HNC Social Care Grief & Loss Essay
HNC Social Care Grief & Loss
Grief is a natural response to a major loss, though often deeply painful and can have a negative impact on your life. Any loss can cause varied levels of grief often when someone least expects it however, loss is widely varied and is often only perceived as death. Tugendhat (2005) argued that losses such as infertility, miscarriage, stillbirth, adoption and divorce can cause grief in everyday life. Throughout our lives we all face loss in one way or another, whether it is being diagnosed with a terminal illness, loss of independence due to a serious accident or illness, gaining a criminal record (identity loss), losing our job, home or ending a relationship; we all experience loss that will trigger grief but some experiences can be less intense.
Kubler-Ross (2005) argued that there were five stages of grief, these being the following stages: ‘Denial, Anger, Bargaining, Depression and Acceptance’. She believes these five stages of grief are part of the framework that makes up our learning to live with the one we have lost and feels these stages make people better equipped to cope with life and loss. She states that they are not tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or goes in a prescribed order (Kubler-Ross et al., 2005). A description of Kubler-Ross’ five stages of grief are: Denial – on first hearing of the death there may be disbelief. The person may hang on to the hope that the deceased will walk in as normal. Numbness and shock may also be felt.
Again, this particular process can be applied to any kind of loss not just death. Anger – the strength of the pain results in anger; this anger can be directed at anyone, including self anger where the bereaved person blamed themselves. Bargaining – some people may try to negotiate with another person or with god to be given another chance, to be able to go back to how things were before. Depression – once the person starts to absorb the full truth they may become deeply saddened. There can be intense feelings of loneliness and hopelessness. The person may be tearful over minor matters and find minor matters hard to deal with. They may have no energy for routine activities. Acceptance – There is no requirement that the deceased person is forgotten, but the bereaved person needs to recognise the truth of their situation and to gradually release their emotions. They need to realise they can still carry on even if they still feel the loss of their loved one. (Kubler-Ross et al., 2005)
In contrast to the five stage recovery model introduced by Kubler-Ross (2005), Wright (2011) introduced a seven stage recovery model. Wright, like Kubler-Ross, believes that losses need to be grieved before individuals can heal and move on and that it is important to interpret the stages loosely, and expect much individual variation. Both believe there is no neat progression from one stage to the next. They argue that in reality, there is much moving back, or stages can hit at the same time, or occur out of order. A description of Wrights’ seven stages of grief are: Shock & Denial: A numbed disbelief occurs after the devastation of a loss. A person may deny the reality or gravity of their loss at some level to avoid pain. Shock provides emotional protection from being overwhelmed all at once. This may last for weeks. Pain & Guilt: Shock wears off and replaced with suffering of excruciating pain. It’s important to experience the pain fully and not numb it artificially.
Anger and Bargaining: Frustration leads to anger. Uncontrolled, it can permanently damage relationships. May result in trying to negotiate with one’s self (or a higher power) to attempt to change the loss that has occurred. Depression, Reflection & Loneliness: A long period of sad reflection overtakes a person and the magnitude of the loss sets in. The Upward Turn: Life becomes calmer, more organized as one starts to adjust to life with the loss that occurred. Reconstruction & Working Through: As a person starts to become more functional, realistic solutions seem possible for life after the loss. Acceptance & Hope: The last stage – a person learns to accept and deal with the reality of their situation. A person is more future-oriented and learns to cope. (Wright, J. 2011)
During the time I have been employed within social care I have worked in conjunction with various organisations who offer support to individuals experiencing grief and loss. Victim Support Scotland is an organisation I have recently referred one of my cases to who has suffered a loss. My service users father was subsequently murdered following a drug related crime, the incident was reported on nationally and images were published on the internet and papers. My service user (who I will name as Ben for the purposes of confidentiality) is a 14 year old male, he maintained a close relationship with his father albeit did not live in the same house as him due to his parents divorcing. Following the death, Ben appeared to pursue his life as normal and at no point showed any emotion for his loss. However, 5 weeks later his mother informed me that Ben began to spend much of his time researching his father’s name using Google and started to keep his father’s belongings in his bedroom.
