Aims: The purpose of this paper is to examine:
1) how bereavement support services have developed in palliative care;
2) Critically assess the assumptions that underpin bereavement support;
3) Consider the implications of the three level model of bereavement support proposed by the National Institute of Clinical Excellence Supportive and Palliative Care Guidance (2004) in England and Wales.
Content: A central tenant of most specialist palliative care services is a recognition that care extends to close companions (carers, family and friends) of the patient and that this care continues beyond the death of the patient, during bereavement. The death of a close relative is widely believed to be a challenge to the coping resources of most people. It will be emphasised that it is the experience of loss that is important in life threatening illness. Families and friends will have encountered numerous losses throughout the person’s illness. Bereavement may be thought of not as a single loss but a culmination of losses and changes to their previously taken-for-granted way of living. Drawing upon research conducted in the UK and New Zealand the paper will explore the types of services and resources which are available to support bereaved people. No assumption is made that all people need additional support. There is evidence that the majority of people are very resilient and manage major life changes with their own resources and support from their families and communities. However, for some people bereavement presents such a challenge that they seek additional support from community based organisations such as Cruse (a charity concerned with providing counselling and bereavement support), their faith groups, hospice and specialist palliative care bereavement services, and other health and social care organisations. The paper concludes by considering the implications of a three tier model of bereavement which delineated levels of needs and provision from those requiring basic social support to those with complex psychological difficulties associated with bereavement. The personnel and financial demands of adopting this framework for bereavement support will be discussed.