Families of deceased residents of institutions, as well as patients and staff members, face loss and grieving when a resident dies. A planned bereavement service may lighten the burden for family survivors and for residents and staff of the institution, especially when the deceased person has been a long-term resident and has established relationships with fellow residents. Rognlie (1988, 1989) reported increased emotional, mental, and physical stability for survivors during and after participation in bereavement services. However, such services are not an integral part of institutions with long-term residents. Bereavement needs are met in other settings such as hospices, which have been on the American scene for 20 years (Simson & Wilson, 1986). In fact, hospices provide an important example of successful intervention efforts with bereaved family members (Longman, Lindstrom, & Clark, 1989).
Bereavement services are a logical component of the continuum of care. This article examines the need for and functions of bereavement services in acute care settings, identifies relevant literature relating to existing bereavement services, considers the community relations implications of such services, and presents a proposed model for a bereavement service based on the authors' experience with a state psychiatric institution using data collected from families of deceased patients and professional staff.
Need for Institutional Bereavement Services
Family involvement in and response to the mental illness of a relative are important components of the treatment and rehabilitation of psychiatric patients (Atwood, 1990; Kreisman & Joy, 1974). A logical extension of this process is the recognition that assistance to family members need not stop when their institutionalized relative dies; there may be a need for follow-up assistance as they adapt to the loss. Bereaved families have substantial needs at the time of the death of a family member that may continue for months or years (Parkes & Weiss, 1983).
Bereaved family members may experience physiological and psychological reactions to grief including depression, increased susceptibility to illness, and increased morbidity (Vargas, Loya, & Hodde-Vargas, 1989; Zisook, 1987). Bereavement counseling, reassurance, and pastoral care may be welcomed by those who had major caregiving roles with the deceased as well as by relatives living alone who have few support resources.
Peers of the deceased may also benefit from bereavement assistance. For example, older, long-term patients in an institution establish continuing relationships and close friendships with other patients who die, and they may realize but may not have adequate opportunity to deal with the fact that they too may die while in the institution. For them, bereavement can be a recurring matter, and planned intervention can increase their dignity and enhance the conditions of institutional living.
Institutional staff members who form close relationships with long-term residents may encounter feelings of loss similar to those experienced by family members. For professionals, frequent exposure to death can lead to anxiety and denial, making them less able to support clients facing death (Holman, 1990). For example, research on perinatal bereavement indicates that staff need education, emotional support, and assistance in coping with the death of patients (Weinfeld, 1990). Therefore, institutional staff may also wish to use bereavement services.
Few structured bereavement assistance services are reported in the social work literature. Some hospitals have bereavement services, and in Catholic and other hospitals with religious sponsorship it is common for a member of the sponsoring religious order to provide support and spiritual guidance to families who have lost a relative. However, we could not find examples of formal bereavement services in psychiatric institutions in the literature, nor could we find examples of recognition of the bereavement needs of staff members. …