Approximately 800,000 people commit suicide each year, and many more make suicide attempts. In fact, suicide is the 15th leading cause of death globally for all age groups, the second for young people aged 15-29 and the fifth for those aged 30-49.1,2 These numbers may be underestimated since suicide deaths are often “hidden” among deaths by single car/driver accidents, unwitnessed drowning and other undetermined causes; there is also underreporting due to social, cultural or religious stigma.3 Suicide is truly a worldwide issue: over three-fourths of reported suicide deaths take place in low- and middle-income countries.1
The causes of suicide are complex and varied. “While the link between suicide and mental disorders (in particular, depression and alcohol use disorders) is well established in high-income countries, many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness.”1 Suicide rates are higher among vulnerable populations such as refugees or lesbian, gay, bisexual, transgender, intersex (LGBTI) persons, and among those who have experienced conflicts, disaster, abuse, loss or violence.1
Suicide is costly from many standpoints. In the U.S., studies show that the average suicide costs $1,287,534.4 Researchers in Australia estimate a cost of AU $2.14 million for each death by suicide5 and in the U.K., £1.5 million.6 While only a portion of these economic costs directly falls on the employer, the impact on the morale and functioning of the workplace, as well as on an employee’s family and community, is unmeasurable.3 “Surviving family members and close friends are deeply impacted by each suicide and experience a range of complex grief reactions including guilt, anger, abandonment, denial, helplessness, and shock.”4
What Global Employers Can Do
The workplace provides opportunities for suicide prevention that have not been realized. For instance, workplaces offer people in potential distress social connection and a purpose that may help sustain them during difficult times. In many instances workplaces are also already situated to disseminate public health messages, and in some cases even refer people to mental health services such as Employee Assistance Services. - Sally Spencer-Thomas, International Association for Suicide Prevention7
There is compelling evidence indicating that adequate prevention and treatment of depression, alcohol and substance abuse can reduce suicide rates. -The World Health Organization8
Provide Access to Mental Health Treatment
Depression affects more than 300 million people worldwide, but fewer than half of those affected have access to effective treatments. In some countries the percentage is as low as 10%.9 Furthermore, “the majority of people who have mental health problems or are suicidal fail to receive appropriate treatment, even in countries where a wide range of cost-effective treatments exist.”10 It is important that employers provide and promote effective mental health treatment options for their employees. In some countries, employee assistance programs (EAPs) may be the only real resource available. In others, there may be more options, including providing mental health/substance abuse coverage (e.g. medication and counseling) in benefits plans and/or partnering with non-governmental (or governmental) organizations to provide suicide helplines and assistance. See the Resources section of this paper for a list of such organizations, where available, in selected geographies of interest to GBGH members.
Fear of stigma may keep people from accessing mental health care or suicide-prevention programs, especially those offered in the workplace. Twenty-seven percent of Canadian respondents to a recent survey said that they feared losing their job or chances for a promotion if they revealed they had a mental health issue or problem at work.11 Employers can combat stigma by:11,12
- Focusing on educational initiatives that provide current and accurate information about mental illness.
- Encouraging senior leadership to act as role models and show “demonstrable leadership around mental health.”11
- Conducting outreach or peer education programs that encourage employees to use available mental health resources if needed (Examples include Mental Health First Aid,2 ICU13).
- Including mental health issues in health promotion activities in a similar way as one would include physical health issues.
On a related note, even employees without a diagnosed mental health issue may be unwilling to utilize employer-provided resources for fear that they will be labeled as “sick” or will be seen as weak for seeking help. Some Global Business Group on Health members have reported success by re-branding their mental and physical health programs in a positive manner (e.g. focusing on self-improvement) or by highlighting the ability of a program like EAP to improve work performance. Manager involvement in promoting programs can also be a helpful way to obtain greater employee acceptance of health-related programs.
Address Employee Stress
Work and life stress is an issue around the world as well; in fact, global company respondents to a 2016 Xerox Corporation survey named stress as a top three health issue driving global well-being programs.14 Employers can help to combat occupational and personal stress by emphasizing the importance of a healthy workplace and making practical changes, including:
- Implementing programs such as work/life balance support, healthy sleep, financial education and resilience/stress management;
- Encouraging managers to redistribute work among colleagues to relieve individuals with particularly high workloads;
- Providing training to assist employees in doing their job more effectively (e.g., managerial training or time management training);
- Offering counseling, disease management and care management for employees dealing with serious and/or chronic health conditions;
- Putting in place workplace bullying and/or harassment education and policies;
- Supporting caregivers of seriously ill family members or for those juggling small children and elderly parents; and
- Providing training and support programs for expatriates and families.
