Integrated Aftercare Support for Parents and Carers Following a Child's Suicide Attempt: A Qualitative Study

ABSTRACT

Background

Parents and carers often provide support for their child following a suicide attempt. Yet many parents struggle to obtain support for themselves during this stressful period which can result in feelings of powerlessness and being unheard.

Purpose

The aim of the current study was to explore the experiences of parents and carers whose child was receiving intensive outreach support following a suicide attempt.

Methodology

The study used semi‐structured interviews with parents and carers. Interviews were conducted via telephone ranging from 14 to 56 min (M = 29 min). An inductive thematic analysis was undertaken to explore the data. Seven parents and carers participated in one‐on‐one interviews.

Results

It was found that the outreach support provided was vastly different from prior experiences and this was a pleasant surprise. In addition, parents described the high level of emotional support for both the child and themselves. A highlight of the support was the family peer worker whom they could relate to. Parents acknowledged that contact with the team provided insights on how to change their parenting or relationship practices.

Conclusion

Direct and dedicated parent support is a key aspect that services should consider when implementing a child and youth service to address suicidality, since this enables the family to readjust following a traumatic event.

1. Introduction

Youth suicide is a worldwide concern and a public health issue. In Australia, it is the leading cause of death in young people aged 15–24 years (Australian Institute of Health and Welfare ²⁰²³). Although public health interventions are slowly starting to address this alarming statistic, there is often little support for parents and carers of these children and young people (Hopkins et al. 2021; Marshall et al. ²⁰²³). Parents and carers of those who have attempted suicide, or are experiencing suicidality, can experience a range of psychosocial challenges as they grapple with the prospect that their child or loved one wishes to end their own life (Krysinska et al. 2022; Lantto et al. ²⁰²³). Further, evidence suggests that parental stress and distress can be significant and long‐lasting (Rogers et al. 2008; Bolton et al. ²⁰¹³; Paryente ²⁰²⁴), resulting in poor long‐term outcomes.

Many young people who experience suicidality live in the family home and continue to have interaction within the family unit, thus, how the family system deals with the suicidality of the young person is an important factor for the well‐being of young people and the family system more generally (Weissinger et al. 2023). The role of the family and the support they provide can either be a risk or protective factor for any future suicide attempts (Lindkvist et al. 2024; Weissinger et al. ²⁰²³). When assisting in the prevention of suicide and when supporting people after a suicide attempt, interventions that involve the family can be important in mitigating the suicide risk and improving the chance for recovery (Lindkvist et al. 2024; Weissinger et al. ²⁰²³). Greater clarity is still needed, however, regarding the family members' perspectives about what support they feel is most helpful or unhelpful. The present study examines parent and carer views of the support they received from a specialized post‐suicide outreach support service for young people following a suicide attempt or due to persistent suicidal ideation.

A systematic review by Marshall et al. (2023) highlights the complex emotions a family member can experience as a carer to someone who is suicidal. This emotional turmoil can leave family members and carers both shocked and angry, and with a sense of failure (Lavers et al. 2022; Marshall et al. ²⁰²³; Weissinger et al. ²⁰²³). Support services for parents and carers often tend to be limited or non‐existent, even when services are available for the young person concerned (Lavers et al. 2022; Marshall et al. ²⁰²³; Sullivan et al. ²⁰²³). Carers and family members are often the primary support to the suicidal person post‐discharge. Despite this, they may not be recognised by healthcare staff as acting in a formal role, especially when the young person is over 18 and therefore considered to be a legal adult. This erasure may exclude them from any decision‐making, with the focus being on the autonomy of the suicidal individual (Wayland et al. 2021). Yet, a more collaborative, safety‐focused relationship between professionals and families can create a more positive impact on family cohesiveness in the period post‐suicide attempt (Marshall et al. 2023) and meet the needs of parents for their own emotional support, as well as support for the child (McLaughlin et al. ²⁰¹⁶).

