Bereavement rituals during the Covid-19 pandemic: Implications for mental health support, funerary practices and public health messaging
Lead Research Organisation:
National Centre for Social Research (NatCen)
Department Name: Research Department
Abstract
Rituals around death and dying allow 'healthy' expression of strong emotions, with funerals identified as a fulcrum in the grieving process. The Covid-19 pandemic has dislocated these significant rituals. Their absence is likely to disrupt 'normal' grief cycles, leading to a range of complex grief presentations.
Evidence from prior infectious diseases (Ebola, SARs, MERs) highlighted that some individuals will subvert public health messages to deliver rituals perceived essential to their relative's care and burial. Anecdotal evidence suggests that these behaviours are being mirrored in the Covid-19 pandemic.
We will carry out a qualitative research programme to: identify the nature and extent of mental health support necessary following Covid-19, understand the experience of subverting or adhering to public health messages, and assess how public health messages could be developed to support the bereaved in managing the funeral process (e.g. development of replacement rituals) when social distancing is essential.
We will carry out qualitative interviews at two time points (six months apart) with 30 bereaved families to explore the short and longer-term impacts of bereavement during the pandemic on mental health and wellbeing. In addition, we will conduct 30 interviews with funeral directors to understand their experiences of the funeral planning process during the pandemic, change in services and their interactions with bereaved people.
Along with interim, final reports and peer reviewed open access papers, we will carry out a 'lessons learnt workshop'. This will develop recommendations about funerary arrangements, bereavement support provision and public health messaging, developing and agreeing industry-specific requirements.
Evidence from prior infectious diseases (Ebola, SARs, MERs) highlighted that some individuals will subvert public health messages to deliver rituals perceived essential to their relative's care and burial. Anecdotal evidence suggests that these behaviours are being mirrored in the Covid-19 pandemic.
We will carry out a qualitative research programme to: identify the nature and extent of mental health support necessary following Covid-19, understand the experience of subverting or adhering to public health messages, and assess how public health messages could be developed to support the bereaved in managing the funeral process (e.g. development of replacement rituals) when social distancing is essential.
We will carry out qualitative interviews at two time points (six months apart) with 30 bereaved families to explore the short and longer-term impacts of bereavement during the pandemic on mental health and wellbeing. In addition, we will conduct 30 interviews with funeral directors to understand their experiences of the funeral planning process during the pandemic, change in services and their interactions with bereaved people.
Along with interim, final reports and peer reviewed open access papers, we will carry out a 'lessons learnt workshop'. This will develop recommendations about funerary arrangements, bereavement support provision and public health messaging, developing and agreeing industry-specific requirements.
| Description | The key findings of this study on the experiences of bereaved people and those working in the funeral industry during the pandemic include: The experiences of people bereaved during the pandemic varied widely. Variations were experienced according to restrictions in place at the time, which at some stages differed in the devolved nations and in some English locations, cause of death and circumstances leading up to the death, personal preferences about the funeral, and religious belief. Not being able to see and be physically present with a loved one before or after their death (in hospitals, care homes, or Chapels of Rest) worsened feelings of grief. For bereaved people, delays to funerals or reduced size of funerals, fewer options for the service, the inability to carry out cultural or religious practices, and the lack of a wake or commemoration were distressing. There was also a viewpoint that smaller, more private funerals were easier to cope with while grieving. A heightened sense of social isolation was experienced, whether because social distancing limited the ability to be near one another and provide physical comfort, or through lack of social contact with the wider community in the weeks and months following. The pandemic impacted on bereaved people's wellbeing and mental health, owing to the restrictions, and because of increased difficulty in accessing formal and informal support. Bereaved people expressed an array of emotions including guilt or anger at not having seen the person who died before, at or after their death. Similar emotions were mentioned in relation to not having been able to give the person who died the funeral that they felt was wished for or deserved by their loved one. There was worry about spreading COVID-19 during the funeral, and feelings of social isolation as part of people's experiences of bereavement. Access to formal support such as bereavement counselling, or bereavement peer support groups was impacted by the move to online delivery and longer waiting lists. Bereaved people appreciated receiving informal support from family, friends, and the wider community, but this was also affected by the pandemic