Making SENSE of traumatic bereavement: A trauma informed approach

Recognising the widespread impact of trauma and stress, and the potential for re-traumatisation is key to supporting individuals who have experienced a traumatic bereavement. In this blog, psychological trauma consultant and clinical adviser to Sudden, Nicola Lester discusses the SENSE trauma-informed approach to support, which she originally developed in collaboration with the Tim Parry Johnathan Ball Peace Foundation.

The SENSE model is a trauma-informed approach to support suddenly bereaved people and was first developed in response to the Manchester bombing in May 2017, as a way of structuring the delivery of support in the immediate aftermath of the attack. Since then it has been adapted and used across a variety of different contexts both in the UK and overseas in the Middle East and Afghanistan.

The SENSE model is underpinned by an understanding of best practice in the field of psychological trauma and informed by the six principles of trauma informed practice to create a structured approach to the delivery of support as part of an early intervention approach. Adopting a ‘trauma informed’ approach to bereavement care provides a framework for organisations and professionals providing support to bereaved families in the aftermath of a traumatic loss.

Fostering resilience and coping

A trauma informed approach is one which recognises the widespread impact of trauma and stress and the potential for re-traumatisation. It actively seeks to reduce this possibility by understanding what is needed to foster resilience and coping and by promoting opportunities for recovery.

It is comprised of six key guiding principles to underpin practice:

  1. Safety – ensuring physical and emotional safety
  2. Choice – restoring choice and control
  3. Facilitating connections
  4. Supporting coping
  5. Responding to identity and context
  6. Building strength

Bereavements which occur under external traumatic circumstances may be regarded as traumatic. This is a term indicating the interface between trauma and loss, where in such circumstances grief symptoms are overlaid with trauma symptoms. In fact, because the impact of sudden, traumatic loss is so devastating, it may result in symptoms of post traumatic stress disorder (PTSD), meaning that the bereaved are faced with the dual task of mourning the loss as well as coping with the trauma that accompanied the death.

In addition there is growing recognition that the processes which occur after a bereavement may also leave the bereaved family susceptible not just to the effects of primary grief but may also serve to exacerbate their distress, as they are required to navigate a myriad of medical, legal and criminal processes, which may prioritise organisational procedures and requirements over the needs and wishes of the bereaved family.

Supporting bereaved families to navigate such processes, increasing their sense of voice and capacity to actively participate is essential and a key part of the support which is provided by the Sudden service and the SENSE model provides an effective way to structure the delivery of this care. In addition, the five stages of the SENSE model are designed to respond to the immediate practical and emotional needs of those who are bereaved, support their coping, mobilise and strengthen their access to social support and identify and address their longer-term support needs by engaging them with relevant services and professionals.

The five interventions of the SENSE model

The SENSE model is comprised  of five interventions: Stabilisation, Education, Normalisation, Social support and Engagement; all of which have been recommended as best practice by both the National Institute for Health and Care Excellence and the broader trauma literature.

In creating the word ‘SENSE’, the order of the letters in turn reflect the chronology in which the interventions should be offered. For example, as part of an early intervention approach the emphasis is on stabilisation to ensure the physical and emotional safety of the person affected and that their immediate needs are met.

This is followed by providing information and education about the signs and symptoms of trauma and promoting an understanding of how trauma may affect someone as a way of ‘normalising’ or validating their experiences and offering reassurance. We recognise that for many in our society death and loss remain taboo subjects shrouded in both secrecy and judgment about how people should be coping and grieving when they are bereaved.

Helping people to understand how they feel and validating their experiences by providing a non-judgemental space in which to access support is intended to shift the focus from how someone should be coping to instead to support and enhance how they are coping recognising their resilience.

Empowering the bereaved person

The normalisation of symptoms coupled with education, introduces the idea of empowering the person and their wider social support network to monitor their symptoms and where necessary to facilitate early referrals to formal psychological services, which is known to improve outcomes over the longer-term. The importance of social support in both reducing the impact of stressful life experiences and in protecting those affected from going on to develop PTSD and other mental health difficulties is well established, suggesting that it is essential to assess the presence and availability of social support as the fourth stage of intervention.

The final stage is engagement; either encouraging engagement with specialist support services; promoting the individual’s engagement with their wider social support network or assisting them to re-engage with their own values and goals and to regain a sense of purpose and control. At this final stage we plan for the longer-term to ensure access to relevant and appropriate services capable of providing the right support, at the right time based on an understanding that everyone is unique and affected by traumatic bereavement in different ways.

Delivering the SENSE model

The five stages of the SENSE model can be delivered in a variety of different ways, including face to face, via email, telephone and online. Whilst it is suggested that the five stages are implemented in chronological order to provide a sense of structure and purpose, each stage can be delivered as a standalone intervention, depending on the needs of those you are working with. It may be beneficial to explain the stages, as this will help the person to feel that they are making progress, particularly if you build in regular opportunities for review.

