Areas of specialism

Suicidology. Nurse suicide. Workplace wellbeing. Critical methodologies. Qualitative methods. Postvention guidance.

My qualifications

BSc (Honours) Social Science.
Open University
MSc Counselling Psychology
University of Worcester
PhD A critical exploration of staff experiences and roles following a student death by suicide within two United Kingdom Higher Education Institutions
University of Worcester

Previous roles

27 September 2021 - 30 June 2022
Research Fellow
University of Birmingham
01 January 2021 - 30 September 2021
Research associate: Developing and delivering evidence based learning and training resources to social care practitioners in public and third sector settings.
Research in Practice
01 October 2016 - 31 December 2020
PhD Candidate: A critical exploration of staff experiences and roles following a student death by suicide within two United Kingdom Higher Education Institutions.
University of Worcester


Hilary Causer; Johanna Spiers; Nikolaos Efstathiou; Stephanie Aston; Carolyn A. Chew-Graham; Anya Gopfert; Kathryn Grayling; Jill Maben; Maria van Hove; Ruth Riley (2022) The Impact of Colleague Suicide and the Current State of Postvention Guidance for Affected Co-Workers: A Critical Integrative Review

People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention guidance for supporting surviving colleagues is often poorly developed. This critical integrative review explored the impact of colleague suicide on surviving co-workers and reviewed postvention guidance for workplaces. Systematic searches found 17 articles that met the inclusion criteria. Articles were appraised for quality and extracted data were analysed using a thematic network method. Article quality was moderate. Two global themes were developed: impact of a colleague suicide comprised themes of ‘suicide loss in the workplace’; ‘professional identities and workplace roles’; ‘perceptions of professional uniqueness’; and ‘professional abandonment and silencing’. Postvention following a colleague suicide comprised ‘individualised responses’; ‘the dual function of stigma’; and ‘complex pressure on managers’. A unifying global network ‘after a colleague suicide’ describes the relationships between all themes. A series of disconnects between existing postvention guidance and the needs of impacted workers are discussed. This review demonstrates the need for robust, systemic postvention for colleagues impacted by the complex issue of colleague suicide.

Hilary Causer, Eleanor Bradley, Kate Muse, Jo Smith (2021) Bearing witness: A grounded theory of the experiences of staff at two United Kingdom Higher Education Institutions following a student death by suicide.

Wider networks of people are affected by a suicide death than originally thought, including those whose job-role brings them into contact with a death by suicide of another person. The impact of student suicide within United Kingdom (UK) Higher Education Institutions (HEIs) is unexplored and the experiences of staff members remain unknown. It is not known whether staff members have specific postvention needs following a student death by suicide. Any postvention support currently offered to staff members within UK HEIs lacks a context-specific evidence base. This study asked ‘How is a student suicide experienced by staff members within a UK HEI and what are the features of that experience?’ Staff members from diverse job-roles in two UK HEIs responded to a qualitative survey (n = 19) and participated in semi-structured interviews (n = 10). Data were transcribed and subjected to a constructivist grounded theory analysis. Participants’ experiences informed the development of a core category: ’Bearing witness’, which encompassed six further categories: ’Responding to a student suicide’; ’Experiencing a student suicide’; ’Needs and fears’; ’Experiences of support’; ’Human stories’; and ’Cultural stories’. The resulting grounded theory demonstrates how participants’ perceptions of impact are informed by their experiences of undertaking tasks following a student suicide within the community of their HEI. Processes of constructing perceptions of closeness to the student who died are evident amongst participants who did not know the student prior to their death. Tailored postvention support is required to respond to the range and complexity of HEI staff needs following a student death by suicide.

Darelle Villa, Hilary Causer, Gerard Riley (2020) Experiences that challenge self-identity following traumatic brain injury: a meta-synthesis of qualitative research


To systematically review and synthesise the qualitative literature on experiences that challenge self-identity following traumatic brain injury (TBI).


Four electronic databases were searched systematically for qualitative research published between 1965 and August 2017, investigating subjective experiences of identity change following TBI. Papers which met the inclusion criteria were evaluated using the Critical Skills Appraisal Programme (CASP) tool and synthesised using guidelines by Thomas and Harden (2008).


Of the 1965 papers retrieved, 36 met inclusion and quality criteria. Synthesis resulted in six themes: (1) awareness of change in physical, cognitive, emotional and social functioning; (2) autobiographical memory loss; (3) responses of other people that highlight change; (4) loss of autonomy; (5) comparing old me and new me–loss of valued roles and activities; (6) social rejection and stigma.


An in-depth understanding of the experiences that challenge self-identity after TBI can inform rehabilitation to support individuals to negotiate these processes with less distress and more successfully.

Hilary Causer, Kate Muse, Jo Smith, Eleanor Bradley (2019) What is the experience of practitioners in health, education or social care roles following a death by suicide? A qualitative research synthesis.