Providing support for the whole family can be especially important as the same destabilisation felt by young people may be echoed in the family unit. Parents' experiences after a child's suicide attempt can often mirror the experiences of the young person themselves, with feelings of hopelessness, worry, guilt, shame, and a loss of control (Lachal et al. 2015). Aftercare services may further add to families' sense of powerlessness if the available services are perceived as being unhelpful or rejecting of them and the young person they care for (Lachal et al. 2015). Providing support for families where they can feel heard, included, and valued in the support process may therefore be an important factor in providing holistic support following a young person's suicidality.

Despite the important role that parents and carers can play following a suicide attempt or ideation of young people, this group remains under‐studied (Lavers et al. 2022). Further work examining the unique experiences of those who are in a caring role, and what support they require, may help to elucidate this area. This paper aims to address this need by examining parents' and caregivers' experiences of a support service for children and young people aged 12 to 26 years following a suicide attempt or with persistent suicidal ideation. The support service involves a 3‐month psychosocial outreach model aimed at supporting the child or young person as well as their family. The model of care is located within a tertiary child and adolescent mental health service in Melbourne, Victoria, which supports young people up to the age of 26 years.

2. Methods

Young people entering the support service were invited to participate in a quantitative and qualitative evaluation of the new service. The overall service evaluation outcomes are published elsewhere (Meyer et al. 2024). Those who consented to take part in the overall evaluation were further invited to nominate a parent, carer, family member, intimate partner, or friend who knew them well to participate in a qualitative sub‐study regarding the parent or caregiver's experience with the support service.

2.1. Participants

A purposive sampling approach was undertaken. Of the 28 young people who took part in the evaluation study, 14 nominated a person whom they were happy for the research team to contact to provide a perspective on their care. These included parents, grandparents, and one intimate partner. Researchers attempted to contact all eligible individuals to invite them to discuss their experiences of their young person/partner taking part in the post‐suicide engagement program. All individuals were contacted three times, as per the ethics‐approved protocol, to enable them to “opt‐in” to the study. Further recruitment attempts were discontinued after three attempts. Seven interviews were conducted with the parents/caregivers (5 mothers, 1 father, 1 partner) of young people who ranged in age from 13 to 18 years (3 males, 3 females, whose parents were interviewed), with one aged 21 years (female, whose partner was interviewed).

Study design: Interviews consisted of a set of qualitative semi‐structured questions designed specifically for this program, to elicit participants' personal experiences of interacting with the support service team, as well as their perspectives on the care that their young person/partner received (see Appendix 1 for the interview schedule).

2.2. Procedure

Interviews were conducted approximately 3 months after the discharge of the child or young person from the support service. Before being approached to participate, consent was sought from the young person they were caring for to gauge a willingness for the support person to be contacted. All participants were then contacted by phone or SMS message. Participants were provided with a written participation and information consent form and provided written or verbal consent before the interviews. Interviews were conducted by telephone in a private setting to ensure confidentiality. Interviews ranged in length from 14 to 56 min (average 29 min). Due to the sensitive nature of the interview content, participants were not offered the opportunity to review the transcript for fear of elevating any possible distress. Ethics approval was received from Alfred Health Human Research Ethics Committee (ref: 173/21).

2.3. Data Analysis

Interviews were transcribed verbatim. Following the interviews' transcription, the data underwent reflexive thematic analysis using the process designed by Braun and Clarke (2006, ²⁰¹⁹). The first stage of analysis involved each member of the research team immersing themselves in the data and independently manually coding the transcripts line‐by‐line using broad descriptive codes to highlight shared categories of meaning in the data. The research team then agreed on the broad codes and independently refined the transcripts into themes and sub‐themes (see Appendices 2–4). Subsequently, three members of the research team met on two further occasions to discuss their identified themes to reflexively identify any further meaning from the themes. During this time, the three members of the research team identified their own potential biases and preparedness to change their themes based on the discussion (refer to the Section 2.4). During this process, an agreement was reached, and the themes and sub‐themes were finalized. Finally, relevant quotes were extracted to illustrate the themes and sub‐themes. Table 1 shows the steps undertaken in completing the data analysis.