About the author

Nicola Lester is a psychological trauma consultant and clinical adviser to Sudden and Brake, the road safety charity.

Half a million people in the UK set to face a sudden bereavement in 2020

Sudden’s Chief Executive Mary Williams announces a new report, Help when the worst happens, published in response to COVID-19. It outlines how the challenging circumstances of this pandemic are affecting bereavement, and the measures that need to be taken to ensure needs are met. 

In 2020, due to COVID-19, people are being bereaved in sudden and shocking ways, under remarkably difficult social circumstances, and at far greater numbers than ever before. In response, we have published an urgent Sudden report, Help when the worst happens, about meeting the needs of people bereaved in these difficult times.

The report explains that sudden deaths in the UK are set to more than double this year to 100,000, with COVID-19 accounting for almost half that number. This will likely leave half a million people in the UK facing the very complex challenges of a sudden bereavement of a close family member, challenges which are exacerbated by ongoing social-distancing restrictions that can cause isolation.

This report aims to shine a light on those challenging circumstances, outline the appropriate systems of support, and reveal the poor outcomes that bereaved people could suffer without proper care. Charities and health experts are rightly calling for an urgent focus on funding and development of the provision of bereavement support this year. Sudden deaths, from COVID-19 or any other circumstances, can affect anyone at any time so support must be wide-spread.

In previous times of mass bereavements with acute needs, we have not known how to help; we do now. The combined expert opinions that have underpinned Sudden’s advice to practitioners over the years, as a provider of professional development regarding early care of bereaved people with acute needs, teach us that sudden and shocking bereavements require an immediate and clinically-informed crisis response from day one onwards. Help is particularly key through the early weeks (the shock period, before grief support services and mental health services, are appropriate to signpost) as well as in later months. The report outlines how support should be assigned according to need, for example, with the impact bereavement can have on mental health. This immediate psychosocial response for people with acute needs must be accessible, have capacity, and be tailored to address an individual’s unique emotional and practical needs.

Without the proper support, we know people bereaved in challenging circumstances can suffer a range of poor outcomes that negatively affect them, their families, the wider community and even our economy. With support, provided in evidence-based, timely and straightforward ways, people are more likely to move forwards into a positive future.

Help when the worst happens calls for bereavement and support charities, health and social care agencies, community leaders, and government to work with urgency, together, to secure these futures for the sake of us all and in the name of humanity. Click here to read the full report.

To help Sudden answer the call of anyone suffering a sudden bereavement, please donate to our charity.

About the author

Mary Williams OBE is chief executive of Sudden. Sudden is a global initiative to help people bereaved by any sudden cause and also to help the professional standards of their carers. Mary is also chief executive of Brake. Brake is a road safety charity providing the National Road Victim Service in the UK for families bereaved by death on the road, including an acclaimed and government-backed national helpline and information service. Brake also operates globally and has a domestic branch in New Zealand too.

Why self-care is important for carers as well as the suddenly bereaved

Following a sudden death there must be a primary focus on the care and support of those who have been bereaved, but it’s important those caring for them look after themselves too. In this blog, Caroline Perry discusses why self-care is important, and how carers can both help ensure bereaved people are cared for and take care of their own wellbeing too.

If you’re caring for someone who has been suddenly bereaved, it’s important that you not only ensure that person is taken care of, but also that you take care of yourself. During the COVID-19 pandemic this is more important than ever, with social distancing, restrictions and lockdowns meaning many of us don’t have access to our usual support systems.

Whether you’re a family member, friend, neighbour or professional, you are undertaking an important role supporting someone at a very sad time, through an experience that can be challenging; even more so during a pandemic.

Many suddenly bereaved people want face-to-face support, or to hug other loved ones, but during a pandemic this may not be possible if you aren’t self-isolating with them. However there are ways you can provide support and comfort through phone calls, video calls or simply regular messages, depending on how the bereaved person would prefer to be contacted.

It’s also possible to check that someone’s basic care needs are being met, and to spot warning signs, even if you’re supporting them remotely. Gentle questioning may help you be assured that they are ok, or to identify things they need help with.

It’s important to check they have access to food and money to look after themselves. If they need help, for example with shopping or making meals, this might be something you can help with, or you could find support for them from local organisations, for example organisations that deliver meals to people.

You can also check whether they have a network of family and friends who can support them, and check on their health, for example do they feel well, unwell or sound as though they are poorly.

If something concerns you, you should do something. If you work or volunteer for an organisation, report your concerns to your manager. If you aren’t linked to an organisation, seek medical help or help from a relevant government agency.

