Written by two world leading experts in death, bereavement and trauma, it looks specifically at the psychological impact of this unprecedented situation and includes some practical considerations and tips relevant for police officers and staff and other emergency services workers and frontline staff, which we hope will be helpful.
In this piece we examine the issues of death and bereavement from a wellbeing perspective only. As with all other areas of the policing COVID-19 response, all operational, process related information is available via the NPCC, College of Policing and Knowledge Hub.
The NPCC have also worked with Police Chaplaincy UK to provide guidance specifically around the death of serving police officers or staff as a result of COVID-19. This is available, as above, through the NPCC or via Knowledge Hub.
Introduction
As UK emergency service responders rise to an extraordinary challenge that is unprecedented in all of their working lives, we examine the specific issues of death and bereavement through two of the world’s leading experts in the field.
Prof Atle Dyregrov is a clinical and research psychologist. He is the founder of the Center for Crisis Psychology in Bergen. Prof Dyregrov is the author of numerous publications, journal articles and more than 15 books. He has conducted research on various subjects relating to bereavement, trauma and disaster. He is one of the founding members of the European Society for Traumatic Stress Studies and the Children and War Foundation.
Dr Noreen Tehrani is the author of numerous books and academic journal articles on trauma psychology. She qualified as a psychologist in 1983 and has Chartered status in occupational, counselling, health and coaching psychology. She has previously worked with organisations affected by the Omagh Bomb, Paddington and Potters Bar rail crashes, World Trade Centre and the 7th July terrorist attacks in London.
Dr Tehrani works closely with the National Police Wellbeing Service (NPWS) in the UK, developing and delivering on a host of psychological programmes, having a wealth of experience working with emergency services.
We are all vulnerable
Unlike earthquakes, train crashes and robberies which are relatively short-term events, the COVID-19 virus threat is on-going. We are aware of the potential harm the disease can cause and begin to behave as if it has already happened or is about to happen to our loved ones.
In most people’s lives there are frail or vulnerable friends and relations. Those working in the NHS, emergency service and social care are constantly reminded of their own vulnerability whenever they support someone suffering from the virus, their families or the dying.
We recognise our own vulnerability and to some extent start to grieve for what may happen to us or our loved ones. Not only do we fear for our family and ourselves, we fear that we may bring the disease to others.
Dying at home
With the extra pressure on the NHS and ambulance service more people are dying from the COVID-19 virus at home. Whilst this may mean family living in the same household are able to spend more time with their loved one. In case of a death, it means that after the death, a death certificate will need to be signed and the body taken to a mortuary.
In order to support the NHS and ambulance service, in some areas, a police officer, detective and registered medical professional will attend the house and arrange for the body to be taken to a mortuary.
This process can be very upsetting for those living in the house, particularly when they see the body being taken away. The bereaved rightly want their deceased to be treated with respect and care, but the necessity of the virus precautions have inbuilt barriers which may skew the perception that this is being achieved.
For the officers and medics this can intensify their own feelings of vulnerability, particularly when they empathise and identify with the bereaved.
Dying in hospital
The situation for those who die in hospital can be equally upsetting for the families, especially where there is no possibility for families and friends to be in direct contact with the dying family member.
There may also be restrictions on visiting procedures, and often the speed of the disease prevents a last farewell.
For those taken to hospital with mental health problems, being taken away from everything that is familiar can be terrifying.
Nurses will try to mitigate this by using social networking to ease the separation distress experienced by their patient and their patient’s family.
Chapels of rest and funerals
Despite COVID-19 virus, some funeral directors will allow the immediate family to view the body in the chapel of rest, but this is not encouraged and will not be allowed where there is a risk to the health of the mourners and the funeral director’s staff.
The new coronavirus bill allows funeral directors to register deaths digitally on behalf of the family, relieving the family of that difficult task.
The numbers attending the funeral will be limited to the smallest possible group to minimise the risk of virus transmission. The timing of the funeral will depend on the available times at the crematorium or cemetery, minister, celebrant.
Other considerations also include whether there is a need for a post-mortem, or the death has been referred to the coroner. As the number of deaths increase the delay in holding a funeral can increase considerably. Read more about COVID-19: arranging or attending a funeral or commemorative event.
Death and the COVID-19 virus
Losing a family member or friend from the COVID-19 virus is emotionally challenging for everyone. The virus invades the body’s own cells, diverting them from their normal functions to produce multiple copies of itself.
Coronavirus like the ‘normal’ flu, is a respiratory disease effecting the lungs and respiratory tracts. The virus spreads when an infected person coughs or sneezes, spraying droplets that transmit the virus to anyone in close contact. It can enter the body through the eyes, nose or mouth.
The body responds to the virus invasion by creating anti-bodies which try to neutralise the virus. In some people the body’s immune system over-reacts to the presence of this invader and not only attacks the virus but also healthy body tissues.
The situation is made worse where there are other health issues which can be exacerbated by the virus’ presence that lead to a rapid decline and death.