Table 1.

The thematic analysis approach.

Step	Process and what we did	Sample codes/themes
1. Familiarizing yourself with your data	Transcribing data (if necessary), reading and rereading the data, and noting down initial ideas. L.H., M.K. and R.W. conducted interviews and read all transcripts, making initial notes about meaningful aspects of the transcripts.
2. Generating initial codes	Coding interesting features of the data in a systematic fashion across the entire data set, collating data relevant to each code.	See Appendix 2
	L.H., M.K., and R.W. all independently coded every transcript inductively to identify shared categories of meaning	Example: Code “parent”. The need for parent support
3. Searching for themes	Collating codes into potential themes, gathering all data relevant to each potential theme.	See Appendix 2
	L.H., M.K., and R.W. met to discuss for the first reflections about data and initial codes. L.H., M.K., and R.W. independently generated further themes by grouping codes.
4. Reviewing themes	Checking if the themes work in relation to the coded extracts (Level 1) and the entire data set (Level 2), generating a thematic “map” of the analysis.
	L.H., M.K., and R.W. met to reflexively discuss the independently generated themes and review for deeper meaning and consistency among the team.
5. Defining and naming themes	Ongoing analysis to refine the specifics of each theme, and the overall story the analysis tells, generating clear definitions and names for each theme.	See Appendix 3
	L.H., M.K., and R.W. each independently re‐coded the data according to the new thematic “map”, looking for key examples to illustrate each theme. This is revised until there is agreement across the codes and themes.	Example: Parent. Social and emotional support
6. Producing the report	The final opportunity for analysis. Selection of vivid, compelling extract examples, final analysis of selected extracts, relating back of the analysis to the research question and literature, producing a scholarly report of the analysis. L.H., M.K., and R.W. met and agreed on final themes. Started collaboratively writing the report.	See Appendix 4
		Example: Parent. Social and emotional support when I was in crisis

2.4. Author Reflexivity Statement

The first two authors (M.K. and L.H.) conducted the interviews and completed the analysis along with author 3 (R.W.). All three researchers are experienced post‐doctoral qualitative researchers, each with over 10 years' experience interviewing vulnerable populations. At the time of data collection, all were employed as researchers in the mental health service offering the new program of care. The study was completed as a quality improvement opportunity, given this was a new initiative. In addition to holding the perspectives of researchers within a health service, other perspectives were also held by the data analysis team, including mental health clinician, lived experience expertise, and parents of children or young people. All perspectives were acknowledged and any potential bias was addressed through the data analysis. The participants and researchers were not known to each other.

3. Results

The analysis identified themes that belonged to four distinct categories. These related to "parents' prior experiences”, “support for the child or young person”, “support for the parents”, and “service elements”. Parents also identified recommendations for service improvements. Each category contains sub‐themes. Figure 1 illustrates the categories and themes.

Figure 1.

Categories and themes.

3.1. Prior Experiences

Individuals described prior negative experiences with mental health services which had left them feeling let down by the care their young person had received. Individuals' descriptions were quite emotive as they discussed insufficient care at a time when the young person needed it the most:

…the referral was absolutely disgusting. They've had a phone call from him overnight trying to harm himself and they discharged him…

(Participant 2)

…I've said to the psychologist there is a mental health crisis happening here and I felt like I wasn't listened to and then suddenly he is trying to kill himself…

(Participant 3)

On a more practical level, individuals felt that prior experiences of care were not tailored to their young person's situation, with the young person often having to rearrange their own schedules to meet clinical appointment times:

It's a problem with all the psychology appointments [he] kept missing school. We're trying to get the kids back in school, you know

(Participant 3)

When describing their experiences with the new outreach service, individuals communicated a degree of surprise, as this was not something they had experienced before:

… none of us expected that they [the team] would be prepared for travel. We thought we'd have to go to various destinations. So, for them to offer to come to our house or take you out for a cup of coffee or whatever and on one occasion, they collected him [their child] and took him to [local service].