If the person says they don’t want help, but it is clear to you they may need help, it is important to seek it. A person’s safety is the most important thing.

Supporting someone who has been suddenly bereaved can also be upsetting for you if you’re providing support. Try to be aware of your own needs and feelings during this time. If you look after yourself, you can look after others, better.

It is important to make time for yourself and have a self-care plan. Include spending some time doing your favourite things, such as reading, cooking, listening to music or doing some meditation or yoga. Make time to be by yourself, or with others you love who are around you at this time.

Only offer support you can reasonably give, and consider in advance who can support you, when you may need support. Find out about other support services too, so that you can access extra support for the bereaved person if needed and/or find a service that allows you to step back when you need to.

Find more information on supporting someone bereaved at this time of pandemic, and taking care of yourself.

About the author

Caroline Perry is the New Zealand director for Brake, the road safety charity. As a Brake member of staff she is also involved in supporting the work of Sudden. Sudden is a global initiative to help people bereaved by any sudden cause and also to help the professional standards of their carers. Brake is a road safety charity providing the National Road Victim Service in the UK for families bereaved by death on the road, including an acclaimed and government-backed national helpline and information service. Brake also operates globally and has a domestic branch in New Zealand.

Bereavement challenges in a time of pandemic

After a death from COVID-19, and after a death from any cause in a time of pandemic, there are bereavement challenges that are new and hard, for both bereaved people and their carers. In this blog, Sudden chief executive Mary Williams OBE discusses the impact of death on families and bereavement services at this time of COVID-19 and applauds the efforts of the bereavement NGO community to offer support.

While governments still battle the spread of COVID-19, a new challenge is emerging: the challenge to help bereaved people in a time of pandemic.

A death from COVID-19 is a shocking, sudden death after a short and increasingly severe illness. To prevent infection, it is usually not possible for families to say goodbye in a normal way.

A death from any cause in a time of pandemic brings additional challenges for everyone who is bereaved. For example, it is ill-advised, or forbidden, for people to meet and hold a normal memorialising event such as a funeral. People whose normal cultural or religious practices involve washing or dressing a dead person’s body are now prevented from doing these things.

Governments are rightly concerned about the perils of isolating people through ‘lockdowns’ that aim to contain the virus, particularly the potential harm to people who are suffering major life challenges, such as poverty, addiction, and problems relating to mental health and physical health. There is also the enormous challenge of being both isolated and bereaved.

As we applaud our medical practitioners for saving so many lives, for those families who are bereaved by COVID-19 (and also by any other causes, particularly sudden causes) their challenges are just beginning.

For some people bereaved at this time, there are acute practical challenges that require immediate intervention from health and social services. For example, imagine the needs of an elderly person with dementia, perhaps also suffering from COVID-19, who was previously cared for by their partner who has died.

For all people who are suddenly bereaved at this time, there will be a range of challenges, compounded by the need for social distancing. Contact from family, friends, carers, and basic human needs, such as to have a hug, are prevented. Or these things are restricted to people with whom the bereaved are self-isolated.

Bereavement charities and mental health services around the world are working to ensure we help, as best we can, with the resources we have. A wealth of information is being published online and bereavement helplines are open.

Across the world, we are all having to help each other in new, and often virtual, ways. We are blessed with the power of phone lines and the internet to enable many people to access information, talk and share their feelings and thoughts online, at a time when, cruelly, it is not possible to say goodbye to someone who is dying, it is not possible to help prepare their body for a funeral event, it is not possible to safely hold a mass gathering of family and friends to mourn and celebrate.

We know, from the findings of academia and practitioners, that early care of suddenly bereaved people is very important. It can prevent the onset of serious conditions such as post-traumatic stress disorder (PTSD) that can blight lives for years.

People who have been bereaved suddenly need to be looked after in the early weeks. They need to feel safe. They need to be informed about symptoms of sudden bereavement so they are prepared. They need to feel supported, through simple tips regarding self-care at this time.

The good news is that meeting suddenly bereaved people’s practical needs and giving them information and support to enable self-care can really help make a difference to their mental health outcomes and enable a normal grieving process.

I applaud all bereavement services for rallying together, to help people bereaved by any cause, including COVID-19, in these very challenging times, and urge a focus on a straightforward approach that helps people through the early weeks in practical, simple ways that enable people to feel safe and supported.

About the author

Mary Williams OBE is chief executive of Sudden. Sudden is a global initiative to help people bereaved by any sudden cause and also to help the professional standards of their carers. Mary is also chief executive of Brake. Brake is a road safety charity providing the National Road Victim Service in the UK for families bereaved by death on the road, including an acclaimed and government-backed national helpline and information service. Brake also operates globally and has a domestic branch in New Zealand too.

