HELPING A PERSON IN CRISIS

What is crisis support, and who provides it?

When we talk about helping a person in crisis, it is important to differentiate between two points:

How can I help a person in crisis?

Even if you are not a crisis intervention professional, you can still provide support to a person who has lost a family member. Your duties include ensuring that the bereaved person has the opportunity to obtain crisis support from a crisis intervention professional.

How to ensure that a bereaved person has access to statutory crisis support?

In sudden cases of death, the emergency services, police, rescue services, primary care providers and the social and crisis emergency services, and, if necessary, third-sector operators collaborate to help family members. In addition, it is the responsibility of municipalities and hospital districts to arrange 24h primary healthcare on-call services, which are usually centralised to hospitals.

Psychosocial support and crisis support are part of primary healthcare on-call services. In addition to this, hospitals can also have mental first-aid workers, priests, and deacons.

If you are a professional who encounters bereaved people in their work, referring them to crisis support and social support are your statutory obligations.

In addition to social and crisis emergency services, crisis support is offered by third-sector organisations. For example, the Finnish Association for Mental Health and the Finnish Red Cross organise crisis support. Find out where your municipality’s closest crisis centre is. The Finnish Association for Mental Health also maintains a crisis hotline.

How and why should an organisation prepare for losses experienced by their employees?

What to do in case of a colleague’s death?

The death of a colleague will impact the entire work community and may cause the operations of the whole workplace to be suspended temporarily. Furthermore, the event may cause shock and grief in the employees as well as concern about how matters will be arranged in the future. Therefore, in case of a death that affects the work community, it is recommended to utilise professional help to overcome the situation. For this purpose, the workplace’s supervisor or HR worker can contact the occupational health services through which it is possible to obtain the help of, for example, an occupational psychologist.

How to consider an employee before they return to work?

An organisation should consider their employee’s changed situation as soon as they become aware of it. The death of a family member can be very sudden, or it can be anticipated. An employee may take time off work already before the death of a family member, for example, to participate in palliative care.

How to support an employee when they return to work?

How to support the work community of a bereaved person?

Supervisor, don’t forget about your own resources

How to support a bereaved person in the long term?

The impact the loss of a family member has on an employee’s life are far-reaching. But, unfortunately, the awareness of a bereaved person often ends too soon.

What does the diversity of grief mean?

The diversity of grief is a multidimensional and multigenerational entity, which is challenging to simplify. The background organisations of the Surevan kohtaaminen program, Käpy Lapsikuolemanperheet ry, Nuoret lesket ry, Surunauha ry and Huoma ry, already in themselves represent bereaved people diversely and emphasise the fact that death can have an effect on anyone and at any stage of their lives. There can also be various causes of death.

When encountering a bereaved person, it is most important for a professional to encounter the person as a grieving individual. However, the professional should be aware of some presumptions, which may impact the encounter. Individual and cultural characteristics also affect encounters. Cultural assumptions must not be the starting point when encountering an individual, but it is good to be aware of them. The diversity of grief is now processed from the perspective of cultural diversity and encountering the LGBT community.

It is important to provide a bereaved person with space to talk about themselves and their close relationships in a manner and scope they choose to, and not make normative assumptions. For example, a minority representative may experience minority stress if previous encounters have been inappropriate, astonished, or heteronormative. Diversity may also be associated with human relationships, in which close relationships reach further than the normative core family or next-of-kin indicated in medical records. A bereaved person often requires legitimation of their own grief, i.e., confirmation that they have the right to grieve, no matter their relationship with the deceased person, and that their own way of grieving is right. It is also important to legitimate the fact that everyone grieves at their own level of intensity, and different family members can experience different feelings of grief.

What must be considered in LGBT grief? Losses concerning LGBT human relationships

Although the general atmosphere has changed a lot over the past decades, life as a sexual or gender minority may still not necessarily be straightforward. The LGBT community may, in fear of being discriminated against, leave some services unused even if the services are needed. If discrimination has previously been experienced, it can be challenging to talk about personal family and relationship situations. Disparaging comments about the person’s own family format may cause the person to find it difficult to trust that the professional is on their side. The threshold to seek help may be high. Therefore, it is important to highlight in services that they are open to all bereaved people. It must be ensured that the services consider the diversity of people and human relationships. There are currently no personalised support services that are targeted solely at bereaved people of the LGBT community.

Therefore, it is important to highlight in services that they are open to all bereaved people. It must be ensured that the services consider the diversity of people and human relationships. There are currently no personalised support services that are targeted solely at bereaved people of the LGBT community.

When encountering a bereaved person from the LGBT community, professionals should acknowledge that they may experience disparaging or dismissal of their grief. Although the position of minorities in our society has improved, a strong heteronormative culture continues to be in place, which may cause minorities to experience a sense of not belonging. Unwarranted grief/no voting rights is also possibly increased by the fact that the relationship with the deceased has not been, for example, legally recognised or accepted within the family circuit. In the LGBT community, many important relationships are placed outside the level of a recognised family in regard to legislation. Examples include friendships, relationships with ex-partners, partners’ children who have not been adopted and relationships that challenge traditional relationship models. The same applies to same-sex couples’ relationships, which end in the death of either partner before any legislative changes have occurred, allowing the relationship to be made official, or relationships, which have not been made official.