(Participant 6)

I just think that's fabulous and as I said they're responsive and the fact we were able to be at home was just……yeah terrific.

(Participant 5)

This higher level of support and flexibility when compared with previous experiences in the mental health system meant that parents were pleasantly surprised by the personalised, wrap‐around care available.

I very much appreciated meeting a parent [family peer worker] who had been through a similar thing. That was an unexpected one.

(Participant 6)

3.2. Support for the Child or Young Person

The second category relates to the direct support provided to the child or young person, as reflected by their parent or caregiver. Parents appreciated the fact that the team was “child‐focused” and tailored care to suit their child. Parents described:

It was that one‐on‐one and she felt that she was been listening to that, so that, she was heard and that was all for her.

(Participant 1)

I think the other thing they did, really well was putting the young person in control of their own decisions… “empowering” might be the word rather than “telling”.

(Participant 2)

The partner‐participant also recognised both the support for themselves as well as their partner:

I mean they offered me support for so from my point of view it was really good to having like someone to talk to about all that about the situation. And I think my partner felt really supported throughout the whole well, process.

(Participant 7)

As for the parents, this approach included outreach to try and meet the young people in spaces that suited them:

I think that the fact that they meet him in the house or in the park, or where [my child] wanted to meet was amazing, rather than coming into a clinical setting, but also the onus on the young person to go in.

(Participant 2)

In addition, the tailored care appeared to put the parents/carers at ease by providing a sense of relief that their young person was receiving support that suited them during what was a very emotionally challenging time.

It gave me peace of mind that [my child] was cared for.

(Participant 2)

Another theme within this category consistently mentioned was the relationship that the young people had with the multidisciplinary team. Parents described the way that the team were able to connect with the young people in a way they had not experienced in other mental health settings.

I think it was something that he actually really quite looked forward to. Getting him going can be a challenge. And I think the girls [clinicians], got him going quite nicely, … [he] looked forward to that little bit of time in his week where he could interact with [the clinicians].

(Participant 6)

[clinician] worked really well with her to get her confidence and for her to let down her guard and for her to be quite frank with her… had her confidence and trust from the get go.

(Participant 1)

[my child] felt that there was someone who finally understood her and made sense about what she was feeling.

(Participant 4)

This focus on the child or young person and the ability of the team to connect with and “hold” the child also allowed the parent to let go of the role of case managing their child's care and instead focus on their own role as parent. This provided a sense of relief from the crisis and ongoing fear associated with the suicidality of their child which assisted them to develop a greater sense of grounding in the family and being supportive as a parent or caregiver.

3.3. Support for Parents

The third category relates to parents' perceptions and experiences of the direct support the parents received from the care team.

Parents particularly appreciated the social and emotional support provided when their family was in crisis. They described the importance of having someone who was prepared to be there for them, as well as for their child and who understood their experience:

…some of that hope, that sometimes you're in the trenches and you don't see that there's another end, and she [the family peer worker] just sort of listened. And that lived experience. She was almost more like a friend who understood because you might not have other people who understood.

(Participant 2)

So she [family peer worker] was incredibly calm. She was supportive… she didn't make me feel like I was wasting her time or anything. There was no urgency about her getting off the phone and everything like that. So yeah, I just felt like, you know, for the first time and the grief, you know, listening to the grief that we were sitting with it at that time.

(Participant 5)

I rang them quite distressed and quite upset and they were fantastic.

(Participant 1)

Receiving direct support from the team also appeared to assist parents through the time of crisis, leaving them feeling very grateful for the support they received:

Just knowing that you have that support coming up again when there was some disaster was very, it was like it did it give you hope.

