This guide has been written for adults who have experienced the death of an adult to whom they were close (a relative, partner or friend) in one of our hospitals.
If you have been bereaved of a child or baby or have experienced pregnancy loss, this guide may still be of help.
A note on language
We use the term ‘someone close to you’ throughout this guide because we are writing it with the intention of being helpful to as wide a range of people as possible and we do not know how you define your relationship to the person who has died.
We acknowledge that some of you may not feel that this does justice to the depth of feeling you have for someone you love but we also want this guide to help people who may feel that ‘loved one’ does not fit so well for the person they are grieving for.
We acknowledge that some of you may have been bereaved of more than one person; we are very sorry that you have experienced this. For ease of reading, we have written this guide as if one person has died; we hope the information will still help you.
We use the words dying, death and died. We understand that these can feel quite stark and direct, perhaps especially when written down. Culturally in the UK, we have broadly become unaccustomed to using these terms and may prefer phrases that seem gentler like ‘passing’ and ‘passed away’.
In our experience, people can become distressed by language that is unclear or does not acknowledge the reality of their situation and so we have chosen what seems like the least ambiguous words. We hope you will bear with us if this is not how you choose to speak about your experience.
How you might be feeling
The grief you experience in response to the death of someone close to you might involve acute pain when you remember the past with them, wish they were here with you in the present, and imagine the things they will not be with you for in the future.
Perhaps, if your relationship to them was not always as you would have wished, you might also be grieving the loss of a chance to have the relationship to them that you had hoped for.
Everyone experiences different emotions whilst grieving; these are some of the most commonly reported:
Intense sadness
All-consuming sadness after bereavement is very normal and it is not unusual for intense sadness to last a long time.
This does not always involve crying, and if you feel that you are unable to cry despite feeling intensely sad, this is not unusual. You might also find that you cry at times when you are not expecting to or in response to things that do not seem directly related to your loss.
The difference between grief and depression can be a bit of a blurry line and you, or people around you may want to see if you fit the diagnosis. It might be more helpful to think in terms of what your experiences are, such as sleep difficulties, difficulty concentrating, loss of interest in hobbies/activities, low energy.
Give space to gently address those difficulties over time without getting too hung up on what to call what you are living through.
Grief can make us feel that we do not want to wake up in the morning, that it will be impossible to go on, or that life is not worth living anymore.
While these thoughts are common during the grieving process, if you are having thoughts about actively wanting to end your life or you are concerned about whether you can keep yourself safe, then please consider if there is someone you trust to share these feelings with so that they can help you feel safer.
Numbness
There may be periods of time when you feel nothing at all, or feel very cut-off from yourself, from others and from day-to-day concerns. People often describe feeling like the death is not real or a sense that the person who died may appear at any moment. This may be especially the case if the death was sudden, unexpected or you did not see them when they were dying or after they had died.
If you experience numbness or feelings of emptiness, you might feel worried or guilty that you are not feeling sad. It is a very normal and common experience when you grieve as your mind tries to adjust to a new reality without the person who died, whilst protecting you from being overwhelmed by the full implications of that all at once.
It is common for people to go into survival mode and busy themselves with the day-to-day tasks that need to be done to keep money coming in, people fed and so on. This means that there can often be a delay to the full impact on our emotions.
Once some kind of new normal starts, people can find that their loss and the full emotional impact of everything that has happened to them hits them harder later.
This is very normal but can mean that people find themselves struggling emotionally just as the initial offers of support may have subsided and the people around them assume that they are through the worst and/or that you appear to have everything under control.
It can be helpful to respond to early offers of help and support with a holding reply via text or email or in person. This will be in your own words but something like this might help you to frame it:
“Thank you for your support/offer of help. At the moment I am focussed on getting through the next days/weeks/months. It is hard to know at this moment what I might need when I get beyond that. Please check in with me again in a few days/weeks/ months and I may be able to take you up on your kindness.”
If you don’t feel up to doing that yourself, you may want to ask someone you trust to send similar messages on your behalf.
If you feel detached from the world around you for sustained periods of time and you are concerned that you feel disconnected from others, or if your life circumstances mean that you continue to feel emotionally numb, then you might want to consider getting some support outside your immediate circle.