Professionals must talk about the relationship between the bereaved person and the deceased person in the same way the bereaved person speaks about it, i.e., refer to a human relationship with its correct name. For example, professionals must refer to a spouse when discussing with a widow because referring to a friend is incorrect and underrates the relationship between the bereaved and deceased person. In this case, the professional will have confirmed the grief to be disenfranchised/unwarranted. Therefore, it is essential that the professional considers the language used by the bereaved person and uses similar expressions as the bereaved person.

Professionals must look into their own attitudes and encounter a bereaved person as an individual. Professionals must show that the relationship, the bereaved person themself and their grief are acceptable. Problems in encounters can also be brought along by other bereaved people grieving the deceased person when the deceased person’s other close relatives do not acknowledge the relationship between the deceased person and the bereaved person or the grief caused by the loss.

Sometimes death forces a representative of the LGBT community to come out of the closet in various situations in order to be seen, heard and get the support they need. Due to the normative assumptions prevailing in society, coming out of the closet is a continuous process. When encountering professionals, LGBT people who openly live their lives also have to consider how they talk about themselves and their own situation. Amidst the grief, it becomes a different matter to consider.

For the LGBT community, priests and churches are not neutral providers of support in grief due to the tensions related to institutional representation and history. Many people may have also resigned from church due to discrimination. The support services offered to a bereaved person may be related to church support groups, and, in this case, participation may involve transparent or visible tension. For a bereaved LGBT person, the presence of a priest may bring up previous, painful experiences of discrimination. On the other hand, acceptance shown by the church and priests can be particularly important for some of the LGBT community. Some ecclesiastical operators have openly shared that they have a positive attitude towards the LGBT community and will bless the relationships of same-sex couples.

Important terms for encountering a bereaved person who belongs to the LGBT community

Chosen family= A family in which the members do not necessarily meet the traditional family model of a father, mother, and their biological children. A chosen family can, for example, consist of non-biological children, friends, bonus parents and ex-partners or their parents.

Disenfranchised grief= Grief in which the person to have experienced a loss is not allowed or able to openly express their grief and, therefore, cannot openly grieve or obtain social support for their grief. According to the theory defined by Doka, disenfranchised grief is divided into three different types, which are:

1. grief in which the bereaved person’s attachment is not acknowledged
2. grief in which the bereaved person’s loss is not identified or
3. grief in which the bereaved person is not identified.

Later on, the conditions of death and the effect of expressing grief has been added to the group of disenfranchised grief.

Coming out of the closet= A person belonging to a sexual or gender majority tells their close relatives or other people that they belong to the said minority group. Coming out of the closet is often a continuous process because new human relationships and encounters place the person in a situation in which the person has to come out of the closet over and over again. Can cause minority stress.

Minority stress= People belonging to a minority group may experience additional stress due to their minority background. Assumptions prevailing in society, experiences of discrimination, fear caused by them, shame and secrecy can increase stress. As a result, minority stress can increase, for example, mental health and substance abuse problems and physical illnesses.

Heteronormativity/cisnormativity= The assumption that all people are heterosexuals.

Cultural diversity and losses

Individuals represent themselves, not a specific culture; therefore, we cannot assume that every representative of the same culture wishes to encounter situations to be the same. For this reason, it is impossible to provide a comprehensive list of operating methods. Care practices have often been prepared from the perspective of Western culture, so it is important to ask the bereaved person about individual needs concerning their own culture and death culture. You can ask the bereaved person, for example, how they experience the matter, how the matter is experienced in their home country or culture or how the individual would like things to be carried out in the said situation. The information must be provided to a bereaved person in writing and in an appropriate language. However, it is important to remember that a bereaved person may not necessarily be able to immediately say what support they would like. Therefore, it is important to ask again.

In different cultures, expressing grief involves both common and specific characteristics. Unlike in the Finnish culture, grief can be expressed strongly and publicly, such as by shouting and visibly crying. When sharing grief, speaking does not necessarily play an important role in all cultures. Instead, grief can be expressed by singing together. It is also necessary to consider which unit is grieving. The grief of an individual, nation or family can be different, and, for example, the commemoration days of genocides can be intense events of experiencing communal grief.

Grieving can involve the experience of loneliness despite the culture. The experience of loneliness must also be considered in the service system. For example, the percentage of immigrants in the total number of mental health service users is smaller and the treatment periods are shorter than in the case of native Finns, and the service system may be unfamiliar. Therefore, seeking and receiving help may not necessarily be recommended. For example, in some cultures, suicide is such a big taboo that the presence of suicide is not acknowledged, leading to seeking help being prevented or the reasons manifest differently. For example, in case of a close relative’s or friend’s suicide, a bereaved person may find it necessary to refer to an accident. It is important that a professional respects this need.
There are no traditions to seek professional help in some cultures, but instead, people get support from their relatives and family. The role of a professional is emphasised if the bereaved person does not have close relatives or friends in the new country of residence with whom they can share the grief or a common language to talk about the grief. Due to cultural reasons, it can be difficult, in some situations, to turn to close ones. Several religions or cultures can also be represented within the same family, in which case the understandings of death, grief and afterlife may exacerbate the family’s situation and drive the family apart.

