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Objective Research has shown that complicated grief has the potential to adversely affect bereaved individuals, and in this context, understanding how mental health professionals engage with it in practice is of relevance. Gaining an understanding of professionals’ knowledge, attitudes, skills and training in relation to complicated grief could provide insights that will inform their training and professional development. The aim of this study was to consider professionals’ engagement with complicated grief, as represented by self-reported knowledge, attitudes, skills and training. Methods The study used a three-phase mixed methods design (systematic review, qualitative interviews, and a quantitative survey) with empirical data being collected from psychologists, psychiatrists and counselor/psychotherapists. Results Analysis yielded 15 integrated findings across the three phases, which were grouped into two clusters: the first highlighted tension between professionals’ reported confidence and competence and the second explored the parameters and contribution of research and training in this area. Conclusion Professionals’ perception of their competence to work with complicated grief seems overstated and research and professional practice are not aligned. Practice implications These findings are positioned to inform empirically supported training that addresses identified deficits in professionals’ knowledge, attitudes and skills. It is important therefore that training is reflective of the needs of different professional groups.

The knowledge, attitudes, skills, and training of professionals regarding complicated grief influence their practice. We conducted 30 semi-structured interviews with psychiatrists, psychologists, and counselor/psychotherapists; the preliminary findings were contextualized via interviews with three experts in complicated grief research/practice. Findings suggest that professionals did not substantially rely on research evidence, favoring instead personal and professional knowledge. They expressed concern regarding the possible pathologization of normal grief that might arise from having a diagnosis of complicated grief. Deficits in professional training were evident. A need for an improved culture of collaboration between researchers and practitioners was identified.

Despite the proliferation of grief research, there is no consensus regarding the naming of grief that does not follow a typical trajectory. How a concept such as grief that has become complicated, ...

In the last 20 years our understanding of the impact of bereavement on adults with intellectual and developmental disabilities (IDD) has developed significantly. Positions have moved from questions regarding whether people with IDD had the cognitive capacity to experience grief in response to a bereavement or loss, to the recognition that people with IDD experience the full range of grief reactions, including showing increased risks of more significant grief reactions and complicated grief. However, the literature has tended to focus on adults in general, to the extent that the experience of older adults has not been explicitly considered. Within this context, this chapter aims to bring together the literature on bereavement, grief and end of life among adults with IDD, and consider the recommendations for understanding and supporting individuals experiencing these reactions to loss.

Purpose The purpose of this paper is to outline the historical background and policy context of mental health services for people with intellectual disability (ID) in Ireland. It then considers recent implementation and lessons from the Irish experience. Design/methodology/approach The policy background and research literature relevant to the development of mental health services for people with ID in Ireland was reviewed and discussed. Findings Mental health services in Ireland remain in a state of change, moving towards the implementation of specialist multi-disciplinary teams in the community, alongside previous models of care and service. Research limitations/implications This paper summarises recent advances and research regarding mental health services for people with ID in Ireland. Practical implications The paper illustrates the process of delivering changes to mental health services with practical implications for mental health services internationally. Originality/value This is the first paper in many years to summarise the development of mental health services for people with ID in Ireland. There has been considerable recent change and it is therefore important to provide a useful reference for the current status of services.

Background Complicated grief encompasses various presentations where aspects of grief do not become integrated into the bereaved person's life. Professionals’ attitudes to complicated grief may impact how they engage with bereaved patients/clients. The aim of this study was to empirically examine the attitudes of mental health professionals, specifically psychologists, psychiatrists and counselor/psychotherapists, regarding complicated grief and to investigate any between profession-differences. Method Psychiatrists, counselor/psychotherapists and psychologists were recruited using publicly available databases managed by professional bodies. A total of 185 professionals (71.8% female), returned a questionnaire containing usable data (23.8% response rate). Results Over two-thirds of the professionals (68.5%) supported the inclusion of complicated grief in diagnostic manuals while only a quarter (25.1%) thought that recognition of complicated grief might lead to the pathologization of ‘normal’ grief. The majority of respondents (83.0%) thought that diagnosing complicated grief would increase the likelihood of clients accessing support and there was no significant difference between the groups. Limitations Although the response rate compares favorably with other studies it is nonetheless somewhat lower than optimum, and it is possible that those who responded were more interested in bereavement and consequently, that the attitudes held by participants are different from those who did not participate. Conclusion The attitude to a diagnosis of complicated grief was more positive than the specialist literature suggests, with the benefits of having a diagnosis of complicated grief outweighing the risks of pathologization.

Background Health disparities and disparities in the provision of healthcare to people with disabilities remains a topic of concern. Research demonstrates that attitudes of healthcare providers contribute to this disparity. The approach to disability education and training in medical school warrants evaluation. Objectives This study sought to investigate the efficacy of an educational intervention in cultivating positive attitudes towards disability in medical students, and determine the specific impact of an interaction-based hospital visit to patients undergoing neurological rehabilitation. Methods Web-based questionnaires were distributed to medical students undertaking a 12-week ‘Understanding Disability’ module. Measures of anxiety, attitude, competency and empathy were obtained from 65 students at the beginning (T1), middle (T2) and end (T3) of the module. At T2, approximately half of the students had completed a hospital visit and half had not. Results Scores changed significantly across all constructs between the beginning and end of the module suggesting a positive overall module effect. Findings confirmed a significant difference in anxiety and empathy levels between the group of students who had completed the visit to the rehabilitation hospital by the middle survey wave and those who had not, indicating a specific placement effect. Conclusions Our findings suggest that interpersonal contact with individuals with disabilities has a distinct impact on the affective variables of anxiety and empathy. Previous research suggests that this contributes towards improved attitudes to disability. Overall, we provide strong evidence for the inclusion of contact-based educational interventions in medical school to enhance students' attitudes to disability.