How do children respond to sudden deaths and trauma?

After a traumatic event or sudden bereavement, children can react in very different ways. Several inter-relating factors that can influence how well a child copes. In this blog, bereavement expert Erica Brown discusses the impact that trauma can have on children, and provides advice on how children can best be supported.

Sudden deaths such as road crashes occur unexpectedly, turning everyday experiences upside down and destroying the belief that ‘it couldn’t happen to us’.

Children’s responses to trauma

A road crash where someone dies is a traumatic event, and children’s responses to the trauma they experience will vary widely. For some children, reactions will be minimal or short-lived, whereas others will experience anxiety, fear and phobias. Sleep disturbances are also common, and many children have problems at school, both with their learning and their behaviour.

Little is known about children’s individual responses to traumatic events, or why some children are more vulnerable than others. A child’s individual personality, and the amount of time that they were exposed to the event, can influence their response. Severe reactions are linked to the suddenness of the event, and the degree to which the child was rendered powerless during the trauma.

Stress reactions in children are complex, but they are in fact normal human responses to unanticipated sudden and frightening events. The child’s world has become unpredictable. In some cases, the nature of the trauma seems to determine the nature of the stress. If the trauma involved noise, some children may experience more intense reactions. Likewise, injury or threat to life may cause particularly severe traumatic responses. Other factors such as the duration of exposure to the trauma, and whether the event was experienced in isolation or with other people, can play a significant part in how a child responds.

Imagery

Matt was 12 when he witnessed a fatal road crash. He was returning from school at the end of the day. It was dark and raining. Suddenly, in front of him, a car overtook an oil tanker and hit a car coming in the opposite direction. The cars hit head on and one was thrown under the wheels of the tanker, leaving only the rear visible.

For Matt, imagery of the event is one of the recurring effects of trauma: “It all happened so fast and to this day I can remember thinking, ‘Oh my God, there is going to be a prang!’ The noise of the skidding and of the metal buckling under the tanker wheels keeps haunting me. It is as if a recording has been made in my mind and it keeps replaying all the time. I am just dozing off at night and I hear the dreadful skidding and squealing of brakes.”

Some children experience a phase of denial and numbing immediately after a stressful event. After this phase the child may be confronted with intrusive, repetitive recollections of the event, including nightmares and flashbacks.

Searching for meaning

All survivors of traumatic events need to make sense of their experience. For children there may be questions such as ‘Why did it happen to me?’, ‘Why did I survive?’ and ‘Why do I feel the way I do?’

Many children believe they were in some way responsible for what happened. Others may be confused about why they were singled out to witness the event. Why a child has survived when others haven’t may pose a myriad of questions to which there are no definitive answers. These questions often lie at the heart of survivor guilt.

Children may also battle with the intensity of their emotions and may not have the language to describe how they feel. Some may not have experienced intense emotions before, and it is not unusual for them to attempt to repress unknown feelings. The world is unfamiliar and frightening.

Coping and support

How well a child copes after a traumatic event is dependent on several inter-relating factors. These include the child’s cognitive ability and capacity to express emotions, the maintenance of familiar routines and levels of support from within and outside the child’s home.

For anyone supporting a child who has experienced trauma, there are both proactive and reactive ways of giving support.

Proactive ways of supporting children include providing opportunities for the child to communicate their experiences, acknowledging the trauma they are experiencing, and allowing opportunities for them to integrate the traumatic event into their life and to move on. The help of specialist support networks may also be required.

More reactive ways of giving support include reassuring the child that their response is normal, keeping routines as normal as possible and encouraging the child to join in activities with their peers. It’s also important to work closely with other professionals who are supporting the child’s family.

About the author

Erica is a qualified teacher and has worked in a variety of roles in the Education and University Sectors. She has experience of teaching Early Years classes and has worked as a Senior Teacher, Head of Department and Head Teacher in Special Schools.

Erica’s academic career has included roles as Senior Lecturer, Principal Lecturer and Principal Research Fellow. She has also worked as Head of Research and Development of Care at Acorns Children’s Hospice and Head of Special Education at Oxford Brookes University.

Erica’s recent research interests have involved supporting children and families who are experiencing loss, and in 2012 she was made a fellow of The Royal Society of Arts in recognition of her work with life-limited children, young people and their families.

Dying Matters Awareness Week – What can you do?

The period following any death is a difficult time, but a sudden death is particularly devastating for the loved ones of the person who has died. Those grieving find their lives have changed greatly, with no warning, and often little preparation. All deaths have an impact, but a sudden death brings its own unique set of issues.

