INFORMATION FOR THE MEDICAL EXAMINER OR CORONER

In Wisconsin, the medical examiner or coroner is elected to their positions by the constituents in their respective county. They are often assisted by deputy coroners and assistant medical examiners who are appointed by the coroner or medical assistant in their county, and they all work closely in their county’s law enforcement community. They have a definite role in the investigation and determination of suspicious deaths and suicides. As community support is the foundation of postvention, the medical examiner or coroner plays an important role, and it is our hope that medical examiners and coroners will see their responsibility as going beyond the investigation. Theseguidelines are intended to serve as suggestions as medical examiners and coroners go about their required duties.

1. Responding to family members or friends that may be at the scene. Approaching them and introducing yourself to them will make them feel like they are not invisible. After giving them your condolences and letting them know you have work to do, you can then join the investigation. Having someone attend to family and friends and possibly calling another family member or friend to stay with those survivors may help in calming them.

2. Interviewing the family. When conducting interviews with survivors of the deceased, you may find that survivors readily agree with your findings or they will not be ready to hear the truth. In the future, survivors may still have questions and, in some cases, be encouraged to look to the reports in the quest for some resolution. It is helpful that you write your reports with the idea that family and friends may be reading them at a later date. There are compassionate ways to write about these deaths: leaving out graphic details that are not important to the case is helpful.

3. Viewing the body. After your investigation, the body may still be in the house and someone may want to view the body. It is difficult for most survivors to believe that their family member would do this. It may be helpful, even crucial, for some people/survivors to view the body; having a friend or a chaplain with them will also help. For other people/survivors, viewing the body may not be as important. Regardless, many scenes won’t allow this to happen. If possible, you may want to set up a time at the morgue for viewing. Making this experience as non-traumatic as possible by having the rest of the body clean and draped will help; sometimes it will only be possible to see a hand or some other part of the body. If the body has been moved to the funeral home, they may be the ones to facilitate the viewing.

4. Clean-up. When a scene needs clean-up, it is important that you or someone from the police or sheriff’s department facilitate the process. You can have contacts from your community or you have numbers that specialize in this kind of clean-up. Having their cards available and accessing those services is very helpful to the family. Once again, this experience can be a source of trauma for the surviving family or friends.

5. Death notification. When the people are not at the scene of the death, the notification is of utmost importance. Completing death notifications in person is essential and should be done whenever possible. A chaplains program or a victims assistance program in your community is a helpful tool for death notifications. That would allow for a clergy person “on call”or a VA staff or volunteer to help you or law enforcement make these notifications.

Survivors are impacted by how they are told of deaths of family members after a suicide. Make sure you have the correct person to notify. Ask the person if you can or a come into their home and ask them to sit down. Tell them about the death and its circumstances. Answer any questions they have and offer your condolences. Find out if there is someone that you can call to be with them. Do not leave them alone. They will most probably be in shock and will need the assistance of family or friends. They can be at an increased risk of suicide at this time (see Appendix for list of warning signs).

6. Autopsy. If you will be doing an autopsy or have taken toxicology tests, let the family know when the results will be available. If there is no question and a determination has been made, let them know when the death certificates will be available. Be sure to leave them your business card as they will retain very little of what you say that day.

7. Resources. HOPES of Wisconsin (Helping Others Prevent and Educate about Suicide),has a “Grief after Suicide” handbook that is available from you may want to give them for their journey of grief. If you have a Survivors of Suicide (SOS) group in your community, find out if they have a brochure that tells them what time and where the group meets. Talking to others that have experienced the same loss has been shown to be very beneficial to those left behind (See Appendix on Resources and Support Groups).

8. Follow-up. Family members may want to meet with you in the future to talk about how you came to your conclusions. Your willingness to meet with them is helpful. Having contacts such as your local SOS group, clergy who you trust, or mental health professionals who you have worked with and trust as resources for them as they work through their trauma and grief is very important (See Appendix on Resources and Support Groups).

Suicide is a very complicated issue, and there are most often many factors that contribute to this kind of a death. For example, it is reported by the American Association of Suicidology (AAS), that 90% of people who die by suicide have a diagnosable mental illness such as depression or a substance abuse problem. It is helpful that you have some knowledge of this fact. People often are not ready to hear that right after a suicide or they will have knowledge of the deceased’s situations. Simply offering your condolences and listening for as long as you can, will go a long way in helping the survivors you meet at a scene. Your knowledge of suicide will help you in helping the family.

9. Suicide prevention. When trends in regards to suicidal behaviorare seen in your community, it is helpful to work with a multidisciplinary team of organizations and individuals (e.g. public health, law enforcement, clergy, mental health professionals, and advocates for suicide prevention). Coroners/medical examiner’s are in a unique position to see what is happening and get others involved in responding to this behavior and working to prevent it from happening further. For example,one county noticed that two people who died by suicide had been given eviction notices; that county law enforcement now offers resources to people that are getting eviction notices. Using your statewide professional organization is another way that you can share life-saving measures that are working in your county. Each county shouldn’t have to wait to learn these lessons in their county. Working with suicide prevention groups in your county (e.g. sharing data and helping to do some analysis of it) is helpful also.

10. Suicide postvention. Your community should be prepared and organized before a suicidal event occurs, especially that of a young person or an influential person. By working together and getting your community mobilized to help with the grief and trauma of suicide, you may be lowering the risk of multiple (contagion) or similar (copycat) suicides. By contacting the people identified in your contact tree you can give the organizations a chance to get supports in place. These contacts would be the schools, crisis intervention services, mental health professionals, law enforcement, health clinics, public health and churches who would be working together (See Appendix on How to Organize Suicide Postvention Activities).

Remember: by working together, we can save lives.

These suggestions were compiled from a variety of sources including:

Postvention: Community Response to Suicide. National Alliance for the Mentally Ill (NAMI). Concord, New Hampshire.

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Community-Based Suicide Postvention Guidelines for Wisconsin