Psychological impact of a COVID-19 death
Loss of significance
Many of those who die from the COVID-19 virus will be in the older age range, as this virus seems to pose greater risks to this group. Whilst it may be understandable that the death of an elderly person may be viewed as less tragic than the death of a younger person, it needs to be remembered that, for the family, each death is significant and worthy of sympathy.
Consideration needs to be given, for example, to the bereaved wife for the loss of a husband of 60 years who is unable to attend the funeral or say goodbye, or the son or daughter hearing of the death of their father or mother in a retirement home; knowing that they were unable to be with them at the end.
With so many people dying of covid (or other causes) it is important to remember that for every person and family the loss of a beloved person is uniquely painful.
Grieving alone
The death of a family member or friend typically brings people together in a shared expression of loss and grief. People comfort each other through kind words and actions. Being there to make cups of tea, listening to the stories, talking and crying together are actions which not only bring comfort but also bind relationships together for the future.
The bereaved do not usually grieve alone. They receive support from others, they take breaks from the grief when they meet others, or they are at work.
In everyday life, the bereaved move towards their feelings of grief and then gently retreat, as they move between relationships, daily tasks and quiet times. This ebb and flow of emotions makes the grief easier to bear.
The COVID-19 virus has halted normal grieving, with families and friends of the deceased being physically separated and the grief often having to be handled alone.
There is always a lonely component to grief, but now most of the grief is left to occur in isolation. The bereaved do not have their usual social networks to rely on, and may find their network is already too overwhelmed in trying to adapt to a COVID-19 life to recognise and meet the needs of the bereaved.
Traumatic grief
For those with unresolved traumatic losses in the past, or where the current COVID-19 bereavement was sudden and traumatic, a more intense grief reaction may occur.
Unlike a typical grief which gradually subsides, complex grief persists for a considerable length of time. Traumatic grief is associated with the trauma symptoms of intrusive memories of the deceased, or the way the death took place, avoidance of reminders of the distressing events and a heightened sense of threat.
When the death is traumatic, it is associated with prolonged grief with a preoccupation with the loss and a constant yearning for the deceased.
Maintaining the rituals in a COVID-19 world
The lack of the normal rites and rituals around death have been severely curtailed by the need for separation to prevent the spread of COVID-19. The UK is blessed with people from many cultures, each of which will have its own cultural and religious rituals.
In many groups the preparation of the body for burial or cremation often involves the family washing and wrapping the body in a shroud. There may be rules about the timing of the funeral or distance a body can be taken. There may be special body viewing and visits to the grieving family.
There has been an increase in humanist and woodland burials where the rituals will often be tailored to the wishes of the family and friends of the deceased. Whilst the threat of infection is high, many of these other rituals will not be permitted; including attendance at the funeral being restricted to close family members. However, the use of live streaming of the burial or cremation can allow mourners to attend, albeit remotely.
Memorial meetings on the anniversary of the death may also help to mark the loss at a time the family may be feeling particularly in need for support.
Helping and supporting
We should remember that the numbers or statistics mentioned when we talk about the amount of people who have died from COVID-19 are not statistics in the heart of somebody who has lost a loved one.
In difficult times where large numbers of people are dying, we need to continue to provide support and remember that each death that happens before its time is a tragedy. Social support is important and becomes more important following a COVID-19 death.
To be helpful, all channels should be used to maintain contact with the bereaved. Grief takes a long time and support is often too short. We expect too soon that life will be back to normal with the bereaved feeling much better. Keeping in touch on social media or by phone can be incredibly helpful and important as the bereaved look for a new way of being.
How can the emergency and social services help?
During the COVID-19 maelstrom the multi-agency teams perform a vital role in supporting those most deeply affected. Even with the best intentions it is possible to get things wrong.
This possibility is increased as the teams become tired and emotionally distressed by the volume and nature of the work. The following do’s and don’ts will hopefully assist.
Do’s:
- take your time - when calling on a vulnerable person or the bereaved give the time needed to demonstrate care
- listen to the story - talking is important for the distressed, use active listening to show you understand
- provide information - make sure you have relevant written information and guidance to share
- be creative - although there are strict rules on not spreading infection, find ways to make a difference
- show respect - people may have strong religious or other beliefs. Be respectful of what matters to them
- accept the depth of their sorrow - grief for some is worse than physical pain, acknowledge the pain they experience
- have patience - distress makes it difficult for people to think straight, be patient and allow time for answers.
Don’ts:
- make assumptions - everyone behaves differently when distressed, there is no normal response to grief or COVID-19
- blame you or others for failing - hear them out, and accept what is true and recognise this response as frustration
- make promises you cannot keep - be realistic in what you can offer
- dismiss values and beliefs - people may express harmful thoughts or behaviours, check if they are at risk of suicide
- don’t forget the children - make sure that children are involved and their needs to understand are met
- put yourself or your colleagues at risk - make sure you always maintain safety standards and procedures
- expect to make things better - recognise you cannot stop the pain, but you can help reduce it a little.