This article provides transcripts and summaries of speeches given at Brake's Sudden Death Forum’s Road to Recovery Conference, 2 November 2010. The event aims to help develop and promote best practice initiatives for professionals working with people who have been suddenly bereaved. For further information about future conference dates, click here.
Case study of a bereavement in a road crash
Linda Heynes, Brake volunteer
Care for road crash victims in a Big Society
Julie Townsend, Brake campaigns director
Psychological Reactions to Extreme Events: Complicated Grief, PTSD and Trauma
The psychiatric approach to understanding reactions to extreme events is used by the legal and insurance professions and guides treatment options through the NHS. However, labels such as PTSD, depression and complicated grief are often a poor fit for the clusters of symptoms the individual has and this often results in the ‘label’ rather than the individual receiving treatment. Instead, there should be a psychological approach to understanding reactions to extreme events. Humans build up an understanding of the world and their place in it through experience. We also develop plans and goals for ourselves and seek to achieve them. When an event causes us to question our understanding of the world or makes our goals unachievable, we experience emotions. Emotions have evolved as a system to quickly deal with difficulties as they arise and help us to readjust our plans. Where an event is so extreme that it causes our entire understanding of the world to be put into question, people can experience a difficulty readjusting their plans or systems of belief. Some of the symptoms of failure to readjust to different types of extreme events can appear very similar to psychiatric conditions such as PTSD or complicated grief. For example, people who suffer a threatening event can experience chronic fear, intrusive thoughts and avoidance, similar to the symptoms that diagnose PTSD. People who experience extreme loss can suffer from intense sadness, intrusive thoughts and avoidance and approach which are similar to the symptoms that diagnose complicated grief. This approach to understanding reactions to extreme events can account for existing diagnoses but can also explain cases that don’t fit existing models. It illustrates similarities and differences across diagnoses and can benefit patients by improving treatment match to individual needs. More info: www.mrc-cbu.cam.ac.uk
Addiction and suicide risk following a sudden bereavement
Dr Ash Kahn, Consultant Psychiatrist, Woodbourne Priory Hospital
Complicated grief leading to a depressive illness may follow the sudden death of a loved one. Around 20% of the bereaved may have a complicated grief reaction. Poor physical and mental health prior to the bereavement is a predictor that the individual may go on to develop a major depressive disorder (MDD) following the bereavement. MDD is twice as prevalent in women as compared to men. People may cope with this by self medicating inappropriately with alcohol or other tranquilliser medication which could eventually lead to the development of dependence on the substance. There are biological, social and psychological aspects of dependence. Suicide has associated risk factors which include a positive family history suicide, mental illness (most commonly depression), substance misuse and childhood adversity.
Cultural and religious issues for bereavement support workers
Professionals should be receptive to cultural and religious differences and consult with the family to identify their particular needs. Although there are some general rules, it is important not to make assumptions based on a religious or cultural background. However, knowledge of other backgrounds may make communication and understanding easier. Rituals and final words before death or while dying can be very important and should be respected wherever possible. Different religions and cultures may express grief differently and more or less publicly. Some families may object to the touching of the body by a non-faith member, but there is no rule for this in Hinduism, Islam or Sikhism, especially in emergency situations. In Islam an invasive post-mortem is forbidden. There are forms of non-invasive post-mortems that are accepted by some coroners and this can be only be arranged with the consent of a coroner. At all times the family should be treated sensitively. Funerals rituals and timings vary by religion and culture and in some faiths women may be forbidden from attending funerals or segregated at funerals.
