More than 300,000 people have died of COVID-19 in the United States. Many families are confronting the winter holidays, a time traditionally devoted to celebration, while bearing the recent loss of a loved one.
Sue Morris, PsyD, director, Bereavement Services, Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC), is using her experience working with bereaved families to create bereavement support systems for the Brigham amidst the COVID-19 pandemic.
Studies have shown that under normal circumstances, about 10 to 20 percent of bereaved people face psychiatric challenges that require support from mental health providers. But this number may be higher during the pandemic. Those most at risk for poor mental health outcomes include people who’ve lost loved ones suddenly, in the hospital or in an intensive care unit (ICU), and/or without having said goodbye. All of these are challenges faced by many who have lost loved ones to COVID-19.
In the November 2020 issue of the Journal of Hospital Medicine, Morris co-authored an article calling on hospitals to implement stronger educational and outreach systems to support people who are grieving. Health Hub spoke to Morris about the publication, the challenges of grieving during the holiday season in a pandemic and when to seek help from professionals.
What are the key aims of bereavement care?
SM: Unlike other disorders in psychiatry, grief is not an illness that we need to treat. It’s a normal response to loss. Most bereaved family members will do okay without professional intervention, but about 10 percent of people may suffer complicated or prolonged bereavement that needs some kind of professional intervention.
We want to think about grief from a prevention model, which means trying to identify those who potentially are at risk to prevent them from having a difficult bereavement. The Brigham Health Bereavement Program, which covers both Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital, mails bereavement packets to family members of the recently deceased. These packets includes a condolence letter from senior management, a psycho-educational grief guide and a list of community-based resources. Social workers are also available to provide telephone support and to assist with mental health referrals and provide outreach to the families of patients who died in COVID-19-specific units.
Our Education, Guidance, and Support model, first implemented in 2019, before the pandemic, gives recently bereaved people information about what they’re likely to experience so that they feel like they have more control — they’re not going to think something is wrong when they have a bad day, for example. We say that grief comes in waves, so if people understand that these waves can pop back up, such as at times that correspond with the holidays, then people won’t be as worried when it happens. Guidance is about reassurance, giving people signposts so that they know where they may be headed. And finally, we try to provide support. It can be support from clinicians or support from other people who are going through something similar. Grief can be very isolating, but when someone in a peer support group, for example, says, ‘Yeah, I understand that,’ it can feel less isolating.
When should a grieving person seek professional counseling?
SM: It’s very normal to feel great sadness after somebody dies and it’s also normal to yearn for the person or even feel a physical pain, as well as an emotional pain. If someone has suicidal thoughts or thoughts that life isn’t worth living, that would be an immediate sign that they should seek help. But some people might still feel very distressed. They may have unanswered questions that are going round and round in their head.
They may have a lot of intense emotions. Feelings such as guilt and anger can be a normal part of grieving, but if it feels beyond what they think they can tolerate on their own, they should seek some kind of support. This can be from family or friends, or a counselor, or even by calling a national health helpline. You should always let your primary care physician (PCP) know if somebody you love recently died. People underestimate how physically stressful grief can be, so talking to your PCP is another layer of support. No one should have to worry alone.
How does the pandemic make grief even more difficult?
SM: Because of the pandemic, people can’t see each other in the ways they normally would. Funerals, for example, are a tradition in our society that let the surrounding community know that a family is grieving, and that they need support. They offer an opportunity for people to come together and offer condolences. Given that these opportunities are not possible in the same way, it is likely that the isolation that many bereaved individuals experience will be much greater.
It’s also hard at the moment because most bereavement support is held over Zoom and some people don’t have access to that. I speak to a lot of people on the telephone because they’re not familiar with computers or don’t have access to a computer.
Minority communities have been disproportionately affected by the pandemic. We have made our grief guides and tip sheet, “Grieving During A Pandemic,” available in Spanish, French, Chinese, Haitian Creole, Portuguese, Arabic, and Russian. As part of the Brigham’s community outreach programs, we’ve had vans traveling to severely affected communities to provide testing, masks, alcohol-based hand sanitizer and written materials about grief.
So there are many difficulties and challenges. Bereaved individuals also might worry about becoming sick themselves. But, I would encourage people to seek support as best as possible, whether through a faith-based community, from family or from healthcare providers. Even though speaking on the telephone or via Zoom is not the same as meeting in person, it’s the best way we have at the moment to tackle the isolation and pain of grief.
What advice can you offer those grieving over the holidays?
SM: I think it’s important to acknowledge that it’s not going to feel the same as usual. For most bereaved people, the holidays highlight the absence of the person who is missing. I would focus on making a plan. Some people may see this as a time to hunker down and just get through, and others may want to celebrate or acknowledge the holidays in some way. People can get creative and use technology to the best of their abilities to connect with people who they may normally see in person.
Some may wish to find a way to acknowledge the person who’s not there, whether by lighting a candle or playing their favorite music or making a certain recipe. This is not to say that it won’t be sad, because it will be sad: the holidays are those times when we want to be with those we love. We know that finding ways to reminisce is a good strategy that helps people who are grieving. Maybe it’s a toast to the person who’s not there or sharing fond memories over Zoom — any way to come together with others to make sure that a loved one’s memory is not forgotten.
Virtual support groups for recently bereaved family members of our patients are being offered. For more information about groups or the bereavement program, please email BereavementService@bwh.harvard.edu.