A number of well-conducted evaluations of bereavement services offered to unselected bereaved people have failed to show benefits on follow-up. It must be concluded that most bereaved people do not need and will not benefit from referral to a Bereavement Service (Reviewed in Schut 2001).
On the other hand, significant benefits have been found from services provided to bereaved persons at high risk or who meet criteria for psychiatric disorder. These include services for bereaved children who are themselves likely to be at risk. Schut concludes that the more complicated the grief process, the better the chances of intervention leading to positive results. The families of people who have died in hospices have been found to have lower mortality rates than those dying elsewhere (Christakis 2003) and the provision of a hospice-based service to bereaved people at high risk has been shown to reduce their use of primary medical care (Connor 1996, Relf 1996).
Hospices and Palliative Care Units
Most Hospices and Palliative Care Units make use of volunteers who have been carefully selected, trained and supervised to help bereaved people (Denmer 2003). They need to have the backing of well-trained professionals including a bereavement service coordinator with appropriate counseling or other specialist training. They should also have easy access to a psychiatrist and/or clinical psychologist who should be consulted whenever clients are unable to carry out normal functions and remain distressed despite the support given by the team.
Support should be offered proactively to the minority of bereaved people at risk. Initial contact is usually made 5-6 weeks after bereavement although it may be needed more urgently if there is thought to be a suicidal risk. Kissane & Bloch (2002) argue that bereavement support should be a continuation of the support given to families before bereavement and provided by the same staff, their approach is awaiting evaluation.
A wide variety of mutual help groups and websites exist to help bereaved people but few, if any, have passed the test of well-conducted evaluation. Even so they tend to receive the enthusiastic endorsement of the bereaved people who make use of their services. Mutual help groups are of particular value to stigmatized or “disenfranchised” people such as those bereaved by HIV or suicide (Doka 1989). Here they can meet others who are “in the same boat” and obtain mutual support.