Bereavement audio transcript

Bereavement – An NHS self help guide

Who is this guide for?

• This guide is for anyone who has experienced a bereavement either recent or in the past.
• It may also be useful to people facing the certain loss of a loved one. Although it is sometimes hard to face these issues in advance, this can be helpful.
• Relatives or friends of a bereaved person may also find this guide useful.

Coping with bereavement, grief and certain loss

“We really didn’t believe it when we found out the diagnosis. I thought these things only happened to other people, but the time we had to come to terms with it was really precious. We were able to think and plan together. “

“My father died six weeks ago after an 18 month struggle with cancer. Now I can’t get the picture of him at his worst out of my mind. I wish I could remember him as he was when he was well, but I can’t. I feel so guilty; I wish I could have done more…”

“I lost my wife six months ago after 45 years of marriage. She only had a short period of illness during which she never regained consciousness. It was so sudden I don’t seem to be able to cope with it. I keep expecting her to walk through the door. I sometimes feel she is present during the night but I always wake up disappointed…”

“My husband committed suicide earlier this year, and I am left on my own to bring up my two small children. I feel so lonely and isolated. Sleeping is a big problem. At times I feel angry with my husband for leaving me to cope on my own even though I know it wasn’t his fault. Other times I feel completely numb and still can’t believe it. I find it so hard to help the children deal with their sadness when I am grieving too.”

“I don’t think people understand how upset I am about losing my dog. Bobby has been part of our family for 16 years and has seen us through so many ups and downs. It was awful to make the decision to have him put to sleep but I couldn’t bear to see him in such pain.”

These are the experiences of some people who have suffered bereavement.

As you can see, people can have quite different experiences when they lose someone close to them. This guide gives some basic details of what needs to be done when there is a death. It aims to help you understand some of the emotions which may be faced during a bereavement or loss. It also makes some practical suggestions which may help you begin to get through this difficult time.

What practical things need to be done if there is a death?

• When someone dies at home a doctor must be called to sign a medical certificate. You should telephone your local surgery to inform the GP that the death has occurred. If the death happens when the surgery is not open then you can call 111.
• When someone dies in a hospital or hospice, the doctor there will give you a medical certificate.
•  If the death has been sudden, the doctor may have to talk to the police who will report it to the coroner. A post mortem examination may be arranged. This may also be the case if the cause of death is unknown or if no doctor is available who is certain of the actual cause of death.
•  Once you have the medical certificate, you must take it to the register office and register the death within five days. You may need to make an appointment to do this. The registrar will issue a death certificate and a certificate for burial or cremation (often called the green certificate), which should be given to the funeral director. Ask for quite a few copies (at least 6-10) of the death certificate. You will have to pay for these extra copies but you may need these for pension and insurance purposes. The registrar may give you details of the ‘Tell us once facility’, if it is available in your area. This really helpful service informs all government departments of the death to save contacting each separately.
  Details of this and other useful information about registering a death can be found on the government website www.gov.uk/after-a-death.
• A funeral director can be chosen before or after you have registered the death. Many people obtain a name through recommendation or word of mouth. You can also look in the telephone directory for local funeral directors. They can usually be contacted 24 hours a day and will advise on all aspects of the funeral. It is important to choose a funeral director you feel comfortable with. In fact, many people find the support provided by funeral directors to be among the most useful. You should take your time and ask as many questions as you need to about arrangements, for example, when they will collect your loved one, where you can visit the body, as well as funeral costs. They are very used to talking to people in your situation and should be able to help you with any questions or concerns you have.
• Contact your local Department of Work and Pensions (DWP) to arrange pension and other entitlements. You may be eligible for Bereavement Allowance. The Directgov website www.direct.gov.uk provides information about benefit entitlement.
• Inform the tax office about your change in circumstances if necessary.
• You may want to put a death notice in the local or national papers.
• If there is a will, the executors will make sure it is carried out. Contact the solicitor. If there is no will, contact the Probate Registry for an application to administer the ‘estate’. Your local Citizens’ Advice Bureau can help you if you are not sure.

Understanding grief

How do people feel when they have experienced bereavement?

Serious loss is something which we will all face at some time in our lives. This may be because of the death of someone close to us including a much loved pet. Or it may be because of other circumstances such as the loss of a relationship, our health or our home.

Many of us will not experience bereavement or loss until later in life and may have little opportunity to learn about death and about how people are affected by grief. It can be difficult to know what is “normal” and to understand how we or our families respond when we face a loss.