He started to become increasingly emotional stating he didn’t understand how his father died and on several occasions left school to return home. After referring Ben to Victim Support Scotland and CAMHS, I offered him a rehabilitation program for bereaved children and young people called Winston’s Wish. The service is a charity specifically tailored to rehabilitate and support, children and young people who have suffered a traumatic loss. The service is a residential rehabilitation unit and each program is conducted over 7 days, this gives all young people the opportunity to discuss their loss with other young people in their position or similar. The program is specifically designed using activities and sports to put each individual at ease and to help everyone engaged with each other. Support After Murder And Manslaughter (SAMM) is another charity I have used, SAMM offers support specifically to individuals who have suffered a loss through murder or manslaughter.
SAMM has offered me as a practitioner great support, advice and guidance on how to support individuals who have suffered a loss through these circumstances. They offer group support and one to one support as well as telephone support, they also have a secure forum that only people who have suffered these particular losses can access. This gives individuals an area where they can discuss their experiences at their leisure. The Compassionate Friends is a charity that supports parents who have experienced the death of a child of any age from any circumstances. This service offers counsellors and support workshops to help parents cope with their loss, similar to The Samaritans charity. The Samaritans is another charity that can be used as a support service for anyone experiencing any kind of loss and grief where they feel support is required.
Similar to other services they have a helpline and counsellors to help implement support packages and support individuals with the recovery process. The Miscarriage Association provides support and information to anyone affected by pregnancy loss, using: helpline, email support, forum, leaflets and regional support (Scotland, England and Wales) from people who have been through pregnancy loss themselves. They do not offer counseling sessions however, they can refer people to the correct professionals where this can be sought. The Miscarriage Association charity also provides support to practitioners working with women and partners who have been affected by a pregnancy loss.
Having spent the majority of my career working with young people and families who are involved in the care system, whether it is residing in residential or foster care I have taken a keen interest in how they feel during the transition process of their life moving from care into adulthood. From research young people leaving care are one of the most vulnerable groups in our society and often go through a grief and loss process when leaving care: they are three times more likely to be cautioned or convicted of an offence they are four times more likely to have a mental health disorder they are five times less likely to achieve five good GCSEs, eight times more likely to be excluded from school and less likely to go to university one in five homeless people are care leavers
(DfES, 2007, Care Matters: Time for Change)
From the statistics above there is clear evidence that leaving care for a young person is traumatic and leaving care often has some impact on their life. One of the main challenges, I have observed from my experience working within child care transitions, is that young people often find the challenges of supporting themselves and no longer having the ‘safety net’ feeling of support from their care workers very overwhelming. A young person (who I will name as Adam for the purposes of confidentiality) I worked with for a long period of time was very upset and showed clear signs that he was experiencing loss and grief when leaving residential care. Adam found it extremely difficult to cope emotionally and physically with the transition process of leaving care. My organisation offers a support package to young people who are leaving care, the package allows the staff team the young person has been working with to support them in their new accommodation for a short transition period.
Adam felt supported and safe whilst in residential but felt leaving care would be like returning to the violent and abusive family he was raised in as this was his only experience out of care. Prior to leaving care I supported Adam by enrolling him on a college course, developing an extensive supported living care plan and gave him additional responsibilities throughout his transition period to help him to cope with the responsibilities of life out of care. After leaving care I visited Adam and offered my support by allowing him to contact us via telephone and letter if he wished to do so to help him with the grief and loss process. For many weeks after leaving care Adam kept in touch daily by calling us and updating us on his life out of care, being there and showing support to Adam was enough for him to still feel supported and comfortable.
Eight month on and Adam has accepted his life out of case, he still maintains contact with his staff team from care and has maintained his college attendance. He continues to live a happy and ambitious life who after several months of leaving care didn’t think it was possible to live out of care. Adam has realised society have accepted him and with the support he has been given during the transition process has gave him the skills and confidence to cope and therefore made the grief and loss process of leaving care easier.