(Participant 3)

Parents also described the way that the support they received extended beyond the feeling of emotional support and assisted them to evaluate their parenting style and to adapt things where needed:

He [my son] wasn't listening to a single word that I said… for me, because it helps him, the support that I got, made me change my parenting… Because I had to change my whole kind of parenting style, which I say it was a bit strict and stuff.

(Participant 3)

Some of the insights that I got from [family peer worker] were key to making me flip my behavior.

(Participant 2)

Parents identified the value of learning from professionals and realised that addressing aspects of their parenting could play an important role in the support they provided for their child. As one parent realised:

you need to let them [their child] grow up a bit too….

(Participant 3)

This highlighted the need to relinquish some control regarding their child and to give them space, acknowledging what their limits were as a parent and giving autonomy back to the child.

3.4. Service Elements

The final category relates to the elements of the model of care which were particularly noted by participants as being useful or beneficial. In this category, a consistent theme was parents/carers' reflections about the model of care and specific aspects of the service. Parents/carers reflected positively about the unique aspects of the co‐designed service, such as being “responsive”, “the immediacy of the response”, and “flexible with after‐school appointments”. One parent, who felt that the model of care supported her child to build his own awareness, said,

I just didn't even know who [my child] was. He changed so much. But I can see him coming back. And it's just been all these new things. I think he's got more awareness of what anxiety means because he says. “My body is shaky that's my anxiety. I'm going for a walk.” so being able to articulate that is new now.

(Participant 2)

Another parent appreciated the timing of the response,

From my perspective, it was the immediacy of the response. So my daughter had her second suicide attempt and sorry, it was her first one. And literally the day we got home from hospital, they were on the phone. So yeah, it was amazing.

(Participant 5)

When describing the benefits of the service, parents outlined their experiences with the staff, which seemed to capture a positive relationship and therapeutic alliance where parents/carers felt heard and respected.

It very much was felt that they were working with us, you know, not just as pen pushers. And just to tick the box, it was very genuine … I felt that they, they really were supportive, like a family would be… we weren't just a number and you know. . they were just there and I still feel safe.

(Participant 1)

The connection with staff members, in particular, the family peer worker, was also highlighted by the parents/carers as providing unique support.

I was very gracious [grateful] and I still am till this day that I had [family peer worker] because very, very early on… she believed me and she, she could read the play… that I cannot praise [family peer worker] enough.

(Participant 1)

I had this amazing support from [Family Peer Worker]… that was almost one of the best things to me (Participant 2).

Similarly, the partner, described the benefit of the youth peer worker.

“the fact that they had someone who was going through had been through something similar like he [youth peer worker] had the chance… he was able to talk to her about, you know, more specific things that relate to it which is good”.

(Participant 7)

Contact with the family peer worker, and peer worker who brought a lived experience of youth suicidality to their role, was really something that both the parents and partner felt was beneficial. The family peer worker could provide a unique element of understanding which was not necessarily shared by clinicians.

3.5. Improvements

While parents were overwhelmingly positive about the service they had received, two main areas for improvement were identified: length of program and longer hours, and improved structure.

3.5.1. Length of Program and Longer Hours

Parents felt that the program would benefit from longer hours of operation as well as a longer length of program, which was clinically time‐limited to 3 months. For example, one parent thought:

if it could, it could have run 50 more weeks, or if [my child] could still maybe have some sort of, you know, counselling through there would have been great.

(Participant 1)

For another:

I think to extend out those hours would be amazing, and especially for, like I work for myself so I have flexibility of when I meet. If you don't, I think it might be really hard for people to meet at 3:00 o'clock. …. And I think a lot of the times, the feelings [my child] have happened at night. Maybe it's just not even extending, moving the hours I don't know. For some people, if it was 12 till 10:00 p.m it's actually a better time slot than a 9:00 to 5:00.

