The previous chapter dealt with the roles and responsibilities of health professionals in relation to the bereaved in the broad context of health care. In this chapter, the more formal bereavement programs and approaches are discussed. Many of the techniques used by mental health professionals and experienced lay care-givers to assist the bereaved are similar to those advocated in Chapter 9 as appropriate for health professionals generally. All are designed to facilitate the grieving process and to have a positive effect on outcomes.

There has recently been a tremendous increase in efforts to assist the bereaved in a variety of ways. Several explanations of this growth can be postulated. First, as discussed throughout this volume, bereavement has been recognized as a powerful, sometimes pathogenic event, both psychologically and physically. This is exemplified by emotional distress, physical symptoms, and loss of social functions in many people and by the excessive mortality, morbidity, and use of health services of some individuals. Second, there has been a growing recognition that the normal bereavement process may take at least a year for most people and often longer. Third, our society has undergone many changes that have an impact on the circumstances of death and the course of bereavement. As discussed in Chapter 8, for example, geographic mobility has a profound influence on the availability of social support from kin and close friends. Growing concern about limited financial resources has sparked greater public policy interest in preventive measures. And finally, as noted in Chapter 9, some professional care-givers may be ill-equipped, both emotionally and in terms of specific skills, to deal comfortably with the bereaved.

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Although most persons recover capacities that had been diminished and adapt to bereavement, the intensity, magnitude, and consequences of grief have attracted the attention of a variety of institutional and individual care-givers. Some programs are designed to facilitate the normal bereavement process while others are intended to help people who are having, or who are at high risk of having, special problems or pathologic reactions to bereavement. Some are directed to the bereaved generally; others focus on people who have particular bereavement circumstances in common. Programs may be designed to help individuals, families, or groups of similarly bereaved people. Increasingly, these programs are based in institutional settings such as hospitals, health maintenance organizations, and community mental health centers. They may be implemented by experienced laypeople, who typically have been bereaved themselves, or by professionals from medicine, nursing, social work, psychology, or the ministry, who may or may not have special training to work with grief reactions.

Many different theoretical perspectives guide the training of grief workers and provide the framework for the actual programs. But whether they are formal or informal, naturally occurring or deliberate, run by peers or by professionals, the goals of all bereavement interventions include the facilitation of the grieving process and, implicitly or explicitly, the prevention or alleviation of the detrimental consequences of bereavement. The many different approaches of current programs and the overlap among the professions preclude a discrete classification of these interventions. In this chapter, four major approaches to helping the bereaved are discussed: mutual support, hospices, psychotherapy, and medication use. Bereaved persons may avail themselves of one or more of these interventions sequentially or simultaneously.

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Category: WHO