Particularly among refugees, there may be the experience that part of themselves is always elsewhere. Even if happy things related to life happen in the new country of residence, grief can also be present in these events because many people cannot be part of everyday life in the new home country. Loss can surround an immigrant at all times because some of the family members remain in their unsafe home country from where bad news are received or feared. Grieving can also involve grieving remotely, and, in this case, grieving can take place alone. Individuals who have arrived in the country alone can experience guilt for surviving while the rest of the family has been left behind in their home country. The framework in which the sense of community is experienced can be the same as how grief is expressed. When alone, these jointly shared frameworks are missing. Grief and grieving have a lot in common despite the culture. Participating in a funeral, looking at photographs and visiting a grave can facilitate the integration of grief as part of the person’s life story. If these opportunities are missing, the expression of grief could be prevented. For this reason, it is necessary to share, for example, at graveyards, about collective memorial sites.

What are culturally sensitive encounters? 

In a multicultural encounter, it is important for the professional to be culturally sensitive.

This does not mean being familiar with all the details of different cultures, but rather appreciating and being curious about the customs and beliefs of different cultures and being able to identify discriminatory behavior stemming from one's own beliefs.

The concept of cultural competence means respecting people from all cultural backgrounds and building and fostering an atmosphere of non-discrimination in society. 

The cultural competence of professionals consists of cultural awareness, knowledge, skills, encounters and motivation. People reflect on and contrast their own cultural roots, customs, values and belief systems with the customs, values and belief systems of other cultures.

Cultural sensitivity refers to culturally respectful interaction and interacting with people in a respectful way (both verbally and non-verbally). Both the professional and the client have the right to express their own culture and to be accepted and heard. 

Ways of grieving

The ways of grieving vary because there are as many different ways as there are bereaved persons. A professional should be aware that not all bereaved persons, for example, want to talk, but instead, they will prefer to process their grief with more concrete acts. On this page, we have compiled different ways of expressing and processing grief.

Publishing photographs on social media

Social media offers new ways of grieving. On social media channels, such as Facebook, Twitter and Instagram, grief can be made into a shared experience of grief when bereaved persons share their thoughts in the form of, for example, photographs and texts. Others can convey their compassion and support through reactions, comments, and messages. Social media has made it easier to share grief due to social networking.

Internet, and thus social media, have made grieving increasingly more public. On social media, bereaved persons can reminisce and maintain their relationship with the deceased close relative or friend. According to studies, bereaved persons, who publish photographs on social media, express the state of their grief and accept their loss, emphasise the significance of memories, and share their thoughts about important days spent with the deceased close relative or friend.

Different emotions vary in the posts. Studies observed that by sharing photographs, bereaved persons might experience, for example, longing, wishes, gratitude, pride and joy. Negative feelings are also possible.

Treasuring keepsakes

The importance of keepsakes can be significant for a bereaved person. When studying mothers who had experienced stillbirths, it was observed that the role of keepsakes in forming a mother’s and deceased child’s attachment relation after the death of a child is significant. Keepsakes allow a deceased family member to be part of the family. In addition to this, keepsakes maintain the memory of the child and authenticate the loss. For mothers who have experienced a stillbirth, keepsakes strengthen the child’s presence, allow the actualisation of parenthood, and develop the family identity. Keepsakes also work as a way of sharing social grief.

Keepsakes can be, for example, photographs of the deceased person, clothes and toys, and various angel statues acquired for the child.

A professional needs to be aware that the meaning of keepsakes, particularly for those bereaved persons who have experienced a stillbirth, is significant because they allow the bereaved persons to express and authenticate their grief and the reality of the loss. It is a professional’s responsibility to support bereaved parents and help them create memories, which affirm the loss. A professional can offer to, for example, take a photograph of the parents holding the deceased child or cut a hair curl from the deceased child.

Tattoos

Memorial tattoos are a bereaved person’s way of maintaining a connection with the deceased family member or removing grief-related stigma, often related to silenced grief, such as stillbirths or the grief related to a family member’s suicide. Tattoos are often taken in places where they are visible to others, hoping to get people to pay attention to them. Tattoos are hoped to keep the deceased person present and show that the attachment to the person still exists.

Guides and publications:

What constitutes as good support and interaction?

What issues may make interacting with the bereaved more difficult?

What factors affect the support given to the bereaved?

Many different factors affect how a grieving person receives support from professionals. These factors can be related to both professionals and organizations. When helping a grieving person, the focus should be on the person’s wants and needs. Below, we have collected some tips that may help professionals and organizations contribute to the support offered to the bereaved.