(Participant 2)

3.5.2. Improved Structure

The other issue which was raised as an area for improvement was the structure of the program and communication with the parents about the model of care. Although clinicians worked hard to articulate the nature of the support available, parents acknowledged that they didn't always hear or understand the communication when they were stressed or distressed themselves. As one parent describes,

I've sort of lost track a little bit of where we're up to, I don't think anybody's really, really enunciated to us what the extent of the service is when it expires, if it expires all that sort of stuff. I think that's probably something that maybe a little more clarity around would have been good. We were probably told back in the early days, but it was a bit of a chaotic time, so perhaps it didn't sink in.

(Participant 6)

A similar comment was made by another parent who provided some suggestions on how to overcome this challenge:

Maybe a flyer with a bit of a flow chart of the people and what the… appointments in chronological approximation look like… So it's like a snapshot, and then it's a bit more of a clear explanation of, this is the programme, this is how it's packaged, and so we're going to give you this support… so that parents know almost what is gonna come up… I was maybe told,…. but I didn't really understand. I was so stressed I wouldn't've understood anything.

(Participant 3)

Even while suggesting these areas for improvement, however, parents were incredibly grateful for the support they had received and especially thankful that the service was free and not means‐tested. As one parent summed up:

I just feel emotional thinking about it because, honestly, it's a short amount of time. But we've come a long way, with a long way to go. But I just, I'm very grateful, so thank you.

(Participant 3)

4. Discussion

This study outlined the views of parents regarding the support they received following a suicide attempt by their child or young person. The findings provide a depth of understanding around the experiences of the parents and carers during this very stressful and distressing period, and their genuine surprise at receiving care which was very different from their prior encounters with mental health services. Multiple components of the model of care provided exceeded their expectations such as a genuine connection between staff and their child, a sense of relief and support for them as a parent or carer and providing responsive outreach. However, parents also expressed how quickly the 3‐month period of care came to an end since this was a highly stressful time spent managing a chaotic situation. This was the focus of suggested recommendations for future improvements.

It is not surprising that in the current study, parents' prior negative experiences shaped their feelings towards mental health services and staff. Caregivers can often feel high levels of stress and yet support is often not available to them (Lavers et al. 2022; Marshall et al. ²⁰²³). A lack of support for parents or carers can result in them being at higher risk of depression with lower well‐being (Marshall et al. 2023). In addition, there can be long‐term impacts for parents' and carers' mental health (Rogers et al. 2008; Bolton et al. ²⁰¹³; Paryente ²⁰²⁴). Often, the emotional cost in supporting their loved one whilst managing feelings of being overwhelmed, and oscillating between overinvolvement and criticism can hinder the help‐seeking of their child or young person (Edwards et al. 2021). However, in the current study, parents were genuinely surprised at the level of support provided to them and their child or young person, suggesting their expectation was that they would receive no or minimal support for themselves. The model of care discussed in this study incorporates a more systemic approach whereby the child and parent or carer are supported by a multidisciplinary team including a family peer worker. There are multiple benefits to incorporating a family peer worker in service provision, such as providing emotional support, reducing stress, loneliness, isolation, and stigma (Hopkins et al. 2021), and this was clearly reflected in the responses in this study. Family peer roles provide a unique view around the role of a caregiver, which can promote self‐care and normalize the caregivers' experiences (Markoulakis et al. 2018).

For some parents, the support of the aftercare team provided them with skills to reflect on their parenting style and “flip” their own behaviour so they could relinquish some need to feel in control of their child's behaviour. This positive outcome has not previously been reported, to the authors' knowledge, in the literature which tends to focus on negative outcomes such as increased vigilance or monitoring of their child, increased strain within the family and impact on employment, creating financial stress (Rheinberger et al. 2023). It is possible that the inclusion of a family peer worker influenced this change since it is known that when peer support is offered to families and carers, it provides an opportunity to learn through modelling of behaviour, provision of practical information and problem solving (Markoulakis et al. 2018). It is also known that the link between parent practice, the parent–child dynamic, and the influence of these can increase the risk of future suicidal behaviour (Perquier et al. 2021). Perquier et al. (2021) therefore recommend that supporting parents and improvements to parenting practice should be a key strategy in policy and public health strategies to reduce youth suicide.

