Bereavement guide for managers and staff
What is the purpose of this document?
People grieve in different ways and there is no right or wrong way to react to the death of a colleague, friend or family member, many people find it helpful to reach out and talk to someone about how they are feeling, and others may wish to deal with their loss in private.
Some of us can find it difficult to know how to respond when a colleague is bereaved, so we have created this bereavement guide for managers and staff.
The purpose of this guide is to:
• understand what grief is and the symptoms
• ensure staff are supported in times of need
• provide tips for Managers and colleagues
• provide tips for having sensitive conversations, and
• promote the support contacts available
Support for individuals going through bereavement
What is grief?
Grief is a natural response to loss. It is the emotional suffering you feel when something or someone you love is taken away. Often the pain of loss can feel overwhelming. You may experience all kinds of difficult emotions and it is important to know that this is OK.
The grieving process
The process of grieving is a highly individual experience, not one person’s will be the same as another. How you grieve will depend on many factors, including your personality and coping style, your life experiences, and your faith.
The grieving process will take time. Healing happens gradually and there is no “normal” timetable for grieving. There is no pattern when it comes to grieving, these are just some of the emotions that people can feel.
Although we all experience bereavement differently, it may be reassuring to know the emotions of grieving and how people may feel – Bowlby and Parkes (1970) Model outlines this.
Shock and numbness
This is the phase where there is a sense the loss is not real and seems impossible to accept. There is physical distress during this phase, which can result in somatic symptoms. If we do not progress through this phase we will struggle to accept and understand our emotions and communicate them. We will emotionally shutdown and not progress through the phases of grief.
Yearning and searching
In this phase we are acutely aware of the void left in our life from the loss. The future we imagined is no longer a possibility. We search for the comfort we used to have from the person we have lost and we try to fill the void of their absence. We may appear preoccupied with the person. We continue identifying with the person who has died, looking for constant reminders of them and ways to be close to them. If we cannot progress through this phase Bowlby and Parkes (1970) feel we will spend our life trying to fill the void of the loss and remain preoccupied with the person, we have lost.
Despair and disorganisation
In this stage we have accepted that everything has changed and will not go back to the way it was or the way we imagine. There is a hopelessness and despair that comes with this, as well as anger and questioning. Life feels as though it will never improve or make sense again without the presence of the person who died. We may withdraw from others. Bowlby and Parkes (1970) suggest that if we do not progress through this phase we will continue to be consumed by anger, depression, and that our attitude toward life will remain negative and hopeless.
Re-organisation and recovery
In this phase your faith in life starts to be restored. You establish new goals and patterns of day-to-day life. Slowly you start to rebuild, and you come to realize that your life can still be positive, even after the loss. Your trust is slowly restored. In this phase your grief does not go away nor is it fully resolved, but for Bowlby and Parkes (1970) the loss recedes and shifts to a hidden section of the brain, where it continues to influence us but is not at the forefront of the mind.
Impact of grief
While loss affects people in different ways, there are some impacts that a lot of us may experience when grieving. Please remember that these are normal and it is okay to not be okay.
Emotional
Shock and disbelief
Sadness
Guilt
Physical
Fatigue
Nausea
Lowered immunity
Anger Weight loss or weight gain
Fear
Aches and pains
It is important to take extra care of yourself during the mourning and bereavement process. Most people find that it takes a long time before they start to feel okay after the death of someone very close. There are no rights or wrongs to grieving – you feel what you feel, and it may not appear logical.
Don’t try to fit in with other people’s expectations – do things at your own pace.
Some final things to remember
At first:
• take it easy for a while
• take extra care of yourself – get plenty of rest and sleep
• don’t drink extra alcohol, it tends to make your symptoms worse
• spend time with people who support you
• take time and care in what you do – accidents tend to happen more easily after a trauma because you are in a distracted state of mind, and
• don’t expect an immediate return to how you were before.
Moving forward, don’t expect too much of yourself but do:
• return to your usual activities as soon as possible
• express your feelings with those who are supporting you
• make a mental note of the good hours and days – as time goes on your symptoms will come less often and they will be less acute. This will tell you that you are recovering.
Trying to return to a new normal
Within a few days or weeks, you will find yourself wanting to take steps to get back to your normal routine (if you can).