You may think you are the only person who has felt the way you do. Whilst everyone’s response to a loss is a very individual experience, there are some common experiences that many people will share.

How do people feel in the hours and days after the death of a close relative or friend?

People often describe the symptoms of shock soon after the death of a loved one. For example, they may feel numb, panicky, very weepy or unable to cry at all. Some people find it difficult to sleep, others may have physical symptoms such as heart palpitations. Some people find they calmly go through the practical tasks surrounding the death, and worry that they may be seen as uncaring. This is just one of the signs of shock and it is most likely that they will feel the impact of the death at a later point. Some people find themselves completely unable to cope and need a lot of practical and emotional support from those around them at this point.

What sorts of feelings do people have weeks and months after a bereavement?

Please remember that everyone is different. There really are no ‘rights’ or ‘wrongs’ when people experience grief in the early stages.

Some people feel a sense of agitation for quite a long time after the death. They may become very active at this time, doing things like cleaning out the whole house, or going straight back to work when not really ready. This agitation can sometimes amount to anxiety and panic, with symptoms such as breathlessness, palpitations, heavy chest, dry mouth, and dizziness being common.

People may feel they are “going mad” because they have such odd experiences. People often report seeing, hearing or feeling the dead person near them or in the distance. These experiences are not unusual following a death. These feelings may alternate with depression, weepiness, tiredness and low mood.

People may start to wonder “what’s the point in going on?” They may feel guilt, and review the circumstances of the death, and their relationship with the person who died. They may wonder what they could have done differently which might have helped the situation. Guilt is also common when there has been relief at someone’s death following a painful and prolonged illness. It is worth remembering that many people feel relief when suffering ends.

People also often feel angry after a death. This can be directed at the dead person; “why has he left me?”, or at those around. Family members or people involved in caring for the dying person may be the target for the bereaved person’s anger. They might think or ask, “Why didn’t you do more?”

Other people’s reactions may be difficult for the bereaved person. Sometimes people will be clumsy in what they say or do. Occasionally they will avoid contact with the bereaved person. These reactions are usually because people do not know what to do or say in the face of someone’s grief. Sometimes other people do not realise that it can take a long time to begin to recover from a death.

It can be particularly difficult for a bereaved person to help others struggling with the same loss, for example looking after children who have lost a parent, when struggling to cope with the loss of a partner.

When do people begin to recover from bereavement?

Coming to terms with a death is a very individual and gradual process which can take a considerable length of time. People usually find that gradually they are able to get on with their lives and think a little less about the person they have lost. Most people begin to feel like this within one or two years of the death of someone close to them, but this depends on many factors. It may be difficult to accept the death of a loved one but still be possible to move on with life in spite of this.

Sometimes bereavement can be more complicated, particularly in a situation where there has been a difficult relationship. Some bereavements are particularly traumatic, for example where death is very sudden and unexpected, or involves the loss of a child. Bereavement by suicide or homocide are particularly hard to come to terms with, and for this reason people often find it most helpful to turn to others who have had a similar experience for support. Counselling can be helpful for many people who are bereaved, although it is usually worth waiting a few months.

It is important not to feel guilty if you are beginning to build a life for yourself following a death. It is quite normal to begin to recover and start to rebuild your life, and is not in any way disloyal to the memory of the person who has died.
If you feel you are stuck or not coping at all well with your grief then contact your doctor to discuss this.

Can tablets help?

Your doctor may offer tranquillisers, to help through the early phase following the death. They can make you feel calmer and may help in the short term but are not helpful for longer term use. Some people find that the numbing effect of tranquillisers does not allow them to experience grief during this time, and grief is an important part of healing. Antidepressants can be helpful if depression following bereavement becomes severe or prolonged.

What can a bereaved person or someone facing certain loss of a loved one do to help themselves?

Bereavement is always a difficult time, but there are things you can do to help yourself through it.

Before someone dies

• If you have the opportunity, prepare for the death of someone you are close to. It is important emotionally and practically to talk things over. If you are preparing for the death of your partner and it is ok with them, discuss such things as the jobs they do that you will need to take over, finances, wills, funeral wishes etc. Try if you can to say all the things you would want to say.
• Accept practical help if offered. It is sometimes hard to look after yourself when you are caring for someone else. So if friends offer to shop, cook, clean for you – say yes!
• Don’t be afraid to ask for support. People are usually only too glad to help.

