'Losing my brother to suicide is a scar that time can never erase. Life goes on and grows around the scar, but it will always be there. I find myself imagining the man he could have become, the moments we could have shared, if only he hadn't felt so lost and broken. It is very painful to know that hope slipped away from him, yet I hold on to the love, fun and laughter he gave throughout his young life and the wish that he had seen the light still waiting ahead.' This is the unedited testimony of a person who lost a sibling, at a very tender age, to suicide. These words surely echo the thoughts of hundreds and thousands of people who have lost someone dear to suicide.

Suicide bereavement represents one of the most intensely painful experiences for individuals, families, and communities. The sudden and unexpected loss caused by suicide affects a wide network of people, including parents, siblings, children, grandparents, friends, and colleagues. The grief experienced after suicide is often more complex than that following other causes of death due to the circumstances and stigma surrounding suicide.

Immediately following a suicide, those bereaved often experience shock and emotional numbness. This initial phase serves as a psychological buffer, allowing individuals time to adjust to the enormity of the loss. As numbness fades, deep sadness emerges, gradually giving way to the pain that has been buried. Sadness, fear, depression, anger and blame seem to take turns with the persistent question which will always remain unanswered "Why?".   Bereaved individuals grieve the loss of their loved one and the future that will never be realised. Memories serve both as sources of comfort and as reminders of what has been lost.

Anger may arise during the grieving process, often directed at circumstances, the situation, or even the deceased. This emotion is frequently accompanied by confusion regarding the reasons behind the suicide. Guilt is another common emotion, manifesting as persistent concern over missed signs or perceived failures in supporting the deceased. Individuals may repeatedly question if more could have been done to prevent the tragedy: "How didn't we notice?" " Could I have done something?"  "Why didn't I do something?" and yet there are no answers to these questions.

Bereavement after suicide is often compounded by social stigma, which can lead to isolation and feelings of hopelessness. In addition to grief, those affected may experience shame or reluctance to seek support due to stigma.

Suicide typically results from a complex interplay of factors and rarely has a single explanation. Risk factors include:

• Mental health conditions - depression, mood disorders, psychosis, personality disorders, and eating disorders
• Chronic health issues and chronic pain
• Traumatic life events such as abuse, significant loss, or financial crisis
• Addictions and bullying
• Complex relationship problems

In some cases, no definitive precipitating factor is identified, which can lead to further wondering and unanswered questions for those left behind.

While the pain of suicide bereavement may never fully disappear, it evolves as life continues. Over time, strong feelings typically begin to lessen. Individuals may find meaning and purpose again, focus on relationships, or rebuild their sense of future.

As we speak about World Suicide Prevention Day, it is important to honour the memory of those who lost their lives to suicide but also give importance to those who are alive and are carrying the grieving hearts of suicide loss. Seeking professional help after suicide loss is referred to as postvention, which is a critical component of the suicide prevention continuum. According to the National Suicide Prevention Strategy, postvention services are paramount for individuals bereaved by suicide or significantly affected by suicidal behaviour. These services help affected individuals process traumatic events and bolster mental wellbeing, reducing the risk of further suicidal behaviour. Recommendations my include:

• Connecting with support groups or others who have experienced similar loss can provide comfort and understanding
• Engaging in self-care activities such as rest, creative expression, or mindfulness can help nurture healing
• Sharing one's experience or talking to trusted friends and professionals may lessen the burden of grief

Suicide bereavement is a complex and challenging experience. Understanding its emotional progression and accessing appropriate support are vital steps towards healing for those affected. Anyone experiencing suicidal thoughts, or who has been bereaved by suicide, is strongly encouraged to seek help. Support services are available for both emergency and non-emergency situations and can be found here: https://commissionermentalhealth.gov.mt/en/helplines-apps-chats/.

Yes, There can still be life after suicide.

Gertrude Buttigieg is officer within the Office of the Commissioner for the Rights of persons with Mental Disorders