For more information about stress and work, see Work-Related Stress: Q&A for Corporate Headquarters (HQ) Staff, Managers and Employees as well as Virtual Teams, Time Zones and Traveling: Coping With Global Demands in a Fast-Paced World.
Educate Managers and Employees on Suicide Warning Signs and Response
Managers and co-workers should be aware of warning signs that may indicate persons at risk for suicide. Education can take place through manager training programs, company newsletter articles, lunch and learns, staff meetings or company intranet/health promotion websites. Warning signs include:15
- Rage, uncontrolled anger, or seeking revenge;
- Acting reckless or engaging in risky activities, seemingly without thinking;
- Feeling trapped or like there’s no way out;
- Increased alcohol or drug use;
- Withdrawing from friends, family, and society;
- Anxiety, agitation, unable to sleep or sleeping all the time;
- Dramatic mood changes;
- Expressing no reason for living or no sense of purpose in life; [and/or];
- Prior suicide attempts.”
Those who have experienced major recent life changes or stresses, such as a change in work circumstances, a loss of relationship(s), poor health status, alcohol/drug abuse and/or depression may be at increased risk. Managers and co-workers who notice warning signs can be of help by listening compassionately, encouraging the person to talk, demonstrating acceptance, asking if there is anyone they would like to have called for support and referring the person to mental or occupational health services. It is important that the manager or co-worker arranges support for the person so they are not left alone when suicidal, or even calls emergency services if danger seems imminent.12
Implement a Suicide Prevention Program
Employers may want to consider implementing a suicide prevention program at their workplaces. According to the Suicide Prevention Resource Center, key components of such a program include:12
- “Policies and procedures to help employees at risk and in crisis.
- A plan for responding to a suicide attempt or death in your workplace.
- Mental health emergency contact information placed throughout the workplace.
- Education and training on mental health, suicide prevention and stigma reduction for employees.
- Specialized suicide prevention training for the workplace’s EAP providers and/or HR staff.
- Established relationships with mental health professionals in the local community.
- A referral guide to resources in your community that offer support and/or treatment for problems related to suicide.
- A work environment that values its employees and promotes respect, open communication, a sense of belonging, and emotional well-being, and that encourages people to seek help when they need it and to support each other.”;
Develop a Response Plan
During a time of crisis, it is crucial to have a plan already in place for how to respond. Some employers have workplace response teams that develop protocols to respond to incidents like suicide. This team may be made up of representatives from, at minimum, senior management, public relations, human resources and health and safety. Suicide response plans should be incorporated into greater critical incident stress management or crisis response plans, as well as into health and safety protocols or statements.4
Additional actions must be taken when the suicide takes place at the workplace. The Irish Hospice Foundation and Console, a suicide prevention, intervention and postvention organization, suggests the following:4
- Contact emergency services.
- Make sure the immediate area is safe and that the body is taken care of.
- Establish the facts: what happened, when, where, to whom and how?
- Communicate with the family or next of kin of the employee.
- Determine what information the family would like shared.
- Communicate with relevant agencies and departments (e.g., employee assistance, health and safety, unions, etc.).
- Report the death both internally and externally to authorities, family and/or the community.
- Support employees who need medical or mental health interventions.
- Return personal items to the family of the employee.
- Convene an incident team and assign responsibilities, such as team leader, family support person, staff support person, information and communication contact person, emergency services and statutory agencies contact person, and workplace cleanup. Workplace cleanup should be done in a sensitive manner and may be best done by an outside facilities service, so as to avoid further trauma to co-workers and acquaintances.
Provide Bereavement Support
Employees will have varying responses to the death of a co-worker. Common reactions include denial, despair, anger, fear, shame, isolation, depression, shock and numbness. In a typical situation, about 60% of people will need Level 1 bereavement support, which includes social support, assistance with tasks and information about the grieving process. An additional 25% will need extra support (Level 2), such as that provided by occupational health, employee assistance programs or non-professional volunteers with training in listening skills, and 10%-15% will need professional support (Level 3) by psychologists or counselors.4 “The goal of the workplace is to provide Level 1 bereavement support and to be able to guide an employee to appropriate Level 2 and 3 supports as needed.”4
Workplace support may include:4,16
- Lists of internal and external resources, as well as places to access information about grief (e.g. suicide support groups, online resources, etc.).