Dying Matters Awareness Week 2017 focuses on the theme ‘What can you do?’. We are encouraging people to offer their support to people who have been bereaved – relatives, friends and colleagues – by helping them in practical ways and listening to them when they are ready to talk. 

So… What can you do?

Everyone grieves differently; however, it is more common after a sudden bereavement for a person to experience intense grief and more extreme emotions, due to the lack of warning.

If you know someone who has been suddenly bereaved, be aware that they may feel scared, vulnerable and angry, but they will also need support. You could support them in practical ways, by offering a lift, helping them around the house, doing their shopping or cooking, or offer to spend time with them in a place where they feel safe and comfortable.

You could also support someone who has been suddenly bereaved by listening to them talk about their bereavement. Remember that you can never understand what the person is going through, and acknowledge that they may not wish to talk straight away. Allow them space and time to talk when they are ready.

Many people feel as though they don’t know what to say, or worry that they may say the wrong thing. It is better to say “I don’t know what to say,” than to say nothing at all.

Talking to children about death may be more difficult, particularly if they are young. They may have extreme reactions and feel frightened and confused about the situation. It is important that you are as open and honest as possible, and explain to them that what they are feeling is normal.

When people are ready to talk about their feelings and experiences, or need extra support, bereavement counselling can be a huge help. Organisations that offer this service include Cruse Bereavement CareWinston’s Wish (for bereaved children) and Widowed and Young (WAY – a service for those who are bereaved and under 50).

In 2016, the National Council for Palliative Care (NCPC) launched Compassionate Employers. This scheme provides practical resources to help companies and organisations to gain a better understanding of the long-lasting effects of bereavement on productivity, morale and absenteeism, and to learn how to introduce policies and good practice to support a bereaved person in the workplace.

If you are offering help to a friend, relative or colleague who has been bereaved, please keep talking to them and offering support. Some people may not feel comfortable saying yes immediately, or – particularly in the case of sudden death – may feel disoriented and need time to adjust to their change in circumstances.

Dying Matters aims to help people to feel more comfortable talking openly about death, dying and bereavement. To find out more, visit www.dyingmatters.org.

Dying Matters Awareness Week

8–14 May 2017

To find out more about Dying Matters Awareness Week, including details of events taking place in your area, please visit the Dying Matters website.

Further reading

Dealing with sudden or violent death: http://www.dyingmatters.org/page/dealing-sudden-or-violent-death

Compassionate Employers: http://compassionateemployers.org.uk/

Find Me Help: http://help.dyingmatters.org/

About the author

Stephanie Owens is communications and marketing officer at the Dying Matters Coalition, and National Council for Palliative Care. Stephanie has worked in communications for healthcare charities for a number of years, and feels strongly about raising awareness of the importance of conversation around death and dying. 

An overview of the Adult Attitude to Grief Scale and Range of Response to Loss Model

In this blog, bereavement expert Dr Linda Machin shares insights into her pioneering models of bereavement and grief, the Range of Response to Loss (RRL) model and Adult Attitude to Grief (AAG) scale, and provides an overview of how these approaches can be practically applied. 

Range of Response to Loss (RRL)

In my research and practice into bereavement, I have observed a wide range of experiences and expressions of grief [1].

As I began to develop a conceptual framework to capture this diversity, what became clear from my own work and that of other theorists was that grief can be seen as being made up of two dimensions.

The first is the instinctive, reflexive reactions to loss, which represent the ways in which we have learned to react to distressing circumstances, and are expressed in a range of feelings and functioning modes [2].

The second is the conscious way in which we cope with the loss that has occurred [3]. When feelings and functioning can be balanced, there is resilience; but where these cannot be managed, for a variety of reasons, vulnerability will result.

These two dimensions can be represented as intersecting elements of grief, as shown in the model below.

RRL in practice

Underpinning this concept of grief are the social and cultural factors that shape reactions and responses to loss. These can include:

Ethnic identity and belief systems

The source of identity and beliefs can vary – they may be shaped by the family, grow from social influence or be conveyed and influenced by political organisations. The media, including social media, can also have a major impact on identity.

Specific social and circumstantial factors

Alongside influence from ethnic, social and religious identity, a range of additional factors can contribute to emotional vulnerability, and may impact response to loss. Difficult relationships, or problems relating to mental or physical health, can cause emotional vulnerability. Further challenges can be caused by economic difficulties or unemployment, which may lead to increased stress and strain. If an individual has suffered multiple life losses, this can also contribute to emotional vulnerability.

Cause of the death

Factors surrounding the cause of the death can also impact on the bereaved. A bereavement caused by a sudden, traumatic death is likely to contribute significantly to psychological vulnerability.

