Prolonged Grief: A Care Staff Guide to Complicated Grief

Grief is not an illness, and most people find their feelings become more manageable with time. For some, though, grief stays intense and disabling long after a death. Care staff see bereavement constantly, among residents who lose partners and friends, among families, and among colleagues. Knowing when grief needs more than kindness helps you offer the right support at the right time.

What is prolonged grief?

Cruse Bereavement Support describes complicated grief, also called prolonged grief disorder, as being stuck or unable to cope long after a death. Marie Curie uses the same term and lists others, including persistent complex bereavement disorder and traumatic grief. Cruse notes that the terms are often used interchangeably, that UK doctors do not usually give it as a formal diagnosis, and that not everyone agrees grief should be seen as a mental health issue. The aim of this guide is not to label people, but to help staff notice when someone needs extra help.

How is it different from normal grief?

Cruse explains that in normal grief, feelings gradually become more manageable or come and go, and most people slowly adapt and find some enjoyment again. In complicated grief, intense feelings do not lessen or change in strength over time. People may feel stuck in one state for many months, such as constant sadness or numbness.

The timeframe is described differently by different organisations. Cruse refers to symptoms persisting for more than six months after the death, while Marie Curie says the usual reference point is more than 12 months, with a diagnosis sometimes possible from six months depending on how much daily life is affected. For staff, the lesson is not to wait for a fixed date. Concern about how someone is coping is reason enough to offer support.

Signs to look out for

• Intense pain, guilt, anger, loneliness or emptiness that is not easing.
• Strong yearning for the person, or difficulty imagining life without them.
• Struggling with basic daily tasks such as eating, shopping or returning to work after several months.
• Withdrawing from others and losing interest in things that were once enjoyed.
• Replaying distressing moments, such as events just before the death, or avoiding reminders.
• Feeling there is no meaning or hope for the future, or difficulty sleeping.
• Neglecting their own health and wellbeing.

Who is at greater risk?

Cruse and Marie Curie list similar risk factors. These include a sudden, traumatic or unexpected death, the death of a child, a strained or cut-off relationship with the person who died, family conflict, previous bereavements or other losses, existing mental health conditions such as depression, anxiety or post-traumatic stress disorder, little support from family or friends, and having been the person's carer. Marie Curie also notes that restricted visiting and reduced support during the pandemic have been a factor for some people. Marie Curie states that complicated grief affects around 1 in 10 people who are grieving.

Grief and depression

Cruse says clinical depression involves sadness and hopelessness lasting weeks or months, often with anxiety, and that depression can occur alongside bereavement. If a person seems persistently low, hopeless or unable to enjoy anything, raise it with the GP so it can be assessed. Our guide to depression screening in older adults explains how to notice changes in mood in care settings.

If someone talks about wanting to die

Marie Curie lists a wish to die in order to be with the person, or thoughts of suicide, among the signs that need attention. Take every such comment seriously. Stay with the person, listen without judgement, and follow your organisation's procedure straight away. Marie Curie advises contacting the Samaritans on 116 123, the GP or NHS 111 if someone cannot cope, and calling 999 or going to accident and emergency if there is a risk of harm. Our guide to suicide and self-harm awareness covers how to respond in more detail.

How to support someone

• Make time to listen. Let people talk about the person who died, as often as they need to.
• Keep routines going. Rest, regular meals, gentle activity and staying connected to others are the self-care steps highlighted by Marie Curie.
• Signpost. Cruse offers a helpline and a signposting list. Marie Curie lists NHS talking therapies, hospice bereavement services and online counselling. Spiritual support from chaplains or faith leaders is available to people with or without religious belief.
• Involve the GP. A GP can assess symptoms, check for depression or physical causes and refer on.

Our guide to bereavement support for care staff covers everyday support in more depth, and this guide adds the signs that suggest grief needs additional help.

Looking after staff

Staff grieve too, particularly in long-term care where relationships last for years. Make space for team conversations after deaths, mark the person's life in a way that fits your culture, and offer support to staff who are struggling. Learnsignal's CPD resources can help teams plan their learning on bereavement and mental health.

Frequently asked questions

Is prolonged grief a formal diagnosis in the UK? According to Cruse, UK doctors do not usually give it as a formal diagnosis.

How long is too long to grieve? There is no single deadline. Cruse and Marie Curie describe six and 12 months as reference points, but the key question is whether intense feelings are easing and whether the person can cope with daily life.

Who should staff signpost to? The GP, Cruse Bereavement Support, Marie Curie and local hospice services, and the Samaritans if someone is in crisis.