There is a list of services that can quickly and effectively support you at the back of this guide.
Anxiety
You might be feeling worried, anxious or fearful for many reasons after the death of someone close to you. You may be feeling worried about how best to organise a funeral or do any of the administrative tasks that need to be completed after a death.
Depending on the circumstances around their death, you might be waiting for post-mortem results, which can bring with it high levels of anxiety. You may have depended on the person who has died for practical or emotional support during times of stress and be feeling their loss during an uncertain and anxietyprovoking time.
Many bereaved people become worried about things they would normally have taken in their stride and which may seem to be unrelated to the death of the person close to them, such as using public transport, driving, shopping, or being in big social gatherings. They may also experience a general loss of confidence in their skills, such as feeling less able to do their day job, more unsure as a parent, socially anxious when they were outgoing before etc.
People sometimes see or hear the person that has died when they are going about their everyday lives. While some people find this comforting, others can feel unsettled or frightened by it.
This does not mean you are going mad as these are not unusual experiences to have following a death and are all part of your mind processing what has happened.
Anxiety often produces strong physical sensations in our body which can be frightening under normal circumstances if you do not know what they are, but which can also mimic health conditions. For example, anxiety can lead to:
• heart racing
• sweating
• chest pains/tightness
• shortness of breath/breathing faster
• feeling lightheaded/dizzy
• increased muscle tension/aches
• feeling sick/needing the toilet
If you are ill, it is unlikely that these symptoms would reliably go away altogether after 20 minutes of sitting still and doing controlled breathing, after avoiding a particular situation, or after distracting yourself. If you are experiencing these physical reactions persistently, speak to your GP.
Anger
It is very common and understandable to feel angry about the death of someone close to you. This can be directed towards the person who has died for leaving you behind; for doing, or not doing things that might have led to a different outcome for them or you.
People can get angry about things that were or were not said between you; things that were or were not done. Depending on the circumstances around their death, you might also feel angry with other people, if you feel that they, or you, were let down in some way.
You may experience intense anger towards strangers who appear to be carrying on as normal in a world that seems completely different. You may find that you get intensely angry about seemingly insignificant or unrelated things.
You may just find yourself more generally irritable or annoyed and having more disagreements with those close to you or taking it out on your family. Or you may notice that you are less generous and kind in your thoughts; this can feel shocking if you generally think of yourself as a good person and then find yourself feeling resentful in response to people’s apparently happy social media announcements, for example.
These feelings are very common and it can be appropriate to express anger about the situation you find yourself in. However, acting out our anger or suppressing it can have unintended negative consequences on our relationships, our health and our everyday functioning.
If you are worried that anger might be negatively affecting your behaviour you should consider seeking further support. Asking for help when you are struggling with something is a sign of strength, not of weakness.
Regret, guilt and shame
It is common to feel that we could have done more before someone’s death and to go over whether it might have turned out differently if we had made different decisions. You may feel that you should have invested more in the relationship before their death.
Try to bring self-compassion to these thoughts and be kind to yourself.
Conflicted feelings
Some people feel relief after the death of someone close to them and this can lead to feelings of guilt or shame. This may be because the person who died was very unwell or in a lot of pain before their death or because their quality of life would have been very poor had they continued to live. It can also come up when you have been under sustained stress before their death.
If you had a difficult relationship to the person that has died this might also trigger very conflicted feelings about their death. It is completely understandable to feel this way, as human relationships are complex and will invite a range of emotional responses.
If, after three to four months, you are still struggling with these thoughts and feelings, you may wish to seek further support.
Things that can help with intense or difficult emotions
The amount of emotions and their intensity can feel overwhelming but they usually become more manageable as time goes on. It takes strength and courage to accept these emotions without developing further unhelpful reactions such as self-criticism or getting stuck with going over the same negative thoughts. Listed below are some simple techniques that may help you.
Posture
Sit in a chair with your feet firmly on the ground, about shoulder width apart. Sit in an upright, confident position, imagining lengthening your spine slightly. Allow your shoulders to open and drop slightly.
See if you can maintain this for a few minutes. See what it is like to allow a slight smile or friendly expression to come to your face.