As the memory of the death becomes less present, it is normal for memories to become stronger if they are triggered. This could be by having to make statements or hearing about a similar incident or hearing a song on the radio that reminds you of the person who has died, visiting a place you visited together, at and around the time of the anniversary of the death, birthdays, and special occasions. This does not mean that the thoughts and feelings are permanently returning – they will subside again.
Support for anyone who has experienced bereavement
Bereavement support is available from your manager, the People Advisory Team, bereavement support cafés and the chaplaincy team.
Personal bereavement:
HELP (Employee Assistance Programme): For confidential, independant and unbiased information and guidance from a team of trained wellbeing and counselling practitioners.
Tel: 0800 047 8843
Website: https://sath.workplacewellbeing.com and https://sath.optimise.health
Bereavement of a patient or colleague: Should you or your team be impacted by the death of a patient or colleague support is available via the Staff Psychology Service:
Website: https://intranet.sath.nhs.uk/Staff_Psychology/individual.asp
Email: sath.staffpsychology@nhs.net
The Trust Chaplains
The Chaplains offer a Dial-A-Priest/Chaplain Service for anyone needing a confidential listening ear. You can call Switchboard and ask to speak to a Chaplain or call 3638 at RSH, or 4519 at PRH or email sath.chaplaincyteam@nhs.net. They also hold information for contacts of other faiths or no faith.
Bereavement cafe
We started our staff bereavement support cafes in May 2022. The bereavement support cafes have the person’s safety at the centre of all we do. These are held on both hospital sites 6 times a year, and cafes are also arranged during Dying Matters Awareness Week (May) and National Grief Awareness Week (December) each year. For more information contact jules.lewis@nhs.net.
The staff who attend these sessions have already sought support from trained staff and are given a safe space to be heard, supported and can be signposted and helped as appropriate if the individual would like further support.
We recognise that staff will be at different stages of their grief & for some it may be too soon to attend a cafe without additional support– everyone is different and we respect the differing needs of individuals.
The cafes have evolved and the group who attend are happy to give peer support to others if that is welcomed by the individuals.
The cafes are a safe environment, cake and hot drinks are provided free & there are additional helpful resources.
The NGAW December cafe also offers staff an opportunity to write down a message on a love/hope tag that they can keep or attach to their Christmas tree or any other faith memorial.
We are evaluating the sessions/cafes to ensure they are helpful to individuals and would welcome feedback.
Optima Health – Occupational Health
Your manager can make a referral to the Trust’s Occupational Health services for advice and guidance on how best to support you.
Trade Union colleagues
You can also speak to your trade union or staffside reps, who can direct you to local support offers and help you talk to colleagues about what has happened.
A list of national support can be found on page 13.
The Good Grief Trust Plaques
The Good Grief Trust recently launched a new national initiative ‘Sit with Hope’, with the aim to help improve awareness and signposting to bereavement services.
Ward / Department cafes can also be arranged if appropriate for a specific area to remember a colleague.
This initiative will see benches and seats across the UK, with a plaque fixed onto them. The plaque has a QR code which will direct people straight to the Good Grief Trust Website. This will enable anyone who is grieving and looking to find advice and support following a bereavement, to be able to find help and hope in one place.
For more information, help and support contact: jules.lewis@nhs.net
SaTH’s Swan Fund has funded 25 plaques to be placed on our benches at SaTH on both sites. If you find yourself needing support, please do take the time to visit these benches and take the time and space to access a wealth of advice and resources.
There are plans for a memorial garden to be at PRH in the future. For more details contact jules.lewis@nhs.net
Memorial Garden
A memorial garden has been designed and opened at The Royal Shrewsbury Hospital; this planted area with benches allows staff to take time out of their busy lives, to sit and reflect.
A plaque can be installed in memory of deceased colleagues who have dedicated their services to SaTH. If you would like this to be arranged to remember a colleague, we ask the Manager of the Ward / Department to gain permission from family and once gained then contact sean.roberts4@nhs.net.
A colleague’s guide on how to approach sensitive conversations
The key message here is to check in and where appropriate, acknowledge the bereavement and continue to support the individual.
It can be difficult to know what to say to a colleague who has suffered bereavement. Here are some tips to help you. Its best to say something than nothing at all. Don’t let fear of saying the wrong thing stop you from saying something.