The role of helplines
Helplines can be useful as interim support in the period following a bereavement when informal support from family and friends is fading away, or before more formal professional face to face support has been set up. The Child Death Helpline is staffed by bereaved parents who receive training and support in the role. Although there are benefits to using bereaved parents, we advocate limited self-disclosure. We encourage supportive listening, ‘normalising’ the feelings associated with the loss and signposting to other services. We keep records on the calls and share information between volunteers, however callers are anonymous. Helplines are a useful form of support because they can provide an immediate response where there may be long waiting periods for other services such as counselling. They are convenient and free of charge. The caller can remain anonymous and can hang up whenever they wish, which gives them full control of the situation. Some people use helplines every now and then as part of a wider support network but others call regularly as the helpline may be their only form of support. We have regular callers to the helpline but we discourage relationships between particular volunteers and callers. We must be mindful of the development of dependence on the helpline and are careful to properly assess the benefits to the caller and avoid situations where dependence can prolong grief in a caller.
More info: http://www.childdeathhelpline.org.uk
The role of self-help groups following a disaster
Self help groups are an excellent source of support and information following a disaster. They are self-determining, which contrasts to the loss of control experienced in a disaster. Groups provide opportunities for mutual support, shared experience and information exchange. Many individuals feel that in groups with shared experiences they can talk about the tough feelings without having to sugar coat their grief for the benefit of others who don’t know how to handle it. Together, groups can seek answers to questions and solutions to prevent similar situations happening again by putting pressure on governments or authorities. They can also seek ways to remember. Of course, groups are not for everyone and just because individuals share an experience, they may not get along and they may have different objectives. More info: http://www.disasteraction.org.uk/support/da_guide07.htm
Families’ experience of inquests in England and Wales
An inquest is called after a sudden or unnatural death to find out the circumstances of the death and learn lessons from the death for public health and safety. Differences in procedure and standards across counties are widespread. Unsatisfactory inquests can exacerbate the experience of bereavement. Examples of these are: inquest delays; lengthy decision making processes; failure of the system to learn lessons from the death; inadequate recognition, insensitivity and lack of assistance for the family. The Government has just announced that promised long needed reform of the inquest system will be discarded and the post of Chief Coroner is to be abolished. This also means that the charter for bereaved people will have to be rewritten if it is to be adopted. More info: http://inquest.gn.apc.org/website/
Sudden death and wills in the UK
Seven in ten adults do not have a will. If you don’t have one, you won’t be able to set out your last wishes, gifts to family, friends or charities or appoint guardians for your children. A cohabitee may have no automatic rights to property or money. Dying intestate (without a will) means a strict formula is applied for the distribution of the deceased’s assets. Who will have guardianship of children depends upon whether there is a will and who has “parental responsibility”. Ultimately who is appointed as guardian may have to be decided by court. Unless a cohabitee is married to the deceased, has joint ownership of a property or a tenancy agreement, they may have no right inherit or even to remain to their home. The deceased’s debts will remain payable from the assets their estate (if there are any). If an estate is “bankrupt” others will not assume responsibility for the deceased’s debts unless the jointly took out the debt or jointly own property upon which the debt is secured. Executors or administrators of the deceased may be able to get short-term funds banks and building societies or from insurance. It may take longer to obtain financial support through applications for benefits or civil claims for damages. The site www.mylostaccount.org.uk is useful for tracing bank accounts of the deceased.
Police family liaison officer best practice in Wales
Family liaison officers (FLOs) provide information and support to families following the death of a loved one in accordance with the needs of an investigation. They also gather evidence and information from the family to support the investigation. They may help with viewing the body, returning property, media assistance, signposting to support services, preparation for a victim personal statement, help in court and provide a link between the police and the family. Although there have been great advances in the FLO role in that more courses are being run now and the selection criteria more rigorously adhered to, family liaison is still not consistent across the country. Currently there is no requirement for FLOs to undergo standardised training or even any training whatsoever before they work as an FLO although the National Policing Improvement Agency recommends a five day course designed to prepare the officer to provide demonstrable competence. FLOs report that there is insufficient training and no continuation training provided. They report insufficient briefing before deployment and a lack of accessible information when working out of area. More info: http://www.npia.police.uk/en/docs/Family_Liaison_Officer_Guidance_2008.pdf