In practice, we might see the following characteristics in the four quarters of the RRL model:

Adult Attitude to Grief (AAG) scale

The AAG scale was devised as a tool to test both the validity of the grief reactions – overwhelmed feelings and controlled functioning – and also the resilient capacity to balance these elements. The AAG consists of nine items on a five-point Likert scale, from strongly agree (score 4), to strongly disagree (score 0). The AAG is now used extensively as an assessment or evaluation tool, and to enhance therapeutic conversation.

The AAG scale incorporates nine concepts, under the three headings of ‘Overwhelmed’, ‘Controlled’ and ‘Balanced/resilient’.

          The 9 concepts represented in the AAG scale

Overwhelmed Controlled Balanced/resilient
Disturbingly intrusiveUnremittingly painful

Robbing life of meaning

Valuing stoicismDenial of, or covering distress

Focus on day-to-day living

Courage in facing the lossSense of personal resourcefulness

Hopefulness

Validating the use of the scale to calculate vulnerability was based on the following formula, where O represents Overwhelmed, C is Controlled and R is Balanced/resilient:

Adding O + C scores and adding reversed R scores = an Indication of Vulnerability             

The research confirmed the psychometric properties of the scale and its use to classify different levels of vulnerability. Where the highest level of vulnerability is 36 and the lowest 0, the following classifications are made [4]:

Severe              >24

High                 21-23

Low                  <20

Practice issues

When applying these ideas and this assessment scale to practice, a primary goal is to address the issues that contribute to vulnerability, and focus on enhancing resilience. Vulnerability may result from practical circumstances or personal factors that need to be recognised, understood and dealt with supportively. Effective practical help and empathy with emotional vulnerability will begin to lead to increased resilience. Helping people recognise the strengths they have and encouraging them to discover hopefulness and meaning can be difficult, especially after an unexpected and traumatic loss.

We know from others who have travelled that journey that new meaning can be found through having a goal or a cause to follow. For example, meaning can be found through memorialising the lost person in some way, through experiences that reconnect with love and beauty, and through beginning to adjust perspectives from tragedy – to the capacity to triumph. None of this may seem easy at the beginning of a loss, but many survivors of the worst of human experience, such as the Holocaust, testify to the possibilities.

Future plans

Research and practice developments continue with the RRL model and the AAG scale, including exploring whether the RRL model and the AAG scale are ‘culturally transferable’ and can be used by services offering bereavement care to diverse ethnic groups. Work is also progressing in validating other versions of the AAG, including adapting it for use in pre-bereavement with patients and carers, and also with children and young people.

For more information, see www.keele.ac.uk/mappinggrief

For copies of the AAG scale, contact Linda Machin: l.machin@keele.ac.uk

About the author

Linda began her career as a medical social worker, and from this experience developed an interest in bereavement. Following this, she began to conduct pioneering research into bereavement for the Anglican diocese of Lichfield. These findings led to the development of published material on grief, and the setting up of a service for the bereaved, Bereavement Care (now the Dove Service) in North Staffordshire.

An academic career followed at Keele University, with Linda teaching on both social work and counselling courses. She has an MA and PhD for her research into bereavement and is now an Honorary Research Fellow at Keele University. Throughout her career, Linda has conducted a range of research into bereavement care and grief, and continues to do so. Her book Working with Loss and Grief [5]  is used extensively in health and social care settings.

In this blog, Linda discusses how she developed the RRL model and AAG scale, and provides an overview of how these approaches can be practically applied.


References:

[1] Machin, L. (2001) Exploring a Framework for Understanding the Range of Response to Loss; a Study of Clients Receiving Bereavement Counselling. Unpublished PhD Thesis: Keele University, UK.
[2] Attig, T. (2011) How We Grieve: Relearning the World (revised edition). New York: Oxford University Press.
[3] Stroebe, M.S., Folkman, S., Hansson, R.O. and Schut, H. (2006) The Prediction of Bereavement Outcome: Development of an Integrative Risk Factor Framework. Social Science and Medicine 63: 2440–2451.
[4] Sim, J., Machin, L. and Bartlam, B. (2013) ‘Identifying Vulnerability in Grief: Psychometric Properties of the Adult Attitude to Grief Scale’, Quality of Life Research.
[5] Machin, L. (2009; 2014). Working with Loss and Grief. London: Sage.

Further reading:

Ainsworth, M.D.S., Blehar, M.C., Waters, E. and Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Erlbaum.
Cooper, M. and Mcleod, J. (2011). Pluralistic Counselling and Psychotherapy. London: Sage.
Machin, L. and Spall, R. (2004). Mapping Grief: a Study in Practice Using a Quantitative and Qualitative Approach to Exploring and Addressing the Range of Response to Loss. Counselling and Psychotherapy Research,4(1), 9–17.
Machin, L. (2007). The Adult Attitude to Grief Scale as a Tool of Practice for Counsellors Working with Bereaved people. A study report sponsored by Age Concern, Tameside and Keele University.

