The family on the hill
But I need to introduce two other concepts before we move any further.
Who needs what kind of help?
Out of their research in Australia, Aoun et. al. suggested a three tier public health model.1 In this model, “the low risk group (first tier) [about 60%] would need support principally from family and friends, the moderate risk group (second tier) [about 30%] would need support from the wider community through some general support from various professionals, and the high risk group (third tier) [about 10%] would need support from mental health services.”
They operationalize these three tiers with specific examples:
“Low Risk: Grieving for a parent. Typically the bereaved person in this group is about 60 years of age, usually married, and compared to the higher two risk groups, the deceased is much older (about 80 years) and usually a parent.” 6
“Moderate Risk: Grieving for a spouse. In this group, the bereaved person is about 63 years of age and usually widowed. The age of the deceased tends to be closer to the age of the bereaved person (69 years) and the deceased is usually a spouse.”7
“High Risk: Grieving for a spouse (of a younger age) or a child. Compared to the two lower risk groups, both the bereaved person (55yrs), and the deceased (52 years) in the high risk group are typically younger. This bereaved group has a high proportion of spouses (46%) and parents (30%)” 9
“The sources of support listed by respondents indicate that for the most part those in the low risk group were satisfied with support provided through everyday interactions. Those in the moderate risk group were also satisfied with the level of support, but most of them were also linked with some sort of bereavement follow-up program, through palliative care or a community support group. Those in the high risk group considered the support they received to be inadequate; such needs necessitate targeted mental health interventions in addition to other forms of support that were effective for people in the lower risk groups.” 11
This work was done in Australia in 2013. There are questions, of course, about consistency in percentages in Allen County in 2024. And about the way that people offer support to one another.
That said, this framework provides a starting point for thinking about how we are providing support. It also suggests that among the people on the hill, there will be different levels of need based on their relationship to the person who died.
Given the significant amount of help that comes from family, friends, and community-based bereavement support (as much as 90% of support), how can we foster the kinds of support that will be accurate. Said differently, how can we make sure that the fishing buddy offering support is actually being supportive?
For this we turn to grief literacy, the idea of having an evidence-based understanding of how grief happens and how to be helpful. The term is only about a decade old, though the idea is fundamentally human. Breen and others are using it to encourage a bridge between the research and theory-building being done about grief and bereavement and the ways people talk to people at times of loss.2
For example, O’Conner, among others, argues the stages model isn’t helpful and is often harmful. She suggests that the Dual Process Model of Coping with Bereavement, first introduced in 1999 offers a richer, more research supported, picture of what is going on. And yet, as recently as 2022, we read, “There hasn’t been much since the stages model.”
Grief literacy includes knowledge about what grief is and where to find resources, skills in listening, and values of care.
At present, there isn’t a grief literacy index, or standard curriculum in grief. And such tools may not be helpful. (In fact, whatsyourgrief.com argues for grief humility rather than a literacy that might make us belief that we can know for sure how someone is feeling.)
However, from a public health perspective, coming to agreement in a community about grief can be helpful.
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Eventually, the groups on the hill separated. People drove away, back to an empty house, back to life.
In another year, when another family group shows up, and then dissipates, given these costs and these change principles and these tiers and the concept of literacy, what can I do, what could we do as a community, to be more confident of supporting people?
- Aoun SM, Breen LJ, Howting DA, Rumbold B, McNamara B, Hegney D. Who needs bereavement support? A population based survey of bereavement risk and support need. PLoS One. 2015 Mar 26;10(3):e0121101. doi: 10.1371/journal.pone.0121101. PMID: 25811912; PMCID: PMC4374848. ↩︎
- Breen, L. J., Kawashima, D., Joy, K., Cadell, S., Roth, D., Chow, A., & Macdonald, M. E. (2020). Grief literacy: A call to action for compassionate communities. Death Studies, 46(2), 425–433. https://doi.org/10.1080/07481187.2020.1739780 ↩︎
Grief literacy helps us all. 