Do
• Create a safe place to talk where you can avoid interruptions
• Plan and consider your wording and phrases to aid clear communication
• Acknowledge the situation
• Express your concern
• Let the bereaved talk about their loved one who has died
• Be genuine in your communication
• Be willing to sit in silence
• Offer your support
• Show compassion and empathy
• Ask them how they are feeling
Do not
• Too quickly jump in with a story of your own loss
• Be afraid of silence or try to unnecessarily fill the gaps
• Make assumptions or comparisons – everyone’s experience is different and how the person will behave
• Be afraid if someone gets upset or is crying. Sit with them and offer comfort if wanted
• Dominate the conversation or push them to talk if they don’t want to
• Assume that because someone seems to be coping they are, or that they don’t need your help
• Act as if nothing has happened or avoid talking about the person who has died. It can be painful when people act as though the person who died never existed.
• Get offended if they reject your support. Respect their decision but be there for them if they change their mind.
• Expect to make things better: recognise you cannot stop the pain, but you can
help reduce it a little.
• Say “I know how you feel” or “Everything will be ok”
• Say anything that reinforces a myth – “Don’t be sad, replace the lost”
• Say anything that is about you, not them
Death by suicide or a traumatic death
Bereavement due to a death by suicide, of a family member, carer, friend, colleague or acquaintance, can be incredibly traumatic for an individual and, alongside grief, can lead to feelings of guilt that you weren’t aware of how someone felt, or upset that the person did not feel able to reach out to you for help.
Bereavement by suicide has similarities to bereavement due to other causes but also differences. Understanding these differences can help you to appropriately support your colleague. The grief associated with death by suicide is often complicated and may last longer than that associated with other types of bereavement. Individuals may experience:
guilt
anger
shame
rejection
sadness
fear
suicidal thoughts
For colleagues who have experienced a bereavement through a traumatic death (for example a murder or manslaughter), this type of bereavement can leave colleagues feeling lonely, frightened and isolated, as if no one understands their pain and grief. It is important that line managers support those bereaved by trauma in a compassionate and informed way and feel confident in signposting colleagues when necessary.
They are also at risk of developing symptoms of post-traumatic stress, experiencing flashbacks or nightmares if they witnessed the death or found the person who has died, or being unable to stop imagining what happened.
Bereavement by suicide may leave people feeling isolated as others may avoid them, not knowing what to say or being worried about upsetting the person. This sense of isolation may be particularly acute if the bereaved person perceives others to be judgemental or uncaring. Alternatively the bereaved individual may avoid contact with others as they may find it difficult to share their feelings, don’t want to upset others, or may be concerned how to answer questions about the loss.
As a manager what can I do to support?
Prior to bereavement
In some circumstances, the death of a loved one is expected and your colleague may require adjustments to their roles and working patterns to allow them time to prepare for it.
This may include but is not limited to
• short or longer term adjustments to working hours or patterns
• leave (paid or unpaid special leave/parental leave/short notice annual leave/time off to attend appointments), and
• career breaks
At the time of notification
Whilst there is some key information managers will need to ask a bereaved person, it is important to recognise that they may be feeling numb or distressed during this initial conversation and may not be able to take in or provide much information.
A follow-up call or email may be appropriate, and a template letter is provided for your use as part of this guidance, see Appendix 1 on page 17.
A calm, empathetic approach in all communications from managers will ensure employees feel supported and minimise their anxiety about returning to work.
If you have not been contacted directly by the employee about their loss but have heard of their loss through other individuals/ways, you are advised to seek clarification about the facts as is reasonably practicable and then make direct contact with the employee.
Note You may not and do not have to cover off all of these bullet points during your first conversation. Concentrate on offering your condolences and offering support when you first make contact.
• Express your condolences
• Assume they will need time off, and make it clear that work should come second
• Keeping in contact, and after the first few days discuss how they would prefer to keep in touch
• Ask them how much they would like you to tell their colleagues about their bereavement, being mindful of confidentiality
• Asking if they are happy for their colleagues to contact them
• Discussing how much time they may need to make arrangements (e.g. organizing a funeral or care for dependants) and to fulfil religious or cultural traditions (if relevant)
• Keep the dialogue open but unpressured
• Tell the staff member about the bereavement support services that we have available & would they like someone from this service to contact them, if so by what means, phone, text, email & when is a better day / time for them
Consider what action needs to be taken if the death is in the media; particularly if the press contacts the workplace or approach colleagues for interview. Note: alert the Communications Team for support if appropriate.
