Peter is 16 and describes how his father died after a long battle with cancer. Laura is 6, and sits alongside her 8 year old brother, Toby. Both children were pulled alive from the wrecked car in which their father was killed. Emilie, 13, tells of how her mother killed herself in front of her. They all talk openly and with astonishing maturity of their devastating experiences. These are but some of the children and young people who have been helped to come to terms with their grief after the death of someone they have loved. They have been fortunate to find their way to a member of the Childhood Bereavement Network (CBN) which since being established in 2001 now encompasses over 250 voluntary organisations across the UK and is based at the National Children’s Bureau in London.
Children and young people are the forgotten mourners of our society in which death is the great taboo subject; even as late as the 1980s there were doubts as to whether children could grieve at all. Of the enormity of the challenge there can be no doubt. A child loses a parent through death every 22 minutes, with 1 in 29 being bereaved of a parent, brother or sister. That’s over 252,000 5-16 year olds in England alone. Moreover, 78% of 11-16-year-olds report that at least one of their close relatives or friends have died.
Many factors affect how a child responds to bereavement, including the circumstances of the death (which can be expected, unexpected or violent or traumatic), the beliefs of the child or young person, their social relationships and the support available for them. How the family responds to a loss, the modelling of behaviour they provide, both positive and negative, and the emotional support they are able to give the child are key for effective resilience.
The range of developmental capacity to understand the meaning and reality of death through early childhood and adolescence mean that there cannot be ‘one size fits all’ in supporting grieving children and young people. Particularly vulnerable groups include young offenders, asylum seekers, young carers, those in care or with physical and learning disability, children who have been abused and those in families with drug or alcohol issues. These children and young people are even more likely to be hidden from view and unable to access support.
The death of someone close affects many aspects of children and young people’s lives, sometimes with major sequelae persisting into adulthood and throughout life. Death challenges their cognitive, emotional, spiritual, physical and mental wellbeing.
As children get older, they may revisit their grief, experiencing and expressing it in new ways, especially at times of further change or loss. Anniversaries, birthdays and Christmas-tide can be especially challenging.
However, many children and families cope well, but the overwhelming challenge even in these families should not be underestimated. It is not so much who died and how and why, what really matters is the child’s attitude to the family death, how they make sense of it, and what story they tell to people they trust. 10-yr follow up of supported children shows that they can and do grow up with emotional literacy that allows them to develop good relationships and a resilient mind set to achieve their full potential. Moreover, 62% of British Prime Ministers were bereaved children emphasising that bereavement in childhood can be a spur to high achievement.
Nonetheless, if they are given negative messages or left to deal with loss alone or unsupported, they may develop destructive or unhelpful coping mechanisms. Children bereaved of a parent suffer more than others from somatic symptoms, accidents and serious illness requiring hospitalization. They visit their GPs more than their peers, and are at risk for immediate and long term serious mental health problems. They may have low self esteem and may be bullied; they are at risk for physical and sexual abuse and, in girls, teenage pregnancy; they are more likely to misuse substances and commit serious crime and more likely to be taken into care and excluded from school. Of special concern, they may be at greater risk of underachievement not only in school but throughout life.
Persistent young offenders are at least four times more likely to have been bereaved of a parent than their peers whilst men who had been bereaved of a parent before they were 16 were more likely to be unemployed when aged 36 than non-bereaved peers.
Bereaved children and young people are clearly an important group of potentially highly vulnerable subjects, so what do we know of what they need and the provision of support available to them?
Children and young people and their families are clear about what they want, and how specialist childhood bereavement services can give benefit.
They need information and education on what death means; encouragement to talk about how they feel and to understand and express their grief; meet others and share experiences, with opportunities to remember and access to support. The member organisations within the Childhood Bereavement Network can provide such support, much of which has grown out of the hospice and palliative care movement.