Recent research has highlighted that the number of people impacted by a death by suicide is far greater than previously estimated and includes wider networks beyond close family members. It is important to understand the ways in which suicide impacts different groups within these wider networks so that safe and appropriate postvention support can be developed and delivered. A systematic review in the form of a qualitative research synthesis was undertaken with the aim of addressing the question ‘what are the features of the experiences of workers in health, education or social care roles following the death by suicide of a client, patient, student or service user?’ The analysis developed three categories of themes, ‘Horror, shock and trauma’, ‘Scrutiny, judgement and blame’, and ‘Support, learning and living with’. The mechanisms of absolution and incrimination were perceived to impact upon practitioners’ experiences within social and cultural contexts. Practitioners need to feel prepared for the potential impacts of a suicide and should be offered targeted postvention support to help them in processing their responses and in developing narratives that enable continued safe practice. Postvention responses need to be contextualised socially, culturally and organisationally so that they are sensitive to individual need.

Hilary Causer (2021) Responding to the Needs of Staff Impacted by a Student Suicide

The purpose of this chapter is to: - explore the experiences of professional workers who are exposed to a death by suicide because of their job role - report the experiences and needs of staff at two UK universities following a student death by suicide - provide guidance in resonding to staff needs following a student death by suicide.

Ruth Riley, Hilary Causer, Johanna Spiers (2022) Giving staff opportunities to talk about suicide also tackles stigma

The suicide rate among health professionals is 24% higher than the national average, with figures showing that 430 practitioners took their lives in the four years from 2011 to 2015 (Office for National Statistics (ONS), 2017). This article outlines the need for evidence based postvention guidance so that the NHS can support staff members who are affected by a colleague death by suicide.

Damien Ridge; Laurna Bullock; Hilary Causer; Tamsin Fisher; Samantha Hider; Tom Kingstone; Lauren Gray; Ruth Riley; Nina Smyth; Victoria Silverwood; Johanna Spiers; Jane Southam. (2023) ‘Imposter participants’ in online qualitative research, a new and increasing threat to data integrity?
Ruth Riley; Hilary Causer; Johanna Spiers; Carolyn Chew-Graham; Nikolaos Efstathiou; Anya Gopfert; Kathryn Grayling; Jill Maben; Maria van Hove. (2023) Postvention guidance: Supporting NHS staff after the death by suicide of a colleague

This guidance has been developed with the input of NHS staff who have been affected by a colleague death by suicide, andstaff who have provided support to those who are affected. Fifty-one NHS staff members across a wide range of job rolesand levels of seniority shared their experiences and insight in one-to-one interviews with researchers from the University of Surrey. Additionally, 68 stakeholders – including policy makers, senior leaders, front-line staff, union and third-sector employees and academics – attended a workshop in which they reviewed and commented on recommendations that had been developed from the interview data. The evidence gathered from these twosources underpins this guidance. 
(14) (PDF) Postvention guidance: Supporting NHS staff after the death by suicide of a colleague. Available from: https://www.researchgate.net/publication/372676883_Postvention_guidance_Supporting_NHS_staff_after_the_death_by_suicide_of_a_colleague [accessed Nov 01 2023].

Ruth Riley; Hilary Causer (2023) Why do NHS staff need suicide postvention? A call to leaders to implement new evidence-based guidance.

We argue that with increased rates of suicide among health workers, and given the specific cultural and professional contexts, narratives and behaviours that shape health workers experiences, that context specific, evidence-based, postvention guidance is required within the NHS to support staff who are affected by, or who offer support following, a colleague death by suicide. 

Ruth Riley; Hilary Causer; Leanne Patrick; Rayna Rogowsky (2023) Why are dominant suicidology approaches failing nurses? A call for a feminist critical suicidology perspective

In​ the ​UK, ​90% ​of ​nurses ​are ​female, ​a​ figure ​replicated​ at​ the ​global ​level.​ A​ significant​ proportion​ are​ also​ from​ the​ global​ ethnic​ majority (NMC, 2023; ONS, 2019).​ Notably,​the ​risk ​of ​suicide ​among ​female ​nurses ​is ​23% ​higher ​compared ​to​ women ​in ​other ​occupational​ groups ​(NCISH,​2020). ​Despite ​this ​significant ​finding,​ our​ understanding​ of ​this ​phenomenon ​remains ​limited, ​in ​part​ due ​to ​how​ we ​interpret​ suicide ​in ​certain ​contexts. ​This ​has ​clear ​implications ​for ​potential​ solutions. 

Johanna Spiers, Hilary Causer, Nikos Efstathiou, Carolyn A. Chew-Graham, Anya Gopfert, Kathryn Grayling, Jill Maben, Maria van Hove & Ruth Riley (2024) Negotiating the postvention situation: A grounded theory of NHS staff experiences when supporting their coworkers following a colleague’s suicide

Suicide is a leading cause of death. NHS workers, especially female nurses, have heightened vulnerability. Being impacted by a colleague’s suicide can lead to increased suicidality. Postvention refers to support following a suicide. We investigated current, available postvention for NHS workers following a colleague’s suicide and the experiences of staff who deliver it (“supporters”). Twenty-two supporters were interviewed, and data were analyzed using classic grounded theory. The theory of negotiating postvention situations was developed. Supporters must negotiate enabling and disabling elements that form a “postvention situation” and impact behaviors and postvention efficacy. Postvention delivery is emotionally burdensome. Supporters need support, which they do not always receive. Postvention can lead to learning, which can better inform future postvention. The extent to which NHS workers can effectively support colleagues will depend on their postvention situation. As such, work must be done to enable supporters to offer effective postvention in the future.