Consider what action needs to be taken if there is police involvement in the death.
When a colleague is ready to return to work
It is possible that a colleague may request a phased return to work or to work flexible hours to help support their transition back to work. In this instance, line managers should remember that each colleague is different and how you support them will vary dependant on their individual circumstance.
Be open to flexible working provisions. Flexible working options can be particularly helpful to bereaved employees in the short and longer term, particularly if the bereavement has led to changes in personal circumstances, such as caring responsibilities.
Bereavement will frequently lead to changes in the personal and financial circumstances of the bereaved employee.
• An employee who loses their partner, for example, becomes responsible for raising their children as a single parent.
• An employee whose sibling dies may take on caring responsibilities for an elderly parent.
• Any death which affects children or vulnerable adults will mean they need increased support from the people who care for them. Bereaved children’s needs
can emerge months or even years after the death, as they understand more about what they have lost and face more changes in their life.
• For parents, the loss of a child will be devastating, and employers will need to recognise that the whole family will be affected.
• A single parent with other children to attend to will possibly need more flexibility (eg time off, flexible working) in order to return to full-time work.
The situation can influence whether the individual needs access to flexible working.
• Be sensitive to requests for time off. It is important to be sensitive to and accommodating of requests for time off where possible, especially around anniversaries or other special memorial events.
When a colleague returns to work after a bereavement
• Talk to the colleague about their wellbeing. Ask how they are and if you can do anything to support them. They may not accept if they have family or friends helping, but ensure they know the offer is always there.
• If they are working a phased return or flexible hours, check in with the colleagues to ensure the arrangement is working for them or if amendments need to be made.
• Listen to them if they wish to talk. If someone opens up to you about how they are feeling, it can be difficult to know how to respond. Actively listening to them can be very helpful.
• Signpost where appropriate. We have collated lots of contacts at the end of this document and further support can be found on the wellbeing page on the Intranet (If you need help and support with this, please contact l.westcott@nhs.net, Health and Wellbeing Lead).
• Don’t leave the staff member to their own devices, when you are bereaved, you may not have the energy to reach out, we as managers need to reach in and help and support.
• An individual often has a lot of support from the people around them in the first days and weeks of their loss, however sometimes the support can fade away. Consider making a reminder note to check in with the individual at intervals as grief can continue for a long period of time.
• Particular care should be taken where the work itself involves dealing with death or bereavement, for example those working in Palliative Care, End of Life and Bereavement Care. The bereaved employee may find that their capacity for working resiliently may be reduced by a personal experience of loss.
• Special or significant days, such as the inquest, anniversary of the death, or the birthday of the person who died, can also be particularly difficult times for
bereaved people. Sensitivity around these times, particularly when considering requests for specific days off, will help employees to manage their grief.
• Over a year, a bereaved employee may breach company sickness limits. Employers should consider whether it is appropriate to exclude some, or all of the time off associated with the bereavement. Similarly, it would be good practice to take the bereavement into account should there be an impact on any aspect of the employee’s work or performance irrespective of any ongoing issues between the employer and employee
• Help is at Hand booklet
• OptimaHealth (occupational health)
• MPFT Psychological Hub
e: jules.lewis@nhs.net ext 3464
e: sath.staffpsychology@nhs.net
Additional resources which may be of use:
Further information: Swan End of Life Care
Facilitator / Lead Nurse & Lead for Staff Bereavement Support
Please make your People & OD Business Partner aware of the bereavement so they can assist in offering support
Individual psychological support available if needed via Staff Psychology Service
Psychological debrief provided by Staff Psychology Service if appropriate
Bespoke Bereavement Support Café and Chaplaincy Team support offered if needed
Additional information to consider should a member of staff be bereaved by suicide: The Bereavement Guide for Managers contains a section on bereavement by suicide
If the need for more in-depth support is identified signpost staff to: MPFT Psychological Wellbeing Hub (all staff) Phoenix Psychology (medical staff only)