Directly after a bereavement

• Carefully consider whether you want to see the body of the dead person. Some people may feel this is too distressing but can regret it later on if they have not done this. Follow your own feelings. There is no right or wrong thing to do, but do think it through.
•  Funeral arrangements should be considered carefully. Try to have someone with you. Don’t feel pressured into a funeral that is too expensive for your budget. Try and think about what you really want. Think carefully when choosing music for the funeral. It may change your feelings about a special song, so make sure you are ok with this.
• Many people find the support of funeral directors or spiritual leaders useful at this time.

In the days, weeks and months following a bereavement

• Do make sure you look after your own health. This is a time when you may become prone to illness including depression. Eat well, rest properly, exercise and take extra care of yourself, for example treating yourself to favourite foods, warm baths etc. This is particularly true if you are bereaved and at the same time supporting others with their loss. You may want to take vitamin supplements if your appetite is very poor. Visit your doctor if your health is not good or you feel your mood is consistently low after some time has passed.
• Do give yourself time to grieve and feel emotions. Its ok to cry and feel sad. This is of course normal. Try to be kind and patient with yourself and accept your feelings, even if you don’t like them. Don’t add pressure by comparing self with others. No-one else can tell you how to grieve or when to stop.
• Do forgive yourself for anything you feel bad about in relation to your loss. It is normal following a bereavement to have regrets about things that could have been done or said differently, but try to let this go if you can. Compassion and acceptance help our emotional wellbeing.
• Do talk to people about how you feel. Family and friends have been found to be by far the most helpful form of support following a bereavement, although sometimes they will be grieving too. Religious or spiritual support for some people can also be helpful. Keeping a diary of your feelings day to day may also help. Go to your doctor if you feel you have no one you can talk to. There may be support groups locally or online. Mindfulness, a form of meditation, has been found to be helpful for emotional wellbeing. It is likely that classes may be available locally. Your GP may be able to advise. If your symptoms do not start to improve with time your GP may suggest speaking to a counsellor.
• Do ask for help if you feel you are not coping. People often ask if there is anything they can do to help but unless you tell them, they are unlikely to know what would be most useful.
• Do keep up activities and relationships. Accept invitations, invite people to visit, keep in touch with family and friends, get out for a walk if you feel able. Find out about local events, clubs and classes. It is important to have things going on that can distract you from the pain of grieving and give you a break. Simple things like watching a film or listening to an audio book can help, although it may take some time to be able to concentrate enough to listen to after a bereavement. It is also worth choosing carefully, try to steer clear of books and films that relate too closely to your own situation.
• Do plan what you will do on anniversaries such as birthdays, Christmas, anniversary of death. It will help if you decide in advance how you want to spend these occasions, which are likely to be emotional times.
• Do think about ways of keeping memories of your loved one alive if this is a comfort. People have found many ways of doing this: memory boxes, bespoke jewellery, memorial fund raising, memorial benches are a few examples.
• Don’t make major changes in your life, such as selling your house, moving areas, jobs, etc. until you have had time to adjust to the death. This is a time when people may make changes they can regret.
• Don’t enter into new financial arrangements without proper advice. Talk to a friend, family member or an advice organisation such as Citizens Advice.
• Don’t turn to alcohol or other drugs at this difficult time. This can be harmful to your body, affect your emotions and slow down your recovery.
• Don’t bottle things up. Talking can really help.

What can family and friends do to help?

Family and friends can help at this difficult time.

• Spend time with the bereaved person if that is what they want.
• Talk and listen to the bereaved person. Don’t be afraid of saying the wrong thing – this is a situation many of us feel awkward about. It may help to admit that you don’t know what to say if that is how you feel.
• Don’t be surprised if the bereaved person wants to talk and go over the same ground again and again, this is quite usual.
• Don’t take anger or irritability personally, it’s part of the bereavement reaction.
• Talking about the dead person can be helpful for the grieving person. Don’t try and avoid mentioning them in everyday conversation.
• Offer practical help if the bereaved person wants this. Caring for children, help with shopping etc. may be useful, especially in the early days following a death.
• Don’t expect too much of the bereaved person initially even if they look as if they are coping.
• Include your relative/friend in social events.
• Support your relative/friend in building new links, social contacts and interests.
• Try to discourage the bereaved person from making any major decisions, such as moving home soon after the death. Support them in thinking through the options and implications of this.
•  If your friend or relative seems ‘stuck’ and not coping at all well, encourage them to seek help. The family doctor is a good place to start.

A list of useful contacts, books and references are available in the written version of this guide.

Written by Dr Lesley Maunder and Lorna Cameron, Consultant Clinical Psychologists.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has developed this resource with the support of NHS healthcare staff, service users and local voluntary sector groups.