This can help to bring the intensity of an emotion down a notch or two.
5-4-3-2-1 grounding
This is a relatively simple approach to help to reduce emotional intensity using the five senses.
5 – Wherever you are, take a few moments to look around, and notice (maybe name these in your head) five things that you can see.
4 – Next notice four things that you can feel. So that might be the contact between your feet and the floor, or your body and the chair. It could be the sensations of clothes against your skin, or the temperature or movement of the air.
3 – Become aware of three things that you can hear. (Again, you may want to silently label these in your head).
2 – Focus now on trying to notice two things that you can smell. Don’t worry if you find this difficult, the attempt to do this is helpful in itself in focusing you on the here and now.
1 – Finally focus on one thing that you can taste. You could just notice whatever taste is currently in your mouth (which might be subtle) or it could be helpful to take a sip of water or perhaps have a mint and just pay attention to what that tastes like.
This won’t make the emotions go away and it is not about trying to avoid them but it may help you to slow down and create a space around the feeling.
Mindfulness
This can be helpful with learning to handle difficult emotions: it can help us to notice unhelpful (although understandable) attempts to avoid intense emotions and become more familiar with our own reactions to them, such as suppressing or blocking. It can also help us to accept the experience of strong emotions without being overwhelmed by them.
The links below are good places to start if you want to explore this:
www.headspace.com or www.nhs.uk/mental-health/self-help/ tips-and-support/mindfulness
Soothing rhythm breathing
Learning to breathe in a calming, soothing rhythm can affect our bodies in ways that help to create an inner sense of stability in the face of strong emotion. If you want to try this, sit somewhere quiet in a comfortable upright posture, resting your gaze or closing your eyes, and notice how you are already breathing. Then gently try to breathe in a smooth, even way. This is likely to be a slower, deeper rhythm than usual but it should feel comfortable to your body.
To begin with it can be helpful to count in your head alongside your breathing: breathe in deeply through your nose for (1-2-3); keep your lungs full (1-2); breathe out through your mouth (12-3); keep your lungs empty (1-2); repeat. Exact timings are not important but see if you can slow down over time.
You can download apps to your phone that can help set a soothing breathing rate (for example, take a look at Breathing Zone or Calm).
This link is a good place to start if you want to explore this further: www.balancedminds.com
Try writing
Sometimes, when we are caught up with intense feelings, it can be helpful to use writing to gain a little space from the experience. Some people find that they can break thinking loops by getting them down in black and white, and perhaps gain some perspective.
Take 5 or 10 minutes to write about the emotion you are experiencing such as anger or fear. Allow yourself to express
what thoughts, urges or desires you are experiencing and why you are feeling this way. Don’t worry if what you write doesn’t make sense as this is not important. What matters is for you to express with words, what you are feeling.
Some people find it particularly useful to keep a pad and pen by their bed to get down strong emotions or racing thoughts at night that are making it difficult to switch off and sleep.
Physical activity
Many people swear by physical exercise as a helpful strategy in dealing with strong emotions. It is likely that part of this effect is through physiological changes associated with certain types of exercise, but similar to writing, it may be that it helps to change what we are doing, helping us to become less immersed in feelings.
Think about what type of exercise has been helpful and pleasurable for you in the past or an activity that you enjoy.
Foster good sleep habits
Poor sleep is very common for people who are grieving. The prospect of trying to sleep can become daunting as this can be the time when memories, or traumatic images for some, can be most present in our minds. It may also be the time, when others are asleep or we are alone, that we have no distractions from thinking about how our life has changed or worrying about our futures.
Some people can turn night into day in their efforts to avoid sleep, staying awake most of the night and only sleeping in the early hours.
Unfortunately, lack of sleep can intensify emotions such as sadness, fear and anger. See the advice later in this guide on how to get some good sleep habits in place.
The grieving process
Here are a few myths that you may have heard about the grieving process and how it progresses over time, along with the realities that many people face.
Myth
‘Grieving takes place in clear stages, and once you have passed through one stage you do not go back to it.’
Reality
People move back and forth between feeling that they are coping well and not coping at all, during the days, weeks, months and years following the death of someone close to them.
There is not a right way to feel, and there isn’t one shared path that people take when they are bereaved.
