The thesis is an exploration of discourse on a particular type of familial child homicide referred to as ‘murder-suicide’ and often appearing to occur ‘out of the blue’. The purpose of the research is to contribute to social work understanding of the cultural context of murder-suicide through description and exploration of how murder-suicide is perceived and constructed in five specific cases. The empirical basis includes a narrative analysis of selected newspaper reports, semi-structured interviews with social workers using vignettes and semi-structured interviews with relevant professionals who had post-incident involvement in the cases. The structure of the thesis follows the format of an introductory chapter; a review of the literature relevant to murder-suicide, family ideology, childhood and the role of professional social work and the influence of the media on the creation of discourse; followed by a discussion of the research methods; and three empirical chapters concerned with narrative analysis of newspaper reports and interviews of social workers and relevant professionals. The thesis concludes with a chapter on the relevance to social work. The key theoretical perspectives are a focus on the social construction of social problems and the existence of multiple discourses. The thesis concludes that a single interpretation of murder-suicide is insufficient. Social workers in particular identify a range of social and individual factors, intertwined and difficult to disconnect from each other, that contribute to the actions of the individual in committing murder of their own children. Familiar discourses are identified within which the phenomenon of murder-suicide is described and made sense of, including gender roles, domestic abuse, power and control and mental health. The thesis concludes that for murder-suicide, like other forms of child abuse, social workers must give up ideas of omnipotence and accept the fallibility of social work in protecting all children.

Rationale and Aims: Grief research has highlighted the difficult reactions experienced by people bereaved by suicide, with studies also looking at the importance of sense and meaning making. There is limited research looking at experiences of individual kinships, for example partners of people who have taken their own lives. The current study therefore aimed to gain an in-depth understanding of the experiences of people who have lost a partner to suicide, using a qualitative approach. The research sought to explore the following:What are the experiences of people whose partners have taken their own lives and how do people experience trying to make sense and meaning of their partner’s death? Method: Semi-structured interviews were carried out with seven participants (two men) who had lost their partner to suicide more than two years previously. Verbatim transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four master themes, including: “Pervasive impact of loss – “oh god, its such a disaster”; “The search for understanding – “There are so many questions that are unanswerable, like ‘why’?”; Challenges and ways of coping – “All the challenges they just come daily, hourly, minute by minute”; and, “Looking to the future – Its been a turning point for me, and a catalyst for change”. A description of these master themes and the related subordinate themes is presented. Conclusion: The results of the analysis are considered in light of existing theory and their clinical implications.

Suicide is a major problem in society and remains a challenge for services. Approaches to suicidality occur across individual, inter-personal and socio-cultural levels. However, the dominant narrative remains a biomedical one. Excessive reliance on a biomedical approach is problematic as complex phenomena may be reduced to linear causes. Service user perspectives may highlight alternative understandings and interventions but can also be constrained by dominant cultural constructions. Accordingly, this study aimed to explore the cultural constructions which survivors drew on in narrating their experiences of suicidality. 11 attempt survivors who had recovered from suicidality were interviewed. A narrative analysis was conducted and highlighted a polyphony of survivor voices and cultural constructions. Attempt survivors drew on the dominant biomedical model to varying degrees, and accounts could be placed on a continuum of acceptance/rejection of this model. 6 stories (one for each point of the continuum) were explored in detail. All participants also related to alternative constructions of suicide including psychological, situational, interpersonal, moral, public and spiritual. Participants used constructions of suicide to justify their experiences. One previously unexplored voice to emerge was of suicidality as having been a positive experience. Results are discussed with respect to previous studies, narrative typologies of illness, clinical implications, limitations and future research.

Investigating the experience of life after a suicide attempt, and understanding how people find meaning and go on living, is important for developing appropriate responses. This study explored the unique lived experience of life after surviving a suicide attempt. Seven adults were interviewed using a semi-structured interview schedule. Interviews were transcribed and subjected to an interpretative phenomenological analysis (IPA). Four themes emerged, each with subthemes: relationship to suicide (the ongoing-ness of suicide, in-between-ness), relationship to healing (proceeding differently, freedom to heal, being regarded), relationship to self (encountering oneself, authentic being), and relationship to life (living with meaning, connectedness and belonging, curiosity and uncertainty). An overall theme of transformation emerged from the analysis. The opportunity for transformation can be experienced as ongoing crisis and can lead to deeper personal meaning if facilitated appropriately. Having meaning and purpose in life were experienced as essential to living. It is recommended clinical psychologists, and others, be prepared for the unpredictability of transformation and adapt existing practices where needed.

