Using the Concept of Community in Suicide Research: the RaPSS Study Nicky Stanley

Psychological autopsy  Focus on the ‘psy’ – explores individual motivation and experience.  Clinical – interest in retrospective diagnosis, focus on pathology, family history  Forensic, positivist – concerned with causes, ‘wotdunnit?’  Uses single source – inquest/family  Not concerned with impact of suicide

Using a community approach?  Allows a suicide to be understood in its social context  ‘Here and now’ privileged over history  Community – heterogenous  exploration of different perspectives  Facilitates study of responses to a death as well as prevention  Emphasises the role of community in developing prevention and response strategies

Multiple Perspectives  Offers focus on recent events plus family history  Contrasts formal records and intimate accounts  Different informants reflect fragmentary nature of personality

Contradictory accounts Male student, aged 21: Parents convinced that he was enjoying university and was doing exceptionally well academically. His tutor’s impression was that he was ‘getting by’ academically but was disappointed at the marks that he was receiving.

Contrasting discourses Normalising v. pathologising “You can’t say that somebody is suffering a mental health problem just because they have chosen to kill themselves....this was nothing to do with mental health issues, whatever that might mean, you know, it’s quite a complicated issue for me but I sort of felt from the outside it seemed like there was a case to say this was something which this person....felt in control of.” (student) “....you could fit the description of manic depressive to him if you wanted.” (Parent)

Methodology 1 Case Studies  20 case studies of student suicide occurring between May 2000 and June 2005  HEIs across the UK  Each case study: 2-6 data sources for each case  Data Sources: Family members29 Students’ friends12 HEI Staff17 Coroners’ and Procurators15 Fiscal Records Total data sources73

Methodology 2 SINGLE PERSPECTIVE DATA 9 Parents’ Perspective Interviews 4 Friends’ Interviews 10 Positive Practice Interviews

Methodology 3 STAKEHOLDER CONSULTATION Expert Seminar on challenges of Data Collection

Findings - Prevention  Context of Transition – ¾ of cases “….had no clue what he wanted to do in his life….he was very concerned about leaving university, he would have left in the second year, he constantly said to me: ‘what am I going to do?’ “(Student) “He was packing all his things up to go to university the day before he took his own life and he just couldn’t tell me what was really happening to him….he was going through all the things that had gone wrong in his life that he wanted to put right.” (Parent)  2/3 diagnosis of mh problems – 9 diagnosed as students

Findings - Prevention  Perfectionism  Disrupted academic careers “….his worst thing was failure, he hated failure, and I suppose failing first year at uni was obviously a massive trigger…” (Student)  Relationship break-ups and difficulties “….the girlfriend situation….made him start to say to himself: ‘are you not any good at relationships? I’ve got a social problem’.” (Parent)

Findings - Prevention  Services perceived as stigmatised: “That bothered him hugely, the fact that he was going to be tarred with this brush of mental illness that, you know, shouldn’t be happening to him….but he didn’t really seem to want to be helped.” (Student)  Co-ordination between community and HE Services

Suicide transmission  Suicide transmission – 4/20 cases When I thought about killing myself, I was feeling the most excruciating pain you could possibly imagine and I thought the way out of this is to kill myself, how will I do it? Oh, I’ll hang myself, that’s what he did…. I wanted to stop feeling the pain…. (Student)

Findings – HE Responses  Proactive approach welcomed “The thing is this isn’t the first student ever to kill themselves….it’s happened before for them [the university], it hasn’t happened before for us [the friends of the student who died], so the university should…. be a little parent-like perhaps about it, and you know at least understand and try to help.” (Student)  Including students in private accommodation in response  Acknowledging impact of suicide on friends’ academic progress “Academically not doing so well but not wanting to be seen to use the death as an excuse …. obviously you were struggling ….(but) you wouldn’t want it to be seen that way … so I think if they’d approached me … I’d tell them.“ (Student)

Findings – HE Responses  Families valued signposting to sources of support  Staff needs for support infrequently met: “What would have been really helpful would have been if someone had turned around to me and said go find yourself someone to talk to …. we’ll pay for it….” (Student Services)

Recommendations ► Emphasis on policy interventions within HEIs’ remit ► Role for HEIs in suicide prevention ► Harm limitation task for HEIs following a suicide ► Highlight relationship between HEI and other systems