Emotions, thoughts and feelings associated with grief are not like an alphabetical list that starts at A and finishes at Z. We all experience different emotions at different times and in different ways. If we can try to accept this, it may not feel quite so crushing.
The grief experienced shortly after a death does seem to be generally different from grief years later, however. The early response is often intense, all-encompassing and can involve daily yearning, significant emotional pain and a range of strong physical reactions.
Trouble focussing attention, zoning out and forgetfulness are common. If you are further on in your grief and do not feel that you have seen a significant shift in any of this, you may wish to seek further support.
‘There is an acceptable period of time to be grieving for. After this point you should not, or will not, feel upset by the death.’
Reality
Everyone has a very different timeline for grief. It is not unusual for things to take longer than people expect to feel less distressed. Try not to be impatient with yourself to be back to normal.
Equally there is no rule that says you have to be acutely upset for a long period of time; this does not say anything about you as a person or the depth of your attachment to the person who has died.
You may notice that the people around you are keen to set a timeline for you to feel better or be back to normal; maybe they are also grieving for the person who died and they are doing it very differently or at a different pace to you.
If you can, try and talk about this with people you care about in a compassionate way. This will be in your own words, but something like this might help you to frame it:
“I know you also miss the person who died and are concerned about me. At the moment I need time to process that they are gone. I know it might seem like I am taking a long time to do that, I’m just doing that in a different way to you. Please bear with me.”
If you don’t feel up to doing that yourself, you may want to ask someone you trust to send similar messages/have conversations on your behalf.
‘Grief has an endpoint.’
Reality
When you are in pain it is understandable to want to know when it will end. Perhaps people around you have suggested that you should be further on or even over it by now and you are wondering if you are stuck.
Grief changes over time, but it is unlikely that you will get to a point where you feel that your grieving has finished. However, as our lives continue on, we often find that a bit of space opens up around the grief and it is not always as all-consuming as it feels at first.
Over time, the reality and meaning of the death are better understood and people feel more able again to re-engage with meaningful or pleasurable activities and relationships. Ideally, we find ways to stay connected to the person who has died – if that is what we need – without their physical presence.
People often find that they are either focusing on their loss and doing things that bring up the feelings of sadness and pain, or they are distracted from their grief for a period of time (this could be minutes, hours, or days) by activities that are focused on restoring everyday life.
Immediately after the death, it might be that you spend most of your time focusing on your loss, and very little of your time is spent on everyday activities. This will change over time, but there is no prescribed timeframe for how this happens and it might not move in the same direction across time.
Both experiences are important in the process of grieving, as we need to have time to process our emotional response and mourn for the person we have lost, but we also need to be able to attend to the lives that continue on for us.
You might find that you spend much more time in one mode of grief than the other. You may feel guilty when you are in a mode that is more about restoring some kind of normal, for instance, catch yourself not thinking about the person who has died for a while or even enjoying yourself and laughing. You may feel stressed, anxious or judged when you are in a mode of focussing on your grief if you feel that you or others think you should have moved on or be coping better.
This is part of being human and does not mean that there is something wrong with you or with your bond to the person who has died.
There may be periods when you feel that you are moving backwards and more intense grief re-emerges. This can occur around the time of significant events, such as holidays, anniversaries, birthdays, other losses or a particularly stressful time.
Things to avoid doing
Drinking alcohol/using substances
People cope with grief in many different ways, and although all of these coping strategies are equally valid, some will be less helpful to us in the short and/or long-term. These are some ways of coping that are generally best not to rely on:
Drinking alcohol or using substances (including prescription sedatives or sleeping pills) to habitually numb difficult or painful thoughts and feelings.
There is likely to be no shame and little harm in using any of these occasionally and temporarily and if you did these things regularly before your bereavement, it is unlikely that now will be a realistic time to stop. Indeed, some people feel that using sleeping pills, for example, for a short time during their acute grief helped them to get the respite they needed to cope better long term.
Things to watch out for are: using many of these in combination; feeling like you absolutely rely on even one of them for more than a few weeks; using them not so much to occasionally switch mode but to dull your experience altogether as this may become a barrier to you dealing with your feelings longer-term.