All residential child care organisations have specific legal policy and procedures to follow in the event of a death of a child in their care. A Glasgow City Council study suggested that almost half the children in their residential care setting had harmed themselves deliberately (Piggot et al, 2004). An analysis of the figures collected by the Social Work Inspection Agency (SWIA) shows that at least two children in care have died from suicide every year since 2000. There is evidence that the number of suicides among care leavers is much higher than those in care (Cowan, 2008). Most deaths now take place in a hospital or nursing home. If someone dies in hospital, a member of the medical team will contact the person’s family. The body will then be taken to the hospital mortuary, where the body will be stored until the family arrange for the body to be collected by funeral directors.
Before the body is taken to the funeral directors chapel of rest the hospital staff will usually collect the person’s personal possessions, such as jewellery. Before someone can be formally registered dead, a hospital doctor or their GP will need to issue a medical certificate stating the cause of death. The family will be given a notice, explaining how to register the death; it is a criminal offence not to register a death. A hospital may ask the families permission to carry out a post-mortem examination to learn more about the cause of death, the family does not have to agree to this! In some cases, a doctor may not be able to issue a medical certificate, in such cases they will refer the death to the Procurator Fiscal for investigation.
It is most common for the Procurator Fiscal to be involved if someone dies unexpectedly or under suspicious circumstances. When someone dies at home, their GP should be contacted as soon as possible and will normally visit the deceased’s home. If the death was expected the GP should be able to issues a death certificate giving the cause of death, however if the person doesn’t have a GP or the name of the persons GP is unknown, an Ambulance should be called. If someone dies unexpectedly or under suspicious circumstances in their own home the Procurator Fiscal would carry out the investigation, the procedures for this are the same if someone dies in a care/nursing home.
There are considerable differences surrounding death in Britain today and how death was viewed during the Victorian Era. The Victorians dealt with death as part of their everyday life, dying was common at all ages and often people died in their home surrounded by family and friends. However, today death has become remote and this has a contribution to the difficulties surrounding people coping with death today. During the Victorian Era three of every twenty babies died before their first birthday, and those who survived infancy had a life expectancy of only forty-two years (Douglas, 2002). Over the past century there has been a considerable decrease in the rates of morbidity and mortality, attitudes began to change as mortality rates declined and life expectancies rose.
Death rates fell between 1750 and 1820 from 26 to 22 per 1000 in England and in Scotland from rates possibly as high as 38 to 20 per 1000 in 1855 (Wrigley and Schofield, 1981). Maternal and infant mortality were known risks of pregnancy, families were larger and many generations were raised within the same household. During Victorian times, the family would be responsible for cleaning and preparing the body for burial and the body would be stored at the family home until the funeral. In Britain today this would not be the case, depending on religion, the deceased would be transported to a mortuary if examination was required, otherwise it would be stored at a funeral directors. The funeral parlour is now responsible for cleaning the body and preparing the body for burial, the family of the deceased have the opportunity to select their loved ones clothing when they are lay to rest. Today there is no restriction on who can attend a funeral, an individual’s sex plays no part on whether they attend a funeral or not, however during Victorian times only men attended funerals and the gravesite.
Christian beliefs vary, however my focus will be on the Catholic beliefs and rites of Christianity. In the Roman Catholic Church, a priest will anoint the person with holy oil as a preparation for death, this is called Last Rites. When a person dies their body is placed in a coffin. Sometimes this coffin is left open so that relatives can say a final goodbye. The coffin is then usually taken to a church or chapel. Here a priest will read from the Bible and a service will be held to celebrate the person’s life. The priest will also say a few words about the person which are designed to comfort the mourners and then say prayers, hoping that the person will now be in heaven. In a Roman Catholic church there will be a special Eucharist called a Requiem Mass where prayers are said for the dead person’s soul. The coffin is taken from the church, either for burial or cremation after the service which mourners can attend (Dickerson et al., 2006).
