Overhaul bereavement support in the wake of the pandemic

About the study

This qualitative research explores the experiences of bereaved people and of those working in the funeral industry during the COVID-19 pandemic. The aim was to consider the implications for bereavement rituals such as funerals, and the impact that the exceptional circumstances of the pandemic had on individuals, their wellbeing, their work, and their support needs.

Aims of the study

In this primary qualitative research study we explored experiences of bereavement, funerals, and support during the COVID-19 pandemic, from now on referred to as the pandemic, to address these research questions:

1. What are the experiences of people who have been bereaved during the pandemic?
2. What is the impact on their mental health and wellbeing, and what support do they need?
3. What are the experiences of funeral directors who have planned funerals during the pandemic?
4. What are the implications of these experiences and impacts on public health messaging, funeral planning and bereavement rituals in the longer-term, and support provision?

Findings

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.

Recommendations

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.

Methodology

This longitudinal, qualitative study into the experience of bereaved people and funeral staff during the pandemic involved qualitative depth interviews of up to 1.5 hours. We interviewed 28 people who were bereaved during the pandemic. Of those, 18 agreed to take part in a follow-up interview to explore the longer-term impact of bereavement, and of support needs and provision. We also carried out 26 interviews with funeral directors and staff. To support the development and refinement of recommendations in the report, we held a workshop with key stakeholders.

Participants were purposively recruited through a range of activities, including via social media and community groups, as well as funeral organisations.

There were a number of ethical considerations for this study, due to the sensitivity of the topic and potential vulnerability of participants. These were considered accordingly and the study was approved by NatCen’s Research Ethics Committee.

This research was funded by Arts and Humanities Research Council (AHRC) as part of the UK Research and Innovation’s rapid response to COVID-19 (grant number AH/V015273/1).