ALFRED PSYCHIATRY
POST BEREAVEMENT
SUPPORT FOR FAMILIES
& CARERS
OFFICE OF THE CHIEF PSYCHIATRIST
INPATIENT LEADERSHIP FORUM
13 JUNE 2012
Assoc Prof Simon Stafrace, Program Director &
Sharon Sutherland, Manager Social Work
Outline
Why?
 Purpose & Principles
 Process- 8 steps
 Experience to date
 Discussion & Reflection

WORKING WITH FAMILIES &
CARERS
FAMILY PARTICIPATION IS EMBEDDED IN
VICTORIAN MH POLICY & LAW

Families and carers should be recognised, respected and
supported as partners in providing care to the consumer.

Families and carers should be engaged as early as possible in the
episode of treatment and care

Victoria’s Mental Health Act

working with families integral to the provision of good mental health care.
7/04/2015
Ψ
WORKING WITH FAMILIES &
CARERS …….SHOULD
CONTINUE AFTER SUDDEN &
UNEXPECTED DEATH
WHEN MH CONSUMERS DIE SUDDENLY &
UNEXPECTEDLY

Working with families affected challenging for MH
clinicians


Difficult emotional states- Anger, Guilt, Blame, Grief
Clinicians find themselves in an ambiguous position
Are we blamed for the death?
 Do we re- traumatize families by our presence?
 Will our offers of assistance be rejected?

Open disclosure vrs the fear of liability
 What of the long-term?
 It can be all too hard……..

WHEN MH CONSUMERS DIE SUDDENLY &
UNEXPECTEDLY
 Information and support after suicide
 help family and friends cope
 can aid the process of bereavement
 People bereaved by suicide at higher risk of
 Abnormal grief
 Depression
 Suicide
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WHEN MH CONSUMERS DIE SUDDENLY &
UNEXPECTEDLY
 Literature on how to assist bereaved persons and
groups has grown extensively over the past two
decades




includes guidelines for clinical caregivers (Rando,1984)
proposals for helping children (Wass & Corr, 1984),
strategies for assisting adolescents (Corr & Balk, 1996),
Guidance for work with specific populations (Quint Benoliel,1999)
Ψ
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PURPOSE & PRINCIPLES
PURPOSE

To describe the process by which families & carers will be
supported after the sudden & unexpected death of a loved
one who is a registered client at the time of death

To identify individuals within the service who can provide
post-bereavement support and facilitate access to external
resources

Maintain a minimum standard of post bereavement follow up
& care

Allow adaptations for needs of individual families, according
to developmental, cultural and religious requirements
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PRINCIPLES

Families will be supported to access internal and external
supports following bereavement

Families will be provided with information about the care of the
family member prior to his/her death (Open Disclosure)

Families will be offered choices should formal support postbereavement be requested
Ψ
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PROCESS
OUTLINE
1.
2.
3.
4.
5.
6.
7.
8.
Immediate response & notification
Responsibility for reporting
Identifying the Post Bereavement Support Person
The Role of the Post Bereavement Support Person
The Framework of Support
Coordination, supervision and governance
Other considerations post-bereavement
External Resources and Services
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1. IMMEDIATE RESPONSE &
NOTIFICATION

Post bereavement contact with the family should be immediate
and not delayed by the need to identify the Post Bereavement
Support Person (PBSP).

The regular treating Consulting Psychiatrist or clinician will make
contact with the family/identified next of kin as soon as possible
following a patient’s death



Condolences, regret
Share information
Explain processes of review.

If AH & death in IPU, the On-Call Seniors assume this role

The SW Manager will be contacted the next business day in order
to ensure implementation of the Post-Bereavement Support
Response
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1. IMMEDIATE RESPONSE &
NOTIFICATION
If death occurs in a bed-based service, reception of
the family must be coordinated by the most senior
staff available.
 Attention to

How information is shared
 The handling of the deceased patient’s personal
belongings
 Families offered the opportunity to pack the patient’s
belongings (issues if on acute IPU vrs residential setting)

2. RESPONSIBILITY FOR REPORTING
 It
is the responsibility of the Program Manager
involved to:
Report the death and family and carer contact in
Riskman.
 Notify the SW Manager

 All
contact with the family is documented in
the consumer history.
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3. IDENTIFYING THE POST BEREAVEMENT
SUPPORT PERSON


The SW Manager will identify the PBSP, in consultation with the
Program Manager & treating Psychiatrist
Factors to consider in the provision of bereavement support
include:
 Staff experience and skill in bereavement counselling;
 Level of engagement with the family; and
 Expressed wishes of the family;
 Circumstances of the care and death of the patient.
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4. THE ROLE OF THE POST BEREAVEMENT
SUPPORT PERSON
Support the family in the post bereavement process
 Engage in a therapeutic alliance
 Be the key contact and communicator between the
organisation and the family
 Advocate for the family
 Ensure access to appropriate health service and
community supports