If you know that you already had patterns of problematic drinking or substance use prior to your bereavement, it is likely to be important to stay connected with people, groups and activities that helped.
Decision making
Making significant decisions or changes to your life, in areas such as work or your living situation, if these can wait. People often find that they need some time to reorient to their circumstances now and can regret decisions that were made in haste.
Work and responsibilities
Rushing back to work or to organisational responsibilities if these can be postponed. Accidents are more common after severe stress, so take extra care especially when driving and using machinery.
Avoiding emotions
Consistently bottling up or avoiding your emotions in response to the bereavement. It might be that you need to use some distraction strategies to give yourself a break from overwhelming feelings, but doing this all of the time will be exhausting for you and will unfortunately not take away the feelings.
In fact, they may then leak out at times you would rather they did not (like at work) or when you are not prepared to experience them.
Avoiding people
Cutting off contact with family and friends. Social contact may feel exhausting. You may feel like you are in a bubble where it is very hard to relate to the concerns of the rest of the world and that they in turn, do not get it.
However, being alone all of the time cuts you off from any support that people might be able to offer you, and this can increase feelings of sadness and loneliness.
You may feel hurt or angered by the response of those around you who may say insensitive things or avoid you. Family conflict is not uncommon during a time when everyone’s emotions are high.
Whilst withdrawing from people temporarily is very normal during grief, be wary of isolating yourself completely or reactively breaking off relationships with people who have been important to you until now.
Things to try and do
Give yourself the best chance of good sleep
People frequently report changes to their sleeping habits after a bereavement, either sleeping a lot more or a lot less. While this might be a complex issue to resolve completely, some quick tips to improve your sleep include:
• avoiding screens, which use LED lights, right before bed
• keeping your bedroom cool
• avoid drinking alcohol; this may help you fall asleep but the quality of sleep you get will be poorer
• avoid drinking caffeine later in the day; some people are more sensitive to caffeine than others, but definitely avoid caffeine in the evenings where possible.
Prescription medication to help you sleep can be a relief for some people who are struggling in the short-term with insomnia. However, they can leave some people feeling more groggy in the day and there is a risk of a rebound effect after stopping the medication as it is not a long-term fix. Discuss with your GP what is best for you.
Using relaxation exercises, such as meditation or relaxed breathing, especially in the evenings, can also help to calm your body and mind. You can use the links below to find out more about these techniques.
Take what is helpful to you from this and try not to have unrealistic expectations of yourself; these are skills that take practice and, if they are new to you, you are unlikely to master them straight away whilst under stress!
www.headspace.com or www.nhs.uk/mental-health/self-help/ tips-and-support/mindfulness
Eating
You may have noticed a decrease in your appetite since your bereavement, or an increased desire to eat for comfort. It may be difficult to adjust the way meals have happened if you were not the primary cook or if eating by yourself is a new thing.
When it comes to eating to maintain wellness as best as possible, the main thing is to try and eat regularly and keep your body nourished.
Emotional, physical and mental tasks will all become much harder if your body is deprived of nutrients and fuel. If this means grazing on things rather than preparing set meals, that may be a good short-term solution.
If people are offering to drop off pre-prepared meals for you or organise home deliveries of food, this may be helpful to accept. You may want to ask one person you communicate well with to coordinate this for you on your behalf. There are apps such as www.mealtrain.com that can help with this.
Exercise
Regular exercise, even if it is just a short walk, on a regular basis can help to maintain mental wellbeing, as well as our physical health.
Do what has helped you in the past and suits your current lifestyle though. If you have never done yoga before, now is unlikely to be the time that you will master it; try new things if the opportunity is there and you like the sound of it but try to have realistic expectations and not put too much pressure on yourself.
Seeking further support
You can contact the following organisations for bereavementspecific support:
Let’s Talk About Loss is the UK’s first support organisation for young people aged 18 years to 35 years, who have been bereaved.
Let’s talk about loss is a national peer support organisation, with advice online and monthly social gatherings called meet ups that run in Bristol, Nottingham and London.
Marie Curie Bereavement Support
Tel: 0800 090 2309
8am to 6pm Monday to Friday and 11am to 5pm Saturday
community.mariecurie.org.uk
You can share experiences and find support by talking to people in a similar situation.