Neimeyer, R.A. and Harris, D.L. (2011). Building Bridges in Bereavement Research and Practice. In R.A. Neimeyer, D.L. Harris, H.R. Winokuer and G.F. Thornton (eds), Grief and Bereavement in Contemporary SocietyNew York: Routledge. pp. 403–418.

Relf, M., Machin, L. and Archer, N. (2010). Guidance for Bereavement Needs Assessment in Palliative Care (2nd edition). London: Help the Hospices.
Stroebe, M. and Schut, H. (1999). The Dual Process Model of Coping with Bereavement: Rationale and Description. Death Studies 23, 197–224.
Worden, W. (1983/1991/ 2003). Grief Counselling and Grief Therapy. London: Tavistock/Routledge.

Widowed & Young – helping young widows and widowers cope with life after death

Losing a loved one at any age is incredibly difficult, and the sudden death of a partner at a young age can be particularly challenging. In this blog, Widowed & Young chairman Georgia Elms talks about the support that the charity was able to offer her following the sudden death of her husband. 

Georgia Elms’ life was turned upside down when her husband Jon died suddenly from meningitis, at the age of just 38.

“Jon went to bed feeling unwell, and woke in the middle of the night a lot worse, so I rang for an ambulance – but by morning he’d died,” says Georgia. “It was two weeks after our daughter Daisy’s first birthday. And the day after his death, I found out I was pregnant with our second child.”

Although Georgia was surrounded by friends and family, she felt utterly alone.

“I didn’t know anyone else who was in my situation. Nobody around me understood what I was going through,” she says. “I just needed to meet other people and talk to other people who’d been widowed at a young age. I needed to have reassurance that the things I was feeling were normal.”

For Georgia, the charity WAY (Widowed & Young) offered a lifeline – linking her up with other men and women who had been widowed at a young age, and who understood exactly what she was going through.

“Just talking to people who had been widowed and were further down the line than me made me feel better,” she recalls.

With a young daughter to look after and a second baby on the way, Georgia turned to WAY’s online forums in the evenings for company and support, reading posts from other people and realising that she was not alone in her grief. Through WAY, Georgia was able to link up with other women who had also been widowed while they were pregnant.

Eventually, she plucked up the courage to organise a get together for local members in Nottingham, and over the next few years she developed a new social circle through WAY.

“We went out for a meal, – then met up once a month after that. When my daughters were a bit older, I started going on some of the organised WAY holidays,” she says.

“My children love their new WAY ‘family’ and always look forward to meeting their WAY friends who allow them to feel normal,” says Georgia, who has been chairman of the charity since 2011.

Finding a way forward

WAY turns 20 this year and has more than 2,300 members across England, Scotland, Wales and Northern Ireland. For many widowed men and women, the lively social groups that meet up throughout the year – for drinks, meals out, walks and picnics – offer the chance to build up a new social life in the aftermath of bereavement. In the last year alone, WAY members have been walking in the Lake District, caravanning in Dorset, camping in Derbyshire and skiing in France over the New Year.

WAY also has a well-used members-only website, with a secure online forum that allows members across the country to post their comments in a safe environment, where others can offer advice and mutual support. Members also have access to a 24-hour confidential telephone helpline, which provides access to counselling and advice.

WAY is often described as a club that nobody wants to join. But the sad reality is that around 80,000 men and women in the UK are widowed under the age of 51 and could benefit so much from WAY’s peer-to-peer support.

Visit our website at www.widowedandyoung.org.uk to find out more about WAY.
Follow WAY on Twitter @WidowedAndYoung
Or on Instagram @widowedandyoung
Find WAY on Facebook at facebook.com/WAYwidowedandyoung

About the author

Vicky Anning has over a decade of experience in charity communications, and is currently Communications Manager at the support charity Widowed & Young (WAY). Prior to her position at WAY, Vicky also has worked on projects for UNICEF, international NGO Camfed and the Catholic international development charity CAFOD. Alongside holding various positions in the third sector, Vicky also has experience in journalism and working as a book editor.

Recognising the signs of PTSD and traumatic grief is essential – and we all have a part to play.

Post-Traumatic Stress Disorder and traumatic grief can have a debilitating impact on people who have been bereaved suddenly. In this first Sudden blog post, Dianne Yates, director and personal injury specialist at Hilary Meredith Solicitors, overviews the importance of recognising the signs of PTSD and traumatic grief, and highlights some of the key symptoms that support professionals should be aware of. 

The months and weeks following an unexpected and sudden bereavement can be incredibly overwhelming and confusing for a bereaved family.