- Time off to attend the funeral, if applicable, appropriate and desired.
- Paid or unpaid leave for family members of the deceased, if applicable, to deal with distress or practical issues.
- Information about how the organization plans to honor the employee’s memory, if applicable (e.g. flowers or cards to the employee’s family, donations to a charity, etc.).
- Contracting with a behavioral health professional who can be in the workplace during the aftermath of a suicide to consult with management, meet with affected employees, provide grief and recovery education and refer individuals to other resources as needed.
Employees who lose family members to suicide or other causes need support and understanding as well. Employers can provide this support by ensuring that bereavement policies (i.e. bereavement leave, emergency loans, leave-sharing) are established, serving as a liason between the grieving employee and co-workers, providing grief counseling and/or education and setting expectations upon return to work so that the employees knows where and how to ask for help if needed.17
It is important to ensure that only accurate and appropriate information is shared in a clear manner, in order to prevent rumors and speculation about the cause of death or reasons for suicide. To this end, it can be helpful to designate someone in advance as the primary point person for these communications, with a secondary support person in place as well to shoulder the burden. Messages should be simple and concise, and when possible, employers should instill “messages of support and cooperation.”4 It may be helpful to call an in-person meeting for employees in a comfortable space to provide information in a compassionate and calm manner.4
Managers play an essential role in communicating with employees, and setting a tone for the workplace, in the aftermath of suicide by:16
- Demonstrating compassion toward the deceased and his or her friends and family members.
- Being visible, including talking with and listening to their employees with an eye toward identifying those who may need extra assistance (including behavioral-based signs such as unusual absenteeism or presenteeism).
- Being aware of any workplace concessions that may be utilized in the first few days (e.g., reduced work hours or workload).
- Being a role model for healthy grieving.
When an employee has died by suicide, it is important to strike a sensitive balance between a timely return to “routine” and allowing space for employees to acknowledge what has happened, talk informally and support each other. - The Irish Hospice Foundation and Console4
- Bloomberg News. China’s Health Has Reached a Tipping Point. https://www.bloomberg.com/graphics/2019-china-chronic-conditions/. Accessed November 1, 2019.
- Mental Health First Aid International. http://www.mhfainternational.org. . Accessed November 4, 2019.
- Forbes. Report: U.S. Among The Ten Most Stressed Nations Worldwide [Infographic]. https://www.forbes.com/sites/niallmccarthy/2019/04/26/report-u-s-among-the-ten-most-stressed-nations-worldwide-infographic/#4b86d1ba6a0c. Accessed November 1, 2019.
- Austin C, McGuiness B. Breaking the Silence in the Workplace: A Guide for Employers on Responding to Suicide in the Workplace. Dublin: Console and the Irish Hospice Foundation.;2012.
- Doran CM, Ling R, Swannell S, Milner A. The impact of a suicide prevention strategy on reducing the economic cost of suicide in the New South Wales construction industry. Crisis. 2016;37(2):121-129.
- Moulin L. Aiming for 'zero suicides': An evaluation of a whole system approach to suicide prevention in the East of England. London: Centre for Mental Health;2015.
- International Association for Suicide Prevention (IASP). IASP Special Interest Group - Suicide and the Workplace. https://www.iasp.info/suicide_and_the_workplace.php. Accessed November 1, 2019.
- World Health Organization. Background of SUPRE. https://www.who.int/mental_health/prevention/suicide/background/en/. Accessed November 4, 2019.
- World Health Organization. Depression. http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed April 24, 2017. In.
- Preventing suicide: A resource at work. Geneva: World Health Organization;2006.
- Mental Health Works. The health case: Mental illness is everyone’s concern. http://www.mentalhealthworks.ca/the-health-case/. Accessed April 25, 2017. In.
- The role of managers in preventing suicide in the workplace. Suicide Prevention Resource Center; February 2013.
- American Psychiatric Association Foundation Center for Workplace Mental Health. ICU. http://www.workplacementalhealth.org/Employer-Resources/ICU. Accessed November 4, 2019.
- Working Well: A Global Survey of Workforce Wellbeing Strategies. Executive Summary. Xerox Corporation;2016.
- ULifeline. Suicidal behavior. http://www.ulifeline.org/topics/130-suicidal-behavior.Accessed April 26, 2017. In.
- Gallup. Gallup 2019 Global Emotions Report. https://www.gallup.com/analytics/248906/gallup-global-emotions-report-2019.aspx. Accessed November 1, 2019.
- Tyler K. Coping with grief. In. HR Magazine2003.