Manager links in with Staff Psychology Service to discuss options for support (1:1, team)
Manager has initial conversation with the team (consider who needs to be informed, what information can be shared, normalising a variety of reactions, highlighting sources of support –use Managers bereavement booklet) Link in with People & OD Business Partner/ People Advisory team
DEATH OF A COLLEAGUE
Individual psychological support is available if needed via Staff Psychology Service
Consider whether a bespoke Bereavement Support Café and Chaplaincy Team support might be helpful for the team (eg longer term patients)
Chaplaincy Team support (available if needed) Multi-faith team providing religious, spiritual and pastoral care along with practical help with funerals and aftercare
Initial conversation with member of staff to take place with Jules Lewis (for 1 to 1 support) before considering attendance at a staff bereavement support café to discuss what support is available and screen for appropriateness
Bereavement Support Café
Psychological debrief provided by Staff Psychology Service if needed
Make sure everyone is invited (consider non-clinical staff such as porters)
Hot debrief takes place –ideally on the same shift
DEATH OF A PATIENT
Bereavement Support for Staff
Use Bereavement Guide for Managers and Staff Link in with People Advisory team if needed
Manager has initial conversation with the staff member normalising a variety of reactions, highlighting sources of support
PERSONAL BEREAVEMENT
Local and national help lines
National Support during Covid-19
Access to a free national confidential bereavement support line, operated by Hospice UK, available from 8am to 8pm, seven days a week. Telephone 0300 303 4434.
Access to a suicide support mental health app (Stay Alive by the charity Grassroots) to support those experiencing suicidal ideation or those concerned about others.
Guidance on how to be a good leader during times of bereavement and a selection of resources for further learning and to support our colleagues facing bereavement.
people.nhs.uk/guides/bereavementsupportduring-covid-19
General
The Good Grief Trust
They bring bereavement services together, to ensure that everyone receives the tailored support they need to move forward with their lives (over 900 organisations/charities)
www.thegoodgrieftrust.org www.twitter.com/goodgrieftrust www.facebook.com/thegoodgrieftrust
Cruse Bereavement Care
Offers telephone, email and website support for bereaved people.
0808 808 1677 www.cruse.org.uk
Bereavement Advice Centre
Supports bereaved people on a range of practical issues via a single freephone number. It offers advice on all aspects of bereavement from registering the death and finding a funeral director to probate, tax and benefit queries. Welcomes not only from those who have been bereaved but the professionals and volunteers that support them
0800 634 9494 www.bereavementadvice.org
Support for Children
Child Bereavement UK
Helps children and young people (up to the age of 25), parents and families rebuild their lives when a child grieves or dies.
0800 02 888 40 support@childbereavementuk.org www.childbereavementuk.org
Winston’s Wish
Helps children and families after the death of a parent, sibling or carer.
08088 020 021 ask@winstonswish.org www.winstonswish.org.uk
After the loss of a child
Compassionate Friends UK
Provides support bereaved family members who have suffered the death of a child or children of any age and from any cause.
0345 123 2304 helpline@tcf.org.uk www.tcf.org.uk
The Child Death Helpline
Provides a freephone service to anyone (parents, grandparents, siblings, family members, friends or involved professionals) affected by the death of a child of any age.
0800 282 986 or 0808 800 6019 (if calling from a mobile) contact@childdeathhelpline.org www.childdeathhelpline.org.uk
Daddys with Angels
A social network for men after the death of a child or children, including miscarriage, stillbirth, and adult children.
www.daddyswithangels.org
Rosie Crane Trust
Provides support to bereaved parents after the loss of a son or daughter of any age through a helpline, dropin centre, befriending service and subsidised counselling.
01460 55120 contact@rosiecranetrust.co.uk
Miscarriage, stillbirth or Sudden Infant Death Syndrome
SANDS
Stillbirth and Neonatal Death Charity –supports anyone affected by the death of a baby.
020 7436 5881 or 0808 164 3332 helpline@sands.org.uk www.uk-sands.org
Petals
Supports parents after the death of a child during pregnancy or birth. Support includes up to 6 hours of free grief counselling. www.petalscharity.org
The Lullaby Trust
A charity that provides specialist support for bereaved families who experience the sudden loss of a baby, promotes expert advice on safer baby sleep and raises awareness of sudden infant death.
0808 802 6868 support@lullabytrust.org.uk www.lullabytrust.org.uk
Infertility
Fertility Network UK
Fertility Network UK provides free and impartial support, advice, information and understanding for anyone affected by fertility issues.