Of crucial importance is the impact of bereavement on schools. Death is a reality for schools with up to 70% having at least one recently bereaved child on their roll at any one time. Moreover, the loss of a student, teacher or other member of staff brings into sharp relief the need for every school to be prepared for death. Whilst many have access to bereavement support services, too frequently this is not the case. Dyregrov has written simple, easily understood books to help staff prepare, with other publications and resources being available through the members of the Childhood Bereavement Network.
A recent questionnaire sent to all Directors of Children’s Services and Chief Executives of Primary Care Trusts in England explored their provision of bereavement services. A response was received from 56%. Of these only 17% include the specific needs of bereaved children in their Children and Young People’s Plans; only 23% of PCTs reported that their end of life care strategy included the needs of bereaved children.
31% of responding areas lack a specialist childhood bereavement service which covers the whole area and works with children whatever the cause of death. Even where services exist many are unable to see all that might benefit from or want their input. These data were collected before the current massive political and financial turbulence that is affecting the UK. The majority of services depend on fragile local fund raising, and already there are anecdotal reports that local authority cuts to voluntary organisations are adversely affecting bereavement services for children.
Childhood bereavement is not being taken with the seriousness that it deserves. So, what does this mean for our Anglican churches, parishes and schools?
There has been little research on the relevance and importance to children of spirituality and faith in coping with the death of a loved one, and this must be a priority for future research. Informal discussion with clergy has exposed that whilst most are able to relate to and support adults in families experiencing funerals, there is deep uncertainty and lack of knowledge on how best to relate to children of different ages. The interface between the theological basis of faith, resurrection and the life hereafter and the practical reality of the needs of children and young people is especially challenging and should be confronted.
In the Salisbury Diocese, our Board of Education has identified childhood bereavement to be a priority area to explore and develop. A pilot event was held recently in Dorchester, Dorset, to provide a study day bringing together head teachers and school staff, clergy, psychologists and counsellors, palliative care teams and health service personnel, funeral directors and parents, children and young people themselves in a format of formal presentations, workshops and group discussions.
The event was over-subscribed, and the highly positive feedback reinforces the uncertainties that adults have in exposing their own often deeply emotional experiences, and their difficulties and uncertainties in relating to children. It provided an opportunity to share best practice, of which there was much to applaud, and to know who was doing what and where across the Diocese. A committee has been formed to take forward ongoing activities including the training of clergy in relating to bereaved children, and working with schools to make sure that death is seen to be part of life. The ‘Salisbury Model’ is one we should be pleased to share with other Dioceses.
We suggest that our parishes, churches and schools should work with other services to make sure that:
- they know how many local children and young people are bereaved of a parent, carer, brother, sister or other close relative and what services they need.
- all children, young people and families can access services according to their needs before and after the death of someone close.
- adults who work with children and young people get training and support to understand how they might help a child or young person who has been bereaved, and where to find extra support.
To play their part, every school should have:
- sensitive and flexible people and systems to provide rapid support and information to children and staff when someone has died.
- opportunities to learn about death and bereavement as part of life.
Training programmes and protocols for staff and clergy working with children, young people and families should ensure that all understand and respond appropriately to the needs of children, young people and families who are bereaved.
Staff working with adults should ’Think Family – Think Child’. In other words making sure that all agencies, including clergy, always consider that there may be children affected by the death of the adult they are responding to.
‘Grief is the price we pay for love’. This is the deeply thought provoking quotation from Her Majesty Queen Elizabeth at the time of the memorial service for the victims of the Twin Towers terrorist attack in New York. Grief is a fundamental human experience, and it is time we realised that children and young people are ‘the ‘hidden mourners’ being all too frequently exposed to unresolved grief with important effects on their young lives. It is us adults who must speak for them and demand the resources they deserve, informed by what they have to say. Above all, we must open our minds to the potential importance of spiritual guidance and support for our grieving children and young people. Are we doing the best we can for them, and if not what should be done?
We cannot afford to fail them!
Al Aynsley-Green is Professor Emeritus of Child Health, University College London, Patron, Childhood Bereavement Network and Chair, Salisbury Diocesan Board of Education
These posts are by guest authors for Fulcrum