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Answering the question ‘why?’

After a suicide, it is common for the bereaved to want to talk about why and how – especially with the deceased’s doctor.47 Sometimes, it may be appropriate to discuss which factors were important in the deceased’s situation, although beware of explanations when there have been relationship problems. It may be more useful to point out how mental pain and illness can affect judgement and why they felt trapped in the path they followed.9

When talking about suicide:

  • discuss risk factors but avoid oversimplifying the causes of suicide – emphasise that suicide is not the result of a single event or factor; rather it is a complex and complicated interplay of events
  • avoid presenting the ‘causes’ as inexplicable or unavoidable – emphasise that there are alternatives to suicide when one is feeling distressed, despairing or hopeless, and make it clear what resources are available for getting help
  • emphasise the correlation between mental illness and suicide, and stress that help or treatment is available
  • but also do not portray the deceased as a villain or worthy of contempt. Emphasise the act of suicide as a serious mistake in judgement due to psychological pain causing impaired recognition of alternatives and resources for help
  • provide a structure that facilitates ongoing suicide prevention efforts
  • discourage focus on the method of the suicide – report the method factually (eg he hanged himself), but emphasise that the person mistakenly felt that he or she could not get help for his or her problem – when in fact help was available.9

Another ‘why?’ that the bereaved may ask is ‘why didn’t I see the signs?’ While talking about warning signs can increase recognition of those signs in the bereaved, it is important to highlight that sometimes there aren’t any.

Remember that agreements about confidentiality continue after a patient’s death unless there are overriding legal considerations. Although legal aspects regarding confidentiality are relatively straightforward, they need to be balanced with the family’s need for answers. Usually this can be done by empathetically acknowledging the family’s needs, explaining why confidentiality exists and responding to questions with understanding and non-defensive openness.47


  1. Berkowitz L, McCauley J, Schuurman D, Jordan J. Organizational postvention after suicide death. In: Jordan J, McIntosh J, editors. Grief after suicide: Understanding the consequences and caring for the survivors. New York: Routledge, 2011.
  2. McGann V, Gutin N, Jordan J. Guidelines for postvention care with survivor families after the suicide of a client. In: Jordan J, McIntosh J, editors. Grief after suicide: Understanding the consequences and caring for the survivor. New York: Routledge, 2011.


After suicide: A resource for GPs