, especially intimately, there’s a lot going on, including managing the death, the funeral, the investigation and their own emotions. People often do not prioritise seeking help for themselves,” he said, adding that
Dr Ravivarma expressed that making these services known to the public is an ongoing effort.

“We also need a whole-of-society approach where individuals turn to NGOs, faith groups or social care organisations for emotional support,” he added.

In Miri, apart from the government hospital, the Mental Health Association (MHA) has been supporting the Miri Psychiatric Unit since the late 1990s.

MHA member Jacqueline Buri, 69, explained that the association connects those in need with appropriate mental health services. However, despite its long-standing presence, the number of people seeking counselling remains low.

“We can tell people where to seek help, but ultimately, it has to come from them,” Jacqueline said in a recent interview with The Borneo Post.

She noted that stigma and shame are major barriers to seeking help.

“Many people hesitate to seek support, often out of fear of judgment.

“However, a recent event at Piasau Boat Club jointly organised by various NGOs drew around 500 attendees, signalling growing awareness,” she added.

This, Jacqueline said, shows that people know that there are counselling and mental health supports available to them, if they need any.

“The information is out there — it’s now up to them to reach out.”

At present, MHA Miri has over 100 support group members, including parents and professionals from various backgrounds.

Located at Jalan Tanjong Lobang, the centre is open to any person who needs counselling or mental support for free.

In Kuching, the Dee Hati Centre for Grief, Bereavement and Trauma (Yayasan Dee Hati) has been offering peer support since 2023.

Its general manager and co-founder Mohamad Nazwan Mohamad Taufik said their centre primarily supports those grieving a loss.

“When someone is grieving and doesn’t receive support, it can lead to more complicated grief or depression,” he said.

The centre operates from Monday to Friday, from 9am to 5pm and on Saturdays (appointment only), and is free and open to everyone.

“We provide a safe, non-judgmental space for the bereaved to grieve and heal,” Mohamad Nazwan said, noting that the centre is run by non-mental health professionals with lived experience of grief.

The centre also hosts a support group for mothers who have experienced miscarriage or pregnancy loss, offering a safe space for them to share their emotions and experiences.