Background
According to the Ministry of Health, every year, about 50,000 people of all ages die in Israel, under all manner of circumstances. Nevertheless, public services estimate that only 5% of bereaved family members in Israel receive comprehensive services from the State – the Ministry of Defense, the National Insurance Institute, and/or the Ministry of Welfare and Social Affairs (hereinafter, Ministry of Welfare). The remaining family members, including many children under 18, receive no comprehensive services, or any services at all.
Current policy in Israel regarding bereaved family members is inconsistent, and the degree of assistance and support received by the families is related to the circumstances of their loss. Family members who have lost loved ones due to national security incidents are entitled to the most generous support, whereas families who have lost loved ones due to traffic accidents, suicide and homicide (hereinafter, recognized civilian bereavement) are entitled to government support, albeit limited in scope and for a limited time. On the other hand, the government does not recognize families who have lost loved ones due to other circumstances, such as illness and other health related reasons, drownings and domestic accidents, and they are not eligible for any support from the government (hereinafter, non-recognized civilian bereavement).
Since 2017, the Ministry of Welfare has operated a program to support bereaved family members that includes three components: a unit for breaking bad news; regional support centers; and treatment centers in the units for couple and family therapy in the local authorities. This is an integrated intervention program designed to support those who have lost a child, a partner, a parent or a sibling under circumstances of recognized civilian bereavement. The support centers operate under the aegis of the “Merkaz Elah” and “Bishvil Hahayim” NGOs and are under the supervision of the Ministry of Welfare.
Some four years after the initiation of the support center program, the Ministry of Welfare commissioned the Myers-JDC-Brookdale Institute to undertake a study providing information to help develop policy for support in cases of non-recognized civilian bereavement, and to improve the practices in the support centers for recognized civilian bereavement. This information will also help to develop a general policy of support for civilian bereavement.
Objective
The primary objectives of this study were to provide information that will help policymakers expand the policy of treating bereaved families and apply it to all families with children under 18 coping with civilian loss and bereavement and to optimize practices in this area. An additional objective was to evaluate the work of the support centers from a variety of aspects, including professional practices and the perceptions of the professional staff regarding the work carried out in the centers.
Method
The study included three components:
- A review of the literature to learn about the effects of civilian loss and bereavement on parents and children in families with children under 18, to become acquainted with the tools used in the diagnosis and evaluation of families in bereavement or trauma, and to examine the principles for best practices for treatment. The literature review data were collected from January-April 2023.
- 25 semi-structured in-depth interviews: Eleven interviews with senior Ministry of Welfare staff and professionals, ten interviews with professionals who, as part of their roles, have had experience with civilian bereavement families, and four interviews with members of families whose loss was not recognized by the state. The interviews were conducted from May-November 2022.
- Analysis of data from a consumer satisfaction survey among service recipients in the support centers conducted in 2021 by the Ministry of Welfare using the χ2 test.
Main Findings
The current policy for supporting civilian bereavement families is not based on pragmatic considerations and appears to have been shaped by the influence of pressure groups rather than on well-defined policy. For example, the traumatic or violent nature of loss related to recognized civilian bereavement can also characterize non-recognized civilian bereavement. Families bereaved under civilian circumstances cope with multiple needs, most of which are not met by the current policy. As a result, most young families with children under 18 coping with bereavement do not receive appropriate services from the State. Therefore, the first and urgent step is to recognize families coping with unrecognized civilian bereavement.
In addition, seven other needs of bereaved family members were identified: emotional support without a time limit; financial support and occupational counseling; realization of rights; health services; social support from the local community; ongoing support for children in their schools; and commemoration of the deceased.
The evaluation of the support centers program indicated several major strengths including comprehensive assistance; the connection between the field and academic knowledge and developing expertise on bereavement and loss; the high professional quality of the social workers at the centers and their ability to be flexible; and the provision of additional supports when required. At the same time, the support centers are coping with challenges due to the current policy of assistance for bereaved families in terms of limited human resources at the centers and the limited emotional support for family members.
Conclusions and Recommendations
Bereavement has a critical impact on the mental and physical health of family members. Accordingly, bereaved family members have a variety of short- and long-term needs in different areas of life. These needs vary across individuals, and in children, they are also closely related to their current developmental stage. The current civilian bereavement policy that distinguishes among different types of loss appears to be segregative and discriminatory. The following are the key recommendations arising from the study’s findings:
- All civilian bereavement families should be fully recognized and help and support should be provided to them according to the depth of the impact of their lives, rather than according to the circumstances of loss.
- Breaking bad news to all bereaved family members should be done with professionalism and cultural sensitivity.
- Broader and comprehensive interventions should be provided to members of bereaved families in a variety of aspects and life areas, including the legal, occupational and health spheres, which are currently addressed insufficiently, if at all.
- Consider the possibility of not limiting the support to five years and extending the emotional support provided to family members according to their actual needs.
- Develop more comprehensive practices for treating children who have lost family members.
- Expand public emotional support services and support them to enable all bereaved family members to be treated according to their needs.