In the past many people did not approve of cremation, only in the last 50 years cremation has been granted in Roman Catholic churches. Roman Catholic’s felt that being cremated would mean that the person could not be resurrected on the Day of Judgement. Therefore, cremation for Roman Catholic’s is a very recent change. When a Jewish person dies, the processes for the burial take place as quickly as possible, cremation is not accepted. Jewish people are very strict when it comes to funerals while more progressive Jews are known to have differing attitudes. When a Jewish person dies the body is traditionally left for eight minutes while a feather is place in the mouth or nostrils to detect signs of breathing before being washed and dressed in tachrichim. A tachrichim is a white shroud, men are also wrapped in their tallit (prayer shawl). The fringes are cut off the tallit to show that he is now free of the religious laws. The body is put in a plain wooden coffin which is sealed.
From the time of death until burial, the body is never left alone as many Jews appoint ‘watchers’ this being a person who will stay with the body day or night until the funeral, praying and reciting (Lewis, 2006). Before the burial the mourners make a tear in their garments – the act of keriah – to show their grief. Jehovah Witness is a relatively new religion that was formed in Pennsylvania in 1870. The Jehovah’s Witnesses funeral service is similar to other Christian faiths and usually takes place within a week after death, their service only lasts between 15 and 30 minutes. Jehovah’s Witnesses believe that when a person dies, their existence stops because the Bible states that human beings do not have an immortal soul that survives when the body dies. Witnesses don’t believe there is such a thing as hell, they argue that it would be completely against God’s nature to torture humans for eternity. They strongly believe death is not the end of everything and that each person can be remembered by god and eventually be resurrected.
Witnesses funeral services usually take place in the Kingdom Hall, the Jehovah’s Witnesses place of worship and can often have an open casket for people attending to view the body. The Congregation Elder conducts the service and delivers a talk, the talk highlights the deceased person’s life and any dying thoughts or expressions they may have left. The purpose of the talk is to comfort the bereaved by explaining what the Bible says about death and the hope of a resurrection. Rather than being an overly mournful event, it is a time when family and friends can be reassured of the time when the Bible promises that, thanks to the ransom sacrifice of Jesus Christ, the dead will be raised, and they will see their loved one again. The family can decide whether to have a burial or a cremation following the funeral service (jw.org). Regardless of religion the death of a family member or friend can be extremely painful and often very difficult for family and friends to cope with.
A humanist and new age funeral are funerals that are non-religious, this does not mean to say it is easier or more difficult to cope with, it simply means that the deceased do not have any particular religious belief. A non-religious person is familiar with cremation and burial procedures and will welcome ideas for readings and music. If the deceased writes down what they would like to happen at their funeral and give it to a family member to take lead, this reduces a huge amount of pressure from the family. It is important the person things about the music they would like played and any poems or stories they would like to be read. A humanist funeral is often very person centered, it looks back over the life of the person who has died and celebrates it. The danger with a humanist funeral is you can make religious people feel excluded, however if you include a period of silence in the funeral this give religious people time to have a silent prayer (Cowling, 2010). Officiants are people who conduct a humanist funeral and are generally at least 35 years old, have experience of public speaking, and have probably had experience in nursing, teaching, social work or something similar. Funeral directors are able to make arrangements with trained officiants in their local area.
Cowan, C. (2008) Risk factors in cases of known deaths of young people with experience of care: an exploratory study, Scottish Journal of Residential Child Care. 7 (1).
Cowling, C (2010). Good Funeral Guide, Continuum. New York. p73.
Douglas, A (2002). Victorian Mourning Customs, Pagewise, Inc. Retrieved from http://ky.essortment.com/victorianmouri_rlse.htm.
Kubler-Ross, E and Kessler, D (2005). On Grief and Grieving, London: Simon & Schuster. p7-28.
Lewis, A (2006). Handling Bereavement, Easyway Guides. Brighton. p55-56.
Piggot, J., Williams, C., McLeod, S., et al (2004) A qualitive study of support for young people who self-harm in residential care in Glasgow, Scottish Journal of Residential Child Care. 3 (2), p45-54.
Tugendhat, J (2005). Living with Grief and Loss, Sheldon Press. London.
Wright, J. (2011). 7 stages of grief: through the process and back to life. Retrieved from http://www.recover-from-grief.com/7-stages-of-grief.html
Wrigley, E. A. and Schofield, R (1981). The Population History of England 1541–1871, London.
‘Supporting Individuals Experiencing Loss and Grief’.