A number of well-conducted evaluations of bereavement services offered to unselected
bereaved people have failed to show benefits on follow-up. It must be concluded
that most bereaved people do not need and will not benefit from referral to
a Bereavement Service (Reviewed in Schut 2001).
High Risk
On the other hand, significant benefits have been found from services provided
to bereaved persons at high risk or who meet criteria for psychiatric disorder.
These include services for bereaved children who are themselves likely to be
at risk. Schut concludes that the more complicated the grief process, the better
the chances of intervention leading to positive results. The families of people
who have died in hospices have been found to have lower mortality rates than
those dying elsewhere (Christakis 2003)
and the provision of a hospice-based service to bereaved people at high risk
has been shown to reduce their use of primary medical care (Connor
1996, Relf 1996).
Hospices and Palliative Care Units
Most Hospices and Palliative Care Units make use of volunteers who have been
carefully selected, trained and supervised to help bereaved people (Denmer
2003). They need to have the backing of well-trained professionals including
a bereavement service coordinator with appropriate counseling or other specialist
training. They should also have easy access to a psychiatrist and/or clinical
psychologist who should be consulted whenever clients are unable to carry out
normal functions and remain distressed despite the support given by the team.
Follow-up Contacts
Support should be offered proactively to the minority of bereaved people at
risk. Initial contact is usually made 5-6 weeks after bereavement although it
may be needed more urgently if there is thought to be a suicidal risk. Kissane
& Bloch (2002) argue that bereavement
support should be a continuation of the support given to families before bereavement
and provided by the same staff, their approach is awaiting evaluation.
Support Groups
A wide variety of mutual help groups and websites exist to help bereaved people
but few, if any, have passed the test of well-conducted evaluation. Even so
they tend to receive the enthusiastic endorsement of the bereaved people who
make use of their services. Mutual help groups are of particular value to stigmatized
or "disenfranchised" people such as those bereaved by HIV or suicide
(Doka 1989). Here they can meet others who
are "in the same boat" and obtain mutual support.