In addition to the impact on parents and parenting style, the parents in the current study described the positive impact on their child or young person through receiving support from a multidisciplinary team that is child‐focused. Feeling connected to at least one other person is an important component of mental health recovery (Grimmond et al. 2019). Other aspects, such as access to a youth peer worker, being person‐centred and having clear, responsive communication, have previously been reported as important components to a successful child and youth post‐discharge suicide prevention model of care (Watling et al. 2022). The development or improvement of interpersonal relationships, such as with family members and mental health care professionals, is considered helpful in ensuring the child or young person can move past suicidal feelings (Grimmond et al. 2019). The parents in the current study described these components as the model of care and service provision, which provided wrap‐around care to them and their child during this stressful period of time.

To examine means and ways that the model of care and service could be improved, parents were asked to identify areas for improvement. Parents identified a number of areas for improvement which for most, as might be expected, was an increase in service provision. Parents described the period as chaotic, and the way that stress affected their comprehension of time, meaning the period of care came to an end quicker than anticipated. As such, parents recommended a longer duration of care beyond 3‐months and extended hours during the day to encompass evenings. However, although research indicates that people are at significantly higher risk of suicide during the first 3‐months post‐discharge from an inpatient admission for suicidal ideation or a suicide attempt, there is no evidence to support the need for care within the community for an extended period of time (Andriessen et al. 2019). In addition, following discharge from the service, young people and their parents are referred to other supports within the community, and if needed offered the opportunity to return to the team for additional care. Potentially, it may be parents' distress and anxiety are the drivers behind their desire for more support, especially when they feel vulnerable and have received what they consider to be exemplary care.

The findings of the study have implications for future models of care to address youth suicide. Youth mental health services need to consider the child as one person who needs care following a suicide attempt, but within their own social context. Treatment and support also need to be provided to parents or caregivers and possibly siblings although this was not the focus of the current study. The inclusion of parents and care givers has the potential to increase parenting skills, reduce future suicide attempts and therefore reduce the burden on overstretched mental health services. To examine the longer‐term benefits, future research should consider a longitudinal study to examine if parents sustained changes to their parenting style and what the changes were to the family dynamic.

There are some limitations to the current study. The study included mostly mothers in the data collection. Although women tend to be the primary carer giver (Australian Bureau of Statistics, Disability, Ageing and Carers ²⁰²⁴) in the daily lives of children and young people, the extent that fathers, other carer givers and those in a romantic relationship also provide support and care cannot be fully understood from these findings. Future research should consider the involvement of fathers or partners via focus groups or perhaps an after‐hours opportunity to provide feedback to understand the family dynamic in a more holistic manner. A further limitation was the available pool of parents, caregivers and partners to draw upon for the interviews. A large number of young people accessing the service did not have a family member or friend who was aware of what the young person was going through, or to whom the young person felt comfortable disclosing their situation. In addition, the study did not examine the context of the household, such as blended families and single‐parent families, to determine if this was a contributing factor in engagement with the service and team. These are aspects which could be considered in future research.

A further limitation was the small sample size of seven participants. The data from the participants cannot be considered as representative of caregivers' experiences beyond this study which occurred following the aftermath of the COVID‐19 pandemic. The intervention provided was a new initiative, and the longer‐term impacts on young people and their caregivers should be a focus in future research. It is also possible that the data collection method, using phone interviews, impacted on rapport‐building due to a lack of non‐verbal cues between the researcher and participant. Future research should consider in‐person or teleconferencing to overcome this limitation.

5. Conclusion

This study offers valuable new knowledge around parents' and carers' experiences of support following a suicide attempt by their child or young person. Existing evidence suggests that the involvement of parents is critical not only to benefit their child but also the whole family dynamic during this stressful time. Our study shows that providing dedicated parental support within a holistic approach to the child or young person at the centre of concern enables the family support system to reset. By supporting the parent and concurrently holding the child, a virtuous circle is established, which enables positive change across the family system. Direct, dedicated parent/carer support, including lived experience support provided by family peer workers, should therefore be a primary consideration in any future services seeking to improve models of care in youth suicide aftercare services.

