Prioritizing Mental Health as a Universal Human Right
By: Neltada Charlemagne, DNP, APRN, PMHNP-BC, PHN, BHC
Describe a bereavement situation you’ve had with a Landmark patient during the Covid-19 pandemic:
MAS: A Landmark patient’s husband was hospitalized, underwent surgery and died during the surgery. Because of the pandemic, she was not at the hospital when he died. Initially, I helped her to process the anger, guilt, and sense of disconnectedness she experienced. Later, I worked with her to begin to develop a new routine, a ‘new normal’ of life without her husband. She was able to identify a strong support network of friends—several of whom are recent widows—that she found connection to and support from. We discussed available grief support online and telephonic resources as well.
How do Landmark social workers help those experiencing grief?
MAS: We start by validating the grief and giving a name to the things that they are feeling. We talk about grief and what they are experiencing, which can often help to normalize what they’re feeling. It helps people to know what they might expect. We can help explain that grief comes in phases, and that it’s a process that comes and goes in waves. We often provide handouts with helpful information and resources. The educational information can help give meaning to what they’re going through, and it can be a reference point for further conversations down the road.
Landmark social workers typically go by the lead of the individual. For example, some people may be interested in books or authors that are spiritually based, and others prefer books that are more fact-based. Some decline our assistance but agree to reach out if needed in the future. We tell patients what is available and help them determine how they can get it. Sometimes, we follow up with key points in writing, so that they can refer to it later.
Depending on the patient history and complexity of the situation, we sometimes determine a person could use additional support from our behavioral health team. If I feel the grief negatively impacts their ability to live their daily life, I will collaborate with our nurse care manager and our behavioral health provider to determine whether a referral is in order.
How are grief resources working to help those experiencing grief during the pandemic?
MAS: Grief resources have become creative in how they are now able to meet the needs of people going through bereavement. The grief support community quickly recognized the need to “switch gears” and made changes to meet the needs of those who are grieving. Online virtual support, one-on-one support by phone, and/or local online support groups have become the main sources of support since in-person groups are not available. Some patients have found ongoing support from their faith/religious leaders. Some have accessed virtual bereavement counselors. Some, like the patient I described earlier, access support of friends and family.
What do you suggest to people who are grieving during this already difficult time?
MAS: I suggest that each person identify what works for him or her. Do you prefer solace and reflection? Then reading grief and bereavement-related books, meditations, and articles may be most helpful to you. If you prefer connection and sharing your grief, consider connecting with friends who have also had a recent loss. You can also access one of the many online and telephonic bereavement support groups that are available. This can make you feel more connected and understood. If you find spirituality and faith important in processing your grief, reach out to your faith community to see if telephonic support is available to you.
Doing hobbies can help, as can creating some type of memorial that gives validity to the life of the loved one who died. Some people find it comforting and somewhat cathartic to create a scrapbook. Others find solace in compiling a list of quotes or favorite sayings that their loved one often expressed.
I think it’s also important for people to openly acknowledge that this is a different time for grief. We can’t follow the customary protocol. The changes to the traditional funeral have been a big deal―now using social distancing or drive-through. All this makes your grief a little different.
What have you learned through the experience of doing social work during the pandemic?
MAS: My experience during the pandemic has shown me that technology is our connection to the world, especially when leaving the house is limited. For example, connecting to family can be difficult by phone for a person who is hard of hearing. Having a tablet and FaceTime can help a lot.
With the pandemic, the awareness of death is magnified for everyone right now. We’re in tune with it. Families are separated, and we can’t help but put ourselves in their shoes, which heightens our awareness.
Day to day, we get accustomed to death as a part of life, and we usually learn to cope, but the pandemic has made it more personal and complex for us. This makes me say to myself, ‘We have to be in tune with this to better meet the needs of our patients.’ Death is a natural part of life, and some people experience grief more and sometimes less than others. But now we look at grief differently. It deserves to have the attention and support we would give to the diagnosis of an illness.
Is there any silver lining to the challenges of the pandemic?
MAS: As a result of the COVID-19 pandemic, I feel that people are more willing to accept help. When you have felt and experienced grief as much as we have, you recognize the strength of asking for help. There is now a greater willingness to accept grief as part of the process, and to give it a name.
Many people go through grief, but they don’t realize what it is. They might associate it with changes in behavior, such as not eating as much as before, or getting stomach aches or headaches. Some experience anger that is constantly at the forefront of their thoughts, and it becomes an unhealthy mode of functioning. Anger may be heightened now because funerals and other memorials have been compromised, and this typical outlet to process grief is sometimes not available or available in a restricted manner. Guilt is normal―it comes and goes, but guilt is a problem when it becomes pervasive.
What warning signs should loved ones look out for with a bereaved family member?
MAS: Warning signs for a grieving individual include disconnection from friends and family, not being as social as they had been before, having difficulty finding joy in day-to-day life, and sadness that goes beyond what you’d expect. It is a problem if the grief reduces their daily motivation to take care of themselves and to do what needs to be done.
Remember that grief and loss do not have to be associated with a death. Sometimes grief is triggered by a move to assisted living, or by losing driving privileges. These major events tend to magnify grief. Sometimes, grief is associated with a build-up of losses. For example, for many people, the connection to their family feels different with the restrictions associated with COVID-19. Perhaps before, they saw their grandkids regularly, and now that’s been removed.
What can people do to help those who are grieving in their community?
MAS: If you know someone who is grieving, it is helpful to reach out by phone to see how they’re doing and to offer a listening ear. Ask whether they’d appreciate help in some way, such as picking up groceries. We can still offer community support, but in different ways. We now need to be more creative. The restrictions of COVID-19 don’t mean that people don’t want or need support.
Consider leaving a fresh bouquet of flowers on the doorstep. Or offer to mow the lawn or do some weeding. Especially for the person who has lost a spouse. They now must handle the responsibilities that the spouse had done.
For example, one Landmark patient, a women age 89, had a car that needed to be inspected. Her husband always took care of car maintenance and she struggled to accomplish this task now that her husband was gone. Working together, we connected her with a trusted neighbor who was able to take the car in for the inspection. You have to think outside of the box.
Any final thoughts?
MAS: Before COVID-19, Americans may have tended to sometimes disregard older people’s grief. With COVID-19, we have all experienced multiple losses and related grief due to COVID restrictions, and we’ve become so much more aware of how death and grief impact the elderly. We have a different degree and quality of empathy. Just because you’re older doesn’t mean your grief is any less.
A Grief Observed, by C. S. Lewis
By: Neltada Charlemagne, DNP, APRN, PMHNP-BC, PHN, BHC
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