Suicide is a prevalent and international problem which has substantive economic and psychological consequences. This has led to governments placing prevention of suicide as a priority on healthcare agendas. Recognition has been given to vulnerable groups in society that have been identified as being at particularly high risk of self-harm and suicide. This includes those in contact with mental health and forensic services. There is a great deal of literature that has considered the risk factors, processes and mechanisms associated with suicide. Comparatively only a small amount of literature has looked at the concept of suicidality within restricted samples such as psychiatric inpatients and prisoners. This may be as a consequence of extensive ethical and procedural processes that are involved in conducting research in such settings. This results in it being necessary to continually make generalisations from community based literature, meaning that factors relating specifically to such settings may be overlooked or underestimated. In the first paper, the initial sections consider existing risk assessments and models of suicidality. Predominantly being structured around static risk factors, means they are often criticised for lacking predictive utility and specificity. Literature examining dynamic psychosocial factors of suicidality in restricted samples was reviewed and 20 articles were identified. A wide range of dynamic correlates are presented. These form a theoretical model of suicidality specific to restricted samples. The clinical and theoretical implications are discussed in terms of risk assessment procedures and adapting and shaping interventions in accordance with the findings. Developing risk assessments around more dynamic factors will allow for greater sensitivity and prediction of those at greatest risk of imminent harm. The second, empirical paper supports the promotion of recovery focused practice and explores the relationship between suicidality and perceived personal agency in patients in secure mental health settings; Personal agency having previously been suggested as conferring resilience to suicidality. Psychometric measures and experience sampling methodology were utilised to examine the relationship. Perceptions of personal agency were found to confer resilience against suicidality. Change in perceptions of personal agency was not associated with suicidality but the overall level of personal agency was. Implications for service delivery are discussed with emphasis given to fostering perceptions of agency, control and self-efficacy and promoting inclusion, empowerment and person centred care. The final paper provides a personal and a critical reflection on the research process. It highlights and discusses clinical and theoretical strengths and limitations of the two papers and considers the methodological processes of both papers in more detail. Further reflections on how practice could be adapted in line with the findings are given. Future directions for research within secure settings are considered, in the hope of maintaining the drive for research with this vulnerable and often overlooked population.

L'enjeu de cette thèse est de définir ce que veut dire un suicide dans le monde militaire, de comprendre comment c'est un fait de gestion dans les armées et pourquoi il vaut mieux dire les choses afin de pouvoir mettre en place une véritable politique de prévention. Le tabou du non-dit de cette question dans les armées s’explique inconsciemment par le fait que chaque suicide d’un militaire vient contredire la fraternité d’arme que revendique l’armée comme étant son socle. / The aim of this thesis is to define what suicide means in the military world, to understand how it is a management fact in the armed forces and why it is better to express a matter in order to be able to implement a genuine prevention policy. The taboo of this unspoken issue in the armed forces is unconsciously explained by the fact that each suicide of a soldier is in contradiction with the arms’ brotherhood claimed by the army as its base.

Suicide in India is a complex social issue and a neglected area by the state. Research has focused on risk factors and the epidemiology of suicide; studies concerning the intersection of culture with attempted suicide are limited. The aim of this study is to explore cultural implications of attempted suicide and its prevention in Southern India by means of comparing and contrasting the accounts of survivors of attempted suicide, mental health professionals and traditional healers engaged in treating people with suicidal behaviour. Methodology: A qualitative design is used drawing on constant comparison method and thematic analysis. The analysis of the data is underpinned by the theoretical concepts of Bourdieu’s work. In-depth interviews were conducted with fifteen survivors of attempted suicide, eight mental health professionals and eight healers from Southern India. Results: Application of Bourdieu’s theory of symbolic power and violence, cultural capital and habitus to the analysis of data revealed the process of constant interaction among visible and invisible fields such as faith, power, control, family, religion and social systems which impact survivors’ disposition to situations. Disparities in gender and role structures within families, financial challenges, health concerns, abuse, and violence were commonly cited factors by all three groups of participants. A few survivors and healers attributed misfortunes and distress to magic, spells and ‘bad times’. Healers and professionals were particularly of the opinion that cultural transition has added to stress among people. Survivors considered religious and traditional methods of support as socially accepted norms. Medical assistance was sought only during apparent ill health. Psychosocial support was very rarely accessed and availed. A lack of awareness among family members and friends to identify mental health concerns and a wide gap between identification of severe stressors and treatment increased the risk of suicide and limited timely intervention. Conclusion: This study identified a set of cultural mechanisms that produced negative impact and led to attempted suicide. The role of culture in causing suicide and attempted suicide is explained by unraveling the dynamics of cultural mechanisms and support processes that survivors experienced and as reported by professionals and healers. This research evidence presents pathways into attempted suicide and a life away from suicide.