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Michelle Kehoe, Liza Hopkins and Richard Whitehead. The first draft of the manuscript was written by Michelle Kehoe, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethics Statement

This model of care was co‐designed with young people (service users), families and carers and mental health service staff (see Kehoe et al. ²⁰²⁴). The research proposal was reviewed by a working group which includes young people and carers with lived experience, to ensure that the design was feasible and acceptable. The project provided participants with the opportunity to reflect on their experiences of the model of care.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix 1. Interview Guide—Parent or Carer

• 1.How old is your child or the young person?
• 2.Had you had any concerns in the past about their mental health/well‐being?
• 3.Was the young person/child seeing a psychologist or psychiatrist or other mental health worker before contact with the Youth HOPE team? If yes, for how long?
• 4.Are they currently seeing someone for their mental health care?
• 5.What do you feel was the best thing about the HOPE team for your child?
• 6.And for you? (prompt—in what ways did they support you?)
• 7.Thinking back on your child's experience with the Hope Team, is there anything you would recommend to change? From both your own and/or your child's perspective?
• 8.Did you feel as though you had enough support or knew where to go for help following your child finishing with the HOPE team?
• 9.Is there anything else you would like to share about your experiences?

Appendix 2. Preliminary Codes and Overarching Themes

L.H.

Theme	Code
Child	Child focus
	Peer support
Parent	Need for parent support
Elements of hope	Strategies
	Diagnosis
	Intense/overwhelming
	Frequency
	Flexibility/timing
	Feeling heard
	Communication
	Outreach
	Regular contact
	Family peer support
	Acknowledging separated parents
	Professionalism of clinical staff
	Family focus
	Safe discharge
Service system	Connection to other services
Improvements to hope service	More/longer service
	Family therapy
	Better information/structure

R.W.

Theme
Concerns about mental health‐ previous support
Direct support/understanding to parent
Family peer worker
Not enough input
Nonclinical warm, understanding Being held.
Staffing
Longer program
Post program support
For kids
Things they could improve ‐ suggestions

M.K.

Theme	Subtheme
Peer worker skills/support	Listening/understanding/commonality/response
Peer worker	Improved parent skill and education
Parent need from staff	Improving parent skill
Clinician quality	Understanding of parent/patience and understanding of YP
Staff quality (general)	Genuine/approachable/respectful
Impact on parents	reassuring
Impact on parent	Sense of hope/reassuring
Staff qualities which impacted parents	Listening/mutuality
Outreach	Accessibility
Suggested improvement	Information/extended hours/planning
Improvement	More parent input
Improvement	More of a family approach
Child	Child centred
Child	New skills
Best thing	Immediacy/regular + free
	Deep gratitude

Appendix 3. Refined Themes and Subthemes—L.H., R.W., M.K.

Theme	Subtheme
Prior mental health experiences	Prior negative experience or lack of care
	Expectations (surprise)
Child	Child‐focused team
	Relationship between child and multidisciplinary team
Parent	Social and emotional support when I was in crisis
	Support to help me make a positive change
Service elements	Model of care
	Quality of care/therapeutic alliance
Improvements	More/longer service
	Better information/structure

Appendix 4. Final Themes and Subthemes—L.H., R.W., M.K.

Theme	Subtheme
Prior mental health experiences	Prior negative experience or lack of care
	Expectations (surprise)
Child	Child‐focused team
	Relationship between the child and the multidisciplinary team
Parent	Social and emotional support when I was in crisis
	Support to help me make a positive change
Service elements	Model of care
	Quality of care/therapeutic alliance
	Family peer work
Improvements	More/longer service
	Better information/structure

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.