Authors' objectives: 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. 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. There were 18,998 deaths attributed to suicide in England between 2011 and 2015 in the general population, constituting 12 deaths for every 100,000 people per year. Among health professionals, the suicide rate is 24% higher than the national average, largely explained by the increased risk of suicide in female nurses (four times the national average), male paramedics and female doctors. We know that NHS staff are likely to suffer from poor emotional and psychological health, but little is known about how NHS staff are affected when a colleague dies from suicide. Past research shows that if people affected by suicide receive support early on, it can help them come to terms with their loss and reduce the risk of further mental health problems and suicide. This support is called postvention, which can be defined as ‘the actions taken by an organisation to provide support after someone dies by suicide; effective support can help people to grieve and is a critical element in preventing further suicides from happening’. Despite the potential adverse impact on NHS staff who have been impacted by the suicide of a colleague, there is currently no postvention guidance to assist NHS organisations or managers to support staff following the suicide of a member of staff. This research will fill this gap. To undertake an integrative review of suicide impact and postvention interventions in other settings. To explore the impact of colleague suicide on staff well-being and grief reactions to such an event. To explore staff views about risk factors which may have contributed to the suicide of their NHS colleague as well as any ‘warning signs’ the individual may have displayed. To identify what helps and/or hinders bereaved colleagues to seek support, to characterise supportive work cultures, and to identify staff preferences for future support. To explore how managers and other staff tasked with delivering postvention respond to and support their employees and colleagues following a death by suicide, and to identify current postvention activity. To use the findings to: develop evidence-based postvention guidance for NHS organisations and managers so that they can support and respond appropriately and effectively to bereaved or affected employees apply for further funding to develop and evaluate the appropriateness and effectiveness of an empirically informed postvention support package for use across the NHS.

Authors' results and conclusions: 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. 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.

Authors' 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. 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. Work package (WP) 1: A critical integrative review of primary research to explore evidence of the impact of suicide in the workplace, including postvention policies and evaluations in other settings (e.g. schools, armed services, railways). A total of 17 articles were reviewed, following guidelines for critical integrative review and thematic network analysis. The articles were assessed for quality, after which data were extracted and synthesised. A thematic network analysis was developed based on synthesised findings. Work package 2: Qualitative interview study. In-depth qualitative interviews were conducted with 51 NHS staff members affected by the suicide of a colleague. Some 29 participants were bereaved coworkers and 22 were ‘supporters’ who had delivered postvention. An inductive, iterative grounded theory analysis was undertaken. Two grounded theories were developed, one pertaining to the experiences of staff affected by a colleague suicide, and the other reporting the experiences of staff who provided support to staff members affected by a colleague suicide. Work package 3: Online co-design stakeholder workshop. Findings of WP1 and WP2 were synthesised by the research team with patient and public involvement and engagement support and presented to an expert consensus group, including policy-makers, managers, front-line staff and study participants. Stakeholders reviewed draft recommendations from study findings and contributed critique and expert knowledge to identify key components of the postvention guidance. Work package 4: Findings and recommendations from WP1, WP2 and WP3 were synthesised to co-produce tailored, evidence-based postvention guidance specifically for the NHS context.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR129341

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/GFTA1212

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GFTA1212

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk