COVID-19 bereavement: providing meaningful support to your team

The past year has caused many challenges for the veterinary professions, who have been on the front line while not actually being properly considered “front line”.

We move through 2021 with significant concerns about workload, burnout, mental health issues and wider veterinary capacity without many easy answers. However, with the success of the vaccine roll-out, so far, some light does appear to be at the end of one tunnel at least.

As we move through the road map out of lockdown there is, understandably, a lot of relief and happiness, and discussions around life “going back to normal”.

However, we know that for many people “normal” is going to look rather different. And for one group of people that is certainly true – those who have been bereaved by COVID-19.

With the death toll from COVID-19 now in excess of 150,000 people, a lot of relatives and friends have been bereaved in the most difficult of circumstances.

Sadly, I am in this category, losing my dad – who inspired my love of animals – in November last year.

There may well be people who have been COVID-bereaved in your team – but even if there isn’t, death is one of the few truly inevitable things in this world.

In our vet world we may talk about – and face – death frequently in our patients, but are we fully prepared to talk about bereavement in a supportive and appropriate way when it comes to humans? In many cases, I suspect the answer is no.

Bereavement policies are generally vague and often suggest a few days off for close relatives only. In some circumstances, this is unlikely to be sufficient and may lead to problems down the line.

Extra challenges

Bereavement is always hard, but a COVID bereavement throws up many additional challenges without the usual support structures in place.

Lucy Selman, part of the University of Bristol’s palliative and end‑of‑life care research group, and Emily Harrop, of Cardiff University, are carrying out a longitudinal study of loss during the pandemic. They have already found those who suffer losses from COVID have greater problems and higher support needs in their grief.

Issues that arise are wide‑ranging and include factors before, during and after the death.

Feelings of guilt are often very prevalent. This may be because of indirect actions that put loved ones in harm’s way – for example, putting them in a care home. Other people unknowingly passed on the virus to their loved ones, in some cases to multiple members of their family. There is often then ongoing anxiety about catching and transmitting the virus.

In many cases the bereaved may not have seen their loved ones for many months, thinking this would keep them safe, but that being in vain because they caught COVID anyway.

The hopes and plans of being able to “make up for lost time” will never happen. Facetime is no substitute for face‑to‑face interaction, and in reality was often hugely distressing when dealing with loved ones with dementia and other conditions.

Then there is the impact of not being able to see and care for loved ones when they got sick, or even see them as they were dying. If visits were allowed, which was inconsistent, there were layers of PPE and the knowledge that a risk to themselves and other vulnerable relatives was present. The whole situation could be very traumatic.

Many people have grieved without the normal rituals of mourning; tiny funerals, no wake or opportunity to celebrate the lives of loved ones. Grieving relatives could be incredibly isolated. Without the opportunity to meet and hug friends and relatives, it seems to be quite common for the grief to be delayed or “stuck”.

Anger seems to be very prevalent among the COVID‑bereaved, understandably; it is something I am certainly dealing with. Loved ones have to process the knowledge that had we had a different Government, as well as a leader less prone to dithering and delaying, and with different politics – more competent and compassionate, less corrupt (why do we call it cronyism in the UK?) – it might have resulted in a different outcome.

Meanwhile, the media and social media offer no escape from COVID-19. This has included coverage of MPs and “celebrities” saying that loved ones were expendable – some people (not me, I’m pleased to say) experienced these views being shared by “friends”.

The NHS vaccination programme is a great success, but it’s come too late for our loved ones. Concern definitely exists that our loved ones will be airbrushed from the narrative, replaced by vaccine success (and nationalism), as they are an inconvenient reminder of the many failings of the Government.

‘Professional bereavement support is, understandably, quite busy at the moment, but members of the group COVID‑19 Bereaved Families for Justice – which can be found through Facebook and has created the National COVID Memorial Wall in London – can access 12 sessions of free counselling through the National Bereavement Partnership.’

Support

So, what can you do to support those who are COVID-bereaved in your practice?

The first thing is just to be aware; to reach out and acknowledge the loss, and listen to the person who has been bereaved. Be aware that the reaction may be delayed and that anniversaries or significant “milestones” can be triggers for grief – for me the UK reaching the 100,000 deaths figure was very difficult, as was the year anniversary of lockdown.

Tremendous upset can be caused by comments that seek to diminish the loss, so it’s important that everyone is mindful of the comments they make about COVID.

The veterinary profession has some particular issues, in that bereaved individuals may face life and death decisions in their patients potentially very soon after their loss. This can be very triggering, especially if decisions had to be made about do not resuscitate orders, or whether to place a relative on a ventilator.

It is important to discuss with the bereaved person how he or she wants to approach end-of-life situations in the practice.

It is a good time to review and update your bereavement policy and training, to see if any additions are needed. Beware of generic advice on grief that is provided through employee assistance programmes during COVID – being told during lockdown to be sure to meet up and socialise with friends was not helpful, although this should be less of an issue now. If you have a programme, check in with the bereaved person about the support you can offer.

Professional bereavement support is, understandably, quite busy at the moment, but members of the group COVID‑19 Bereaved Families for Justice – which can be found through Facebook and has created the National COVID Memorial Wall in London – can access 12 sessions of free counselling through the National Bereavement Partnership. The site is also a useful place for mutual support, information sharing and discussion, although will certainly not be for everyone.

The Good Grief Trust (www.thegoodgrieftrust.org) has some really excellent guidance, resources and signposting.

Business in the Community (BITC) has created a toolkit (https://bit.ly/3bFLhWx) to help businesses support people suffering from COVID bereavement. This contains a lot of good advice that will be relevant long into the future.

The toolkit highlights three important steps:

• Acknowledge: many employees will be affected by death during the COVID-19 pandemic.
• Respond: provide pragmatic support to employees to help them look after their well‑being.
• Refer: let employees know that help is available. Signpost internal support or organisations that can help employees affected by bereavement.

As the toolkit explains: “The impact of not handling deaths well during COVID-19 may risk mental health issues and post‑traumatic stress disorder, and there can be serious implications if trauma remains untreated.”

BITC also advises that ”now is the time for employers to meet the challenge, talk about death in a meaningful way and to consider the impact that tens of thousands of deaths linked to COVID-19 will have on the workplace”.

I can only commend that as very good advice for organisations across the veterinary profession.

Even as the number of deaths thankfully slows, we will be dealing with the impact of COVID bereavement for some time to come.