© 2019 Created by SAVE 

A Guide for Medical Examiners and Coroners 

Best Practices for Talking With FAMILIES About Suicide

The following best practices were developed by SAVE, informed by an advisory board of Medical Examiners and Coroners, and endorsed by the National Association of State Mental Health Program Directors (NASMHPD).

About

Medical Examiners and Coroners oversee medicolegal death investigations, perform postmortem examinations, and certify cause and manner of death (NIST). This guide is intended to help Medical Examiners and Coroners (ME/Cs) communicate to families about suicide death. Before using the best practices, ME/Cs should ensure that any communications with families are done in compliance with state law or their employer's governing policies and procedures.

Where and how to talk to families

WHERE

When possible, it is best to have the conversation with survivors in a place that is familiar to them (e.g. home), where they feel safe. Try to do this in a room where families can be sitting down, and you should be sitting as well—looking at them, rather than standing over them and looking down on them. If home is not an option, find a quiet room away from police, EMTs, media, and other disruptions.

 

HOW

It is important you share this information directly and compassionately. Begin by saying, "I am very sorry, but your X has died," Give them a moment and say that, "People die in lots of ways," before stating that they died by suicide. Be brief and only share what is most important and known at the that time with the family. Avoid sharing details of suicide method with children/youth, or unnecessary details (e.g. "Your Dad put a gun to his head"). Do not speculate or try to explain why the suicide happened, rather be patient with them as the shock sets in. Be prepared for them to have a range of emotions and be in denial and be angry with you, someone else, God, etc. They might demand to see their loved one. Help families with their grief by assuring them that "what you are thinking and feeling is normal when someone dies by suicide." Tell them that they will be okay, but that it will take time and healing before they will be. Ensure that they know that there is no right or wrong way to grieve when someone has died, that everyone does it differently. Avoid using medical or legal terms. Be aware that you may have to repeat things several times.  

Let survivors know that it is not uncommon for family members left behind to think about suicide. Tell them that if suicidal thoughts happen to them or another family member, help is available, they should talk about it with trusted loved ones, and contact a crisis service immediately.

We may never know the exact reason(s) why it happened. Let the family know it is normal to ask “why” for as long as they need to.

Address the "Why?" question

Address expressed feelings of guilt

Survivors of suicide loss almost always experience a deep sense of guilt. Let families know that this is very common. Help them by explaining that there are many factors that contribute to a person taking their life, and that no one person or event causes suicide. Remind the family that sometimes people die of an illness regardless of the treatment they seek or how much they are loved and cared for.

Handle suicide notes carefully

  • Be aware of how suicide notes are handled in your jurisdiction. Sometimes a note will need to be held as evidence by police. Try to obtain a copy of the note for the family.

  • Prepare the family that the contents of the note may not answer their questions.

  • Remind the spouse or parent next-of-kin to keep the note in a safe place.

  • When no note is left, inform the family this is common and that only 20-25% of those who die by suicide leave a note.

Use appropriate language

The language we use when we talk to individuals and families about suicide matters. By using the appropriate terminology and avoiding stigmatizing words and phrases, Medical Examiners and Coroners can have more thoughtful, compassionate, and helpful conversations with families who have lost a loved one to suicide.

Don't Say This

Say This Instead

  • Committed suicide

  • Successful suicide

  • Unsuccessful suicide

  • Completed suicide

  • Failed attempt at suicide

  • Died by suicide

  • Died by suicide

  • Attempted suicide

  • Took his/her/their own life

  • Attempt to end his/her/their life

Know how to talk with children about suicide

If children are present, special consideration should be taken into account when discussing a suicide death. A parent or legal guardian may ask you to talk to or explain suicide to a child. Here are some general tips to follow when talking with children.

  • Always have permission from parents or guardians before talking about a suicide death. When possible, have a parent or guardian present.

  • 
Ensure a child knows that the suicide death was not their fault. Children often feel it happened because of something they did.

  • Be direct and speak in short, simple sentences appropriate for the age of the child.

  • Use words that the children know and can understand. Do not speak in medical or legal terms. Ask the child if they understood what you told them before you leave.

  • Ensure you are comfortable talking with various age groups of youth. 


  • Reassure children that suicide is not common, it is not contagious, and it will not happen to them.

  • Reassure children that they are not alone and will be taken care of. When a parent or guardian dies, children often are afraid their other parent or guardian will leave too.

  • Let children know that they might have more questions later and that it's ok to keep talking about the suicide death and to continue to ask questions as long as they need. Reassure a child that there are people there to help them at any time.

  • Follow your state’s laws and jurisdiction regulations as well as any policies and procedures of the agency in which you work.

  • Consult with others who have expertise in explaining death to youth before you talk with children.

  • Refer families to additional resources for talking to children about suicide and grief.

Resources for talking with children

Provide resources to the family

Provide reputable resources specific to dealing with suicide loss. Be sure to offer this information free of charge. Some good resources include:

Provide a list of counseling or other mental health services for the family.

Respond ethically to requests to change manner of death 

Sometimes family members will place pressure on a Medical Examiner or Coroner to change the manner of death so that it is not suicide. Let them know that you cannot submit to such a request. For example, if they say that insurance will not cover a death by suicide, explain that it would be unethical and illegal to change the manner in order to help them collect on a policy, and recommend they call their insurance agent or an attorney. Others may ask you to change the manner to protect children or the family's reputation. Let them know that you cannot do this, and that they will find caring and supportive people in their community to help them in their grief, no matter the manner of their loved one's death. Finally, let them know that if more information becomes available in the future, the manner of death can be changed.

Proactively inform families that the manner of death is public record

In some cases, families may wish to keep the manner of death secret due to the stigma, shame, and guilt that still persists surrounding a death by suicide. It is important, therefore, that you inform the family up front that the death of their loved one is a matter of public record, and that the true manner of death may not remain a secret. Be familiar with the public records laws in your jurisdiction so you can help the family make an informed decision.