Mind Bristol
Tel: 0117 203 4419
MindLine helpline, Wednesday to Sunday 7pm to 11pm.
They also have a dedicated daytime telephone line that can point you in the right direction to find support for mental health and wellbeing needs. The information and signposting line is open between 9:30am and 3:30pm, Monday to Friday (excluding bank holidays).
You can reach them on 0117 980 0370, or at: info@bristolmind. org.uk. www.bristolmind.org.uk
Anyone who has been bereaved through the death of someone under the care of the hospice is welcome to contact the team. Anyone requesting support from the emotional and
psychological support team at St Peter’s Hospice will be assessed, and if appropriate, offered support from a psychotherapist, counsellor or trained volunteer.
Sue Ryder Online Community
community.sueryder.org
You can share experiences, get things off your chest, ask questions and chat to people who understand.
The Harbour provides specialist counselling services to people who face death, dying and bereavement. They offer individual, couple and group counselling.
There is a dedicated Bristol team who meets with families in community venues across the city.
Twitter: @winstonswish Instagram: @winstonswish
Facebook: Winston’s Wish
Winston’s Wish support bereaved children and young people aged 0 to 19 as well as their parents, carers and siblings.
Non communicative resources
You may not wish to communicate with others online or on the telephone but instead, explore bereavement and grief at your own pace. There are some excellent reading materials available which we hope you might find of use.
The Good Grief Trust has a page with stories from others who are bereaved and articles explaining how people deal with their own grief early on.
There is advice from professionals which you may find useful.
Beyond Words provide books, e-books and downloadable resources for people who find it easier to understand pictures than words, including people with learning difficulties. www.booksbeyondwords.co.uk
It might also be worth exploring whether there are any bereavement blogs which you might find supportive. These tend to be less formal.
Let’s talk about loss is a charity that publishes a regular bereavement blog which you can sign up to receive. www.letstalkaboutloss.org
Podcasts and useful apps
It can be helpful to hear others tell their bereavement stories and experiences.
Good Grief Bristol
Good Grief Bristol created an article listing the 10 best podcasts on grief which is worthwhile reviewing.
www.goodgrieffest.com
www.calm.com
www.headspace.com
www.apps.psyt.co.uk/grief-works
Teams at UHBW NHS Trust
Supportive and Palliative Care Team
The Supportive and Palliative Care Team offer support and advice to patients and families who are under the care of the hospital Trust. Please ask ward teams for more information about their services and the referral process.
The Hospital Carers Liaison Team
The Hospital Carers Liaison Team provides help, support and advice to carers including those who have been recently bereaved. Carer Liaison Workers can help you by:
• explaining hospital processes
• communicating your needs or concerns to ward staff. Attending meetings with you and acting as an advocate
• talking to you about benefits, carer’s assessments and connecting you to other services.
You can contact the team to find out more about the service by emailing CarersLiaison@uhbw.nhs.uk or calling 07557 441 613.
Macmillan Information and Support Centre
The Macmillan Information and Support Centre in Weston General Hospital is located on the first floor.
They offer a drop in service which is open 9am to 4pm Monday to Friday for anyone affected by cancer, weather they be the patient themselves or family/friend or carer.
Feedback on this leaflet
Psychological Health Services
This book has been developed by Psychological Health Services at UHBW.
If you have any comments about this booklet or want further guidance, you are welcome to contact us during normal office hours on: generalpsychologicalhealthservices@uhbw.nhs.uk or 0117 342 8168.
As well as providing clinical care, our Trust has an important role in research. This allows us to discover new and improved ways of treating patients. While under our care, you may be invited to take part in research. To find out more please visit: www.uhbw.nhs.uk
Help us prevent the spread of infection in hospital. Please make sure your hands are clean. Wash and dry them thoroughly/use the gel provided. If you have been unwell in the last 48 hours please consider whether your visit is essential.
Smoking is the primary cause of preventable illness and premature death. For support in stopping smoking contact NHS Smokefree on 0300 123 1044.
Drinkline is the national alcohol helpline. If you’re worried about your own or someone else’s drinking, you can call this free helpline in complete confidence. Drinkline on 0300 123 1110.