How do professional helpers in municipality’s health and welfare services relate to persons bereaved by illicit drug use? Qualitative research

Abstract

Introduction: This doctoral study was carried out between 2020 and 2023 in the Department of Welfare and Participation at Western Norway University of Applied Sciences and is part of the END project (Drug Death Related Bereavement and Recovery project).

Background: There is a high worldwide mortality rate from the use of illicit drugs, which is recognised as a public health problem by the World Health Organization. Annually, half a million individuals worldwide and approximately 260-300 in Norway suffer drug-related death (DRD). Many are bereaved as a result, and as the deaths are often sudden, unexpected, often premature, and sometimes violent, such losses cause great strain. The bereaved are at risk of prolonged social and healthrelated difficulties and early death. As the deaths are unnatural, the bereaved qualify for psychosocial follow-up and health and welfare services in Norwegian communities. When a close family member is lost traumatically, many bereaved persons cannot be expected to take the initiative to make contact and ask for help. Proactivity based on helpers’ knowledge of the situation is a prerequisite for reaching out and assessing the need for psychosocial and practical assistance. The immediate postvention by first community responders may affect the bereaved’s grieving process and represent an important health promotion opportunity. We lack knowledge about how professional helpers meet this group.

Aim: This doctoral study aimed to explore how municipal health and welfare professionals relate to persons bereaved by illicit drug death in the acute phase after DRD and what prevents and facilitates the provision of professional assistance. Municipal leaders were asked to suggest improvements for such community services.

The doctoral study explores this through four research questions:

Article 1: What is known about professional helpers’ experiences of providing assistance to the bereaved following a DRD?

Article 2: How do professionals in municipal health and welfare relate to bereaved persons during the acute phase of a DRD?

Article 3: What prevents and facilitates the provision of professional assistance to persons bereaved after a DRD during the acute phase?

Article 4: How do municipal managers describe improving the services provided to drug death-bereaved persons?

Method: The doctoral study commenced with a systematic review to investigate studies addressing professional helpers’ experiences of assisting persons bereaved by illicit drug use. An empirically driven, inductive, and flexible approach was then applied to focus group interviews with municipal professionals. Twelve semistructured focus group interviews explored the perspectives of professional helpers (n = 27) on providing acute services to the DRD-bereaved and the improvement suggestions of managers (n = 26) in six communities in Norway. Reflexive thematic analysis (RTA) was applied to the interviews. A questionnaire was used to obtain identify variables.

Results: The systematic review documented that no previous studies addressed professional helpers’ experiences of assisting persons bereaved by illicit drug use and a vital need to develop better knowledge of professional helpers’ perspectives.

The analysis from the first-attending helpers showed that, in the acute phase, a major challenge in assisting the bereaved was identifying and reaching out to those who needed help and determining whom to prioritise. Reasons that were discussed as to why the bereaved were not included in the services included not following existing national routines, inadequate screening processes, a lack of knowledge about bereavement following illicit drug use, and associated stigma. Bereaved persons who used illicit drugs were not considered to fit within the current crisis services, as the helpers found it challenging to bridge the follow-up when the bereaved were concurrently using illicit drugs.

Both samples displayed challenges in cooperation between the services involved. Psychosocial follow-up was considered professionally and personally demanding work. The managers emphasised that competence is a vital, comprehensive aspect of the collaborative foundation. Both samples considered transboundary managerial latitude of action to be vital for local managers to assemble crisis teams.

Conclusion: Service provision during the acute phase after an unnatural death is affected not only by societal and individual understandings and competence but also by the overall organisational framework and the health and social services structures.

Societal, organisational, administrative, financial, and communicative processes are interconnected within service provision. Approaching the services from a perspective that understands the services as a form of value creation on the macro, meso, and micro levels could provide an alternative understanding. In line with the empirical results of the research, value creation incorporates comprehensive, reciprocal, and transboundary interrelationships. A lack of integration in service delivery may negatively affect value creation. Practical suggestions for improved services include following the national guidelines for psychosocial interventions in the event of crisis, accidents and disasters; integrating collaborative principles; and including complex dynamic and relational processes in the service provision. This doctoral study may contribute to research-based municipal service innovation in health and welfare services as this relates to the bereaved by illicit drug use. The results may also be transferable to services relating to professional assistance following other losses due to unnatural death.