Info Line: 01424 732361
Support Line: 0121 323 5025 www.fertilitynetworkuk.org
British Infertility Counselling Association (BICA)
The BICA are a registered charity and the only professional infertility counselling Association recognised by the Human Fertilisation and Embryology Authority and the British Fertility Society in the UK.
www.bica.net
Resolve
The National Infertility Association is dedicated to ensuring that all people challenged in their family building journey are supported.
www.resolve.org
Suicide
Samaritans
A suicide prevention charity that provides telephone, face to face and email support.
116 123
jo@samaritans.org www.samaritans.org
Survivors of Bereavement by Suicide (SOBS)
A helpline, support groups and retreats for people over 18 years of age who have been bereaved by suicide, including specific help for LGBT+ people.
0300 111 5065 email.support@uksobs.org www.uksobs.org
Suicide Bereaved Network
Online forum and directory of support groups and grief counsellors for people who have lost a loved one to suicide in the UK.
0300 999 0003 support@sbnwk.org.uk www.sbnwk.org.uk
Support After Suicide Partnership
A special interest group of the National Suicide Prevention Alliance focusing on supporting those bereaved or affected by suicide. www.supportaftersuicide.org.uk
Help
is at Hand
The Support after Suicide Partnership is the UK’s hub for organisations that support people who have been bereaved by suicide; who work together to achieve the Vision that “Everyone who has been bereaved or affected by suicide is SASP offered timely and appropriate support”
Booklet www.supportaftersuicide.org. uk/resource/help-is-at-hand
LGBTQ+
Switchboard LGBT+ helpline
A helpline for LGBT+ individuals that takes calls 10am to 10pm on any issue 365 days a year, on any issue, including bereavement and grief.
0300 330 0630 chris@switchboard.lgbt www.switchboard.lgbt
Useful books
Bereavement – A practical guide for NHS Managers by Jules Lewis, Roy Lilley and Jules Lock (2019).
The Plain Guide to Grief by Dr John Wilson (2020).
Supporting people through loss and grief: An introduction for counsellors and other caring practitioners by Dr John Wilson (2013).
The Grief Recovery Method Handbook 20th Edition by W. James & Russell Friedman (2009).
The Grief Garden Path by Julie New (2019).
And many more all available at SaTH’s Library.
Appendix 1: Template letter to employee following their loss
Dear [insert name]
I wanted to write to you on behalf of everyone in the team to express our sadness at hearing of the loss of [insert name and/or relationship]. We all want to extend our deepest sympathy to you and your family at what must be a difficult time for you all.
[If the member of staff is taking some time off work] As discussed, you are not expected to work, and you must take what time you need, and I will stay in touch with you by phone/email as agreed [delete as appropriate as to what has been agreed].
Please be reminded of the support that is available to you through HELP who are professionally qualified Counsellors and Information Specialists, who are experienced in helping people to deal with all kinds of practical and emotional issues. They can be contacted on 0800 047 8843 or going to https://sath.optimise.health / https://sath. workplacewellbeing.com/
I can also refer you to our Occupational Health service, Team Prevent, who can provide advice and guidance, so please let me know if you would like me to make this referral.
I attach a list of organisations who can support you at this time, see Appendix C information and a list of support available in the community, see Appendix D information.
I attach for your information a copy of our Leave Policy Chapter 4: Maternity Leave Procedure. [Depending on the circumstances, attach the maternity policy which covers Stillbirth and Miscarriage].
I enclose a copy of our Leave Policy Chapter 8: Special Leave Procedure.
Whilst we have discussed how we will stay in touch, please let me know if there is anything I or anyone at SaTH can do to support you and your family through this difficult time, or if you would just like to talk to someone, please do not hesitate to contact me.
Yours sincerely Managers
Name
Job Role
Enc Support Information
Community Support Information
Leave Policy Chapter 4: Maternity Leave Procedure [delete as appropriate]
Leave Policy Chapter 8: Special Leave Procedure.
Help and hope is available
Please remember there are people you can contact to support you to find the best support for the bereaved staff member, don’t leave it to chance lets support every staff member who is bereaved to make our organisation the safest and kindest it can be, at the hardest of times for our valued staff.
Publish date: August 2023