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5. FRAMEWORK OF SUPPORT

Follow up will be offered for up to 12 months

Multi-modal





Letters
Telephone calls,
Face-to-face,
Written information
Social- eg. invitation to attend annual Alfred Health Family Memorial
Service
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5. FRAMEWORK OF SUPPORT

Involves counselling
 Short to medium term
 Supportive




Separate to but may include support during feedback about internal
critical incident review
Information about resources
Referral to external agencies, local GP, etc
Repeated contact at intervals




within one week of a death
@6 weeks
@ 3 months
@ 12 months of the death.
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5. FRAMEWORK OF SUPPORT

Collaborative


The nature and frequency of the contact will be
decided in consultation with the family and include
a range of therapeutic interventions and
approaches
External partnerships

Poorly developed

External agencies may be more appropriate
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6. CO-ORDINATION, SUPERVISION AND GOVERNANCE

The Social Work Manager will






Be responsible for the coordination of the protocol
Appoint the PBSP in consultation with the Program Manager
& Treating Psychiatrist
Supervise the PBSP
Audit, evaluate the process, seeking family feedback into the
process
Review the guidelines annually
Report to the Family and Carer Committee
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7. OTHER CONSIDERATIONS
Ψ
SUPPORTING STAFF

Education, training and specialist supervision to be
provided (ASIST,SANE)
 May include access to specialist grief and loss
services to provide additional peer support for
selected staff initially

Staff should have the have the opportunity to talk
about the suicide and participate in debriefing.
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SUPPORTING CHILDREN & YOUTH
 Concerns
about the mental health of
bereaved friends or family

The mental health needs of children and youth
may require specialist secondary consultation or
specialist assessment at CYMHS.
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MEDICO-LEGAL ISSUES
The coronial process following a suicide
 Families will usually have contact with the
coroner’s court.
 Every state and territory has coronial services that
offer some form of support to people who have
experienced the traumatic death of someone close.
 Collaboration with this service may be helpful
 Medico-legal issues -may need to seek a legal opinion
 Confidentiality considerations create complexity
surrounding disclosure without consent or advanced
directives

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8. EXTERNAL RESOURCES
Ψ
EXTERNAL BEREAVEMENT REFERRAL
SERVICES

Should families and carers decide to access external
bereavement support the following services are
available:
24-hour crisis telephone counselling – Lifeline: 13 11 14
 Australian Centre for Grief and Bereavement – 1300 664
786
 24 Hour Loss and Grief support line Free call 1800 641 091
 Jesuit Services suicide help line -039427-9899

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EXTERNAL BEREAVEMENT REFERRAL
SERVICES
Compassionate Friends Hot line-(03) 9888 4034 24
Hour Grief Support Phone: 03 9888 4944 Freecall:1800
641 091Fax : 03 9888 4900
 Salvation Army Help Line – 1300 467 354
 SANE Helpline – 1800 18 sane (7263);
helpline@sane.org
 Suicide Call-Back Service – 1300 659 467
 The Bereavement Counselling and Support Service
(03) 9265 2111, fax (03) 9265 2150 or email
counselling@grief.org.au
 National Missing Persons Coordination Centre – 1800
000 634

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ON LINE RESOURCES
www.grief.org.au
 www.compassionatefriendsvictoria.org.au
 www.lifeline.org.au
 www.supportaftersuicide.org.au
 www.missingpersons.org.au
 www.nalag.org.au
 www.sane.org
 www.copmi.net.au
 www.siblingsgrief.org.au
 www.beyondblue.org.au
 www.blackdoginstitute.org.au
 www.kidshelpline.com.au

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THE EXPERIENCE OF POSTBEREAVEMENT SUPPORT 2012
Ψ
OBSERVATIONS
Communication has
been prompt
 The protocol has been
adaptable to different
settings and family
needs across the
service.
 High level engagement
esp. in youth service

7/04/2015
Strengths
Limitations
Notification indirect via
senior managers
 Partnerships with
complementary
organizations have not
been formalized
 Families in adult
services have not
engaged directly in
short term

Ψ
FURTHER CONSIDERATIONS
What do families want/need from our services in the
post-bereavement phase?
 Should we engage a regular bereavement team or
appoint individuals on a case by case basis?
 Are social workers best placed to provide this
support?
 What are the key competencies in this area of service
delivery and how do we select staff?
 Should we focus our efforts on developing
partnerships with external agencies?


How do we establish reliably what these agencies actually provide?
7/04/2015
Ψ
A REFLECTION
 Families



were identified in each case
Are families EVER indifferent to the suffering of
their children
Do we consider the degree to which TRAUMA
drives disengagement?
Can this change how we think about family
engagement in active clients?
7/04/2015
Ψ