Support and guidance from professionals such as emergency service workers and funeral directors can be vital in the hours, weeks and months that follow a sudden bereavement, playing a crucial role in helping mitigate the immediate shock and raw emotions that follow an unexpected death.

However, it is often only in months and years after a sudden death that a clearer picture develops of the personal challenges a grieving person faces.

When the inquest, police investigation and funeral have passed, friends and family return to their lives, the phone stops ringing, and visitors stop calling, who then recognises that a person is struggling with something more than the cathartic grieving process?

It is the support workers and counsellors, community nurses and family doctors, who support families in the extended period following a sudden death.

Working alongside these professionals is vital in my role as a lawyer. As an experienced serious and catastrophic specialist solicitor, I feel strongly that it is crucial that the needs of my vulnerable clients are met. Recognising any potential symptoms and warning signs for PTSD and traumatic grief are essential.

The stage at which a lawyer becomes involved following a sudden death can vary, but often occurs within the first few weeks. Initial support from legal professionals can involve assistance with coroner’s inquests or police investigations, and following this early support, relationships with clients can develop which last for years.

My position as a lawyer provides me with a special – and privileged – position, allowing me to support an adult and child over an extended period of time.

Throughout our lives, many of us will know people who have been devastated by the sudden death of a loved-one; sudden bereavement of this sort can be associated with traumatic grief and post- traumatic stress disorder (PTSD).

What are the signs of traumatic grief?

In the immediate aftermath of a bereavement, a number of symptoms may be expected, and form a normal part of the grieving process. However, a person who has experienced a sudden bereavement may be at higher risk of suffering traumatic grief reactions.

Traumatic grief is defined by bereavement professionals’ as grieving thoughts and reactions that are more traumatic, and challenging, than those suffered in most cases after a bereavement. Generally, these symptoms can be expected to last for longer than two months[1].

Whilst the intensity and type of traumatic grief can vary widely between individuals, some commonly experienced symptoms may include:

Increased likelihood of emotional challenges

Individuals suffering traumatic grief may be at risk of experiencing heightened irritability, or find themselves more likely to express anger or bitterness, with sudden, or unexpected, outbursts. Other negative emotions, such as a sense of unfairness around the death, or strong feelings of guilt, may also be likely. Phobias, including social anxiety, fears and the development of depression or suicidal thoughts can also arise, alongside intrusive thoughts.

Physical symptoms

It is also important to be aware of physical symptoms – these could include severe weight change, or on-going issues, such as pains, illness, or other symptoms developed through the manifestation of stress.

Other issues

As a result of emotional problems, individuals may experience long term insomnia or nightmares, or difficulty doing daily tasks during stressful moments at work or while caring for children.

What are the signs of PTSD?

People who have been diagnosed with PTSD are defined as having suffered a traumatic event, which can include a sudden death of a loved one[2]. Symptoms of the condition generally take around a month to manifest, and it is believed that in about a third of cases[3], these debilitating symptoms are suffered more than a year later if appropriate care is not provided.

Many of the symptoms of Post-Traumatic Stress Disorder are also similar to those suffered during traumatic grief, and it is possible that a suddenly bereaved person will suffered from both.

Some typical signs of PTSD can include

  • Recurring thoughts, and vivid flashbacks, to the event, which may sometimes be expressed through traumatic nightmares
  • Intense distress when reminded of the event, and fears that similar events may happen again
  • Avoidance of things associated with the event. Reminders of the event can arouse intense distress and a sense of detachment and unreality
  • A loss of a sense of safety, and feeling of isolation and being powerless
  • Self-destructive or reckless behaviour

What next?

It is important to remember that each person’s grief will be uniquely experienced, and that people may respond to seemingly similar circumstances in a very different way. Recognising that a person may be suffering from traumatic grief and PTSD is just the beginning. It is essential that a formal diagnosis is obtained and that treatment is devised and delivered appropriately for the suddenly bereaved person’s situation, which may involve other life challenges.

If you want to know what to do next, a good place to start is right here at Sudden. Further information and guidance about PTSD and traumatic grief is available here.

About the author

With more than 20 years’ legal experience Dianne has a formidable reputation in the legal world, particularly for working for the ‘underdog’ and those without the resources to fight for their rights. She represents clients from across the UK.


[1] Shear, M.K. et al. 2011. Complicated Grief and Related Bereavement Issues for DSM-5. Depression and Anxiety. [Online]. 28 (2), pp. 103-117. [Accessed 17/01/2017]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075805/

[2] National Institute for Clinical Excellence. 2005.  Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. [Online]. [Accessed 17/01/2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015848/pdf/PubMedHealth_PMH0015848.pdf

[3] Cohn. S. and Dolich. M. 2014. Complications in Surgery and Trauma. USA: CRC Press.