in terms of lack of physical proximity and physical touch, owing to social distancing. Among funeral industry staff, the first phase of the pandemic was characterised by a pronounced uncertainty requiring frequent adjustments, and an increased workload. There were feelings of being overwhelmed by the volume and rapidity of changes, of fatigue, and of disappointment at not being able to deliver their usual choice of services. Funeral staff reported feeling scared that they might contract the virus and spread it to their families, but they also expressed feelings of pride at doing their best to provide a good service despite the challenging circumstances. Funeral directors and managers provided a range of formal and informal support to their staff to mitigate the impact of the pandemic on mental health and wellbeing. These initiatives ranged from external counselling, therapy sessions, and support helplines, to weekly staff wellbeing sessions, chats with colleagues, and checking-in to support colleagues who had worked a particularly difficult shift. Participants in both groups described their experiences as shaped by new COVID-19 guidance and restrictions being introduced on a regular basis. The views of bereaved people about the restrictions were varied, ranging from more supportive (restrictions were sensible and proportionate), to less supportive (restrictions were too strict). Similarly, bereaved people's level of compliance with restrictions varied widely. Funeral arrangers had to keep themselves constantly up-to-date given the importance of public health guidance and restrictions to their industry and delivery of their services. They had a crucial role as a source of information to bereaved people who appreciated their help with navigating the ever-changing regulatory landscape. |
| Exploitation Route | Findings from interviews with bereaved people, with funeral directors, and from the stakeholder workshop gave rise to these recommendations. Support for bereaved people The creation of publicly funded support networks designed in consultation with bereaved people was proposed. Capacity building within existing support networks with additional counsellors specialised in bereavement would also reduce risk of burden on services. Access to clear, impartial guidance and support could be developed and made available to bereaved people when they need to plan a funeral. Funeral industry staff Funeral industry workers should have been recognised as key workers early on during the pandemic. Consult the funeral industry in the event of future pandemics or large-scale emergencies, and increasing the number of crematoria. Provide more comprehensive informal and formal support for funeral industry workers, and using existing informal support networks within the industry. Digitalisation and new technologies Retain the digitalisation and simplification of death registration along with the large-scale adoption of new technologies, such as video streaming of funeral services. Introduce measures to mitigate concerns about potential abuses and fraud in relation to death registration was seen as a priority by funeral staff. |
| Sectors | Communities and Social Services/Policy Healthcare |
| Description | Collaboration with University of Suffolk |
| Organisation | University of Suffolk |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | The PI, Dr Karen Windle of this particular award has moved to the Integrated Care Academy at the University of Suffolk. |
| Collaborator Contribution | To ensure that the collaboration between NatCen and the University of Suffolk is robust, the latter will be hosting and carrying out the learning workshop, while Dr Windle will be delivering the peer-reviewed papers. |
| Impact | As detailed above, the collaboration adds value through the hosting and management of the learning workshop and, Professor Windle's lead of the peer reviewed publications. |
| Start Year | 2021 |
| Description | Blog post on the key findings and policy implications |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Blog post on 07/03/2023: https://natcen.ac.uk/s/understanding-impact-bereavement-during-covid-19 |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://natcen.ac.uk/s/understanding-impact-bereavement-during-covid-19 |
| Description | Citation in peer reviewed article |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | It brought the study to an international audience of researchers and policy makers |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-06570-0 |
| Description | Cross-party presentation |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Presentation of the project findings at the cross-party group on bereavement and funerals at the Scottish parliament building in Edinburgh - 14/06/2023 |
| Year(s) Of Engagement Activity | 2023 |
| Description | Radio interview |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Interview with one of the authors on Awaaz Community Radio 99.8 FM to discuss the findings and the recommendations |
| Year(s) Of Engagement Activity | 2023 |
| Description | Research Live article |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Article on Research Live announcing the start of the study, 19/05/2021 |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://www.research-live.com/article/news/natcen-launches-bereavement-study/id/5083982 |
| Description | Stakeholder workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Stakeholder workshop on 15/11/2022 to present preliminary findings and to hone and refine the study recommendations. |
| Year(s) Of Engagement Activity | 2022 |