Objective A systematic review and qualitative synthesis was undertaken to deduce the knowledge, attitudes, skills and training of mental health professionals regarding complicated grief (CG). Methods PsychInfo, Embase, Medline, CINAHL, PBSC, Web of Science and ERIC databases were used to identify relevant literature. Searches were executed from inception to September 2014. Results The electronic search yielded 305 results. Forty-one papers were selected for full text review, 20 were included for analysis. 6 examined primary data, the remaining 14 being reviews, opinion or guideline pieces. Conclusions Despite the lack of consensus on terminology, criteria and diagnosis, it appears that there is more than sufficient agreement within the CG research community regarding the knowledge and skills required to assist someone presenting with CG. A palpable fear of medicalising grief exists, but this would seem to be based on a conflation of normal grief and CG. This review highlights the mainly unidirectional nature of current research, the voice of the practitioner being largely unheard. A need for and an interest in training in CG was expressed. Practice implications There is an urgent need to translate research findings into clinical practice. Training must take account of attitudinal barriers to implementation, balancing evidence and stories.

Accessible summary • People with intellectual disabilities are living for longer than ever before and are experiencing the deaths of their friends and other service users. • This study describes the experiences of people with intellectual disabilities who have lived through the death of a friend or service user from the point of view of staff from intellectual disability and palliative care services. • It is important to understand the experiences of people with intellectual disabilities to try and help people cope with the deaths of their friends. • The study shows that it helps to include people with intellectual disabilities when their friends become unwell and to talk openly with them about what is happening. Summary Research is lacking on the effect of the deaths of fellow service users on people with intellectual disabilities. This qualitative study formed part of a project which aimed to describe the provision of palliative care to people with intellectual disabilities in Ireland and to assess the population’s palliative care needs. We report on findings from 16 focus groups held with staff in which participants described their perception of the experiences of people with intellectual disabilities when other service users die. Interviews were analysed using Framework Analysis. The findings highlight the emotional impact of the death of a friend on people with intellectual disabilities. Situations where staff facilitated the involvement of services users are described, and the study points to the benefits of this approach. Possible barriers to involvement are highlighted. The findings affirm the importance of ensuring that people with intellectual disabilities have a good understanding of the concept of death to alleviate the bereavement experience.

Given the research evidence that people with intellectual disability (ID) do grieve following bereavement, the present study aimed to describe and gather preliminary psychometric data for a version of the Inventory of Complicated Grief [Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., et al. (1995). Inventory of Complicated Grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59, 65-79] adapted for use with this population. Carers completed the Complicated Grief Questionnaire for People with ID (CGQ-ID) for 76 individuals with ID, half of whom had experienced a parental bereavement within the last 2 years. The final scale and subscales (Separation Distress and Traumatic Grief) showed very good internal and inter-rater reliability and distinguished between the two groups. While the findings suggest that the CGQ-ID is suitable for identifying complicated grief-type symptoms among adults with ID, further research must be conducted to ascertain whether the findings can be replicated.

Introduction Previous studies have shown a significant association between familial bereavement and the onset of challenging behaviours and psychopathology in people with intellectual disabilities (ID). However, little work has been done to accurately describe the specific symptoms of grief, in particular symptoms of complicated grief in this population. Consensus criteria for the diagnosis of complicated grief have been drawn up and tested for validity in the general population. Aims To examine the occurrence of symptoms of complicated grief, and to explore the relationships between complicated grief and bereavement experience. Method A bereavement history questionnaire and a newly developed measure examining for symptoms of complicated grief were administered to a group of carers of people with mild or moderate ID, who had experienced a parental bereavement within the previous 2 years. The questionnaires were also administered to a matched comparison group, who had not been bereaved. Results/Conclusions This carer-based comparison study has revealed that bereaved individuals with ID experience complicated grief symptoms following the death of a parent, with one-third of the bereaved group experiencing 10 or more clinically apparent symptoms. In addition, complicated grief symptoms were more likely to occur with higher rates of bereavement ritual involvement. These findings have both clinical and research implications.

The impact of a staff-training program on knowledge and confidence in supporting people with intellectual disabilities (ID) at the time of bereavement was examined. Thirty-three staff members from a Dublin, Ireland-based ID support service participated in the study. Both the training (n = 17) and control (n = 16) groups completed measures of confidence at the beginning and end of a 4-week period around supporting service users through a bereavement survey designed for the study, as well as the Staff Support and Satisfaction Questionnaire. During this interval, the training group completed a two-day training focusing on exploring existing strategies for supporting service users and providing staff with additional skills. Staff members also completed a survey of knowledge at the outset of the study. Over the 4 weeks, there was a significant increase in confidence among the training group, with no comparable changes in the control group. However, as predicted, neither group showed significant changes in general support or job satisfaction. The findings suggest that the training significantly increased staff members' confidence in their ability to respond to the challenges of support service users during bereavement. The study's findings also have a number of practical implications, including the need to provide appropriate support for staff.

Background The influence of grief and bereavement on the lives of people with intellectual disabilities is currently receiving much interest. Many of the long-standing rituals associated with bereavement are still practised in Ireland, probably more than in many other Western countries. The present authors were interested in studying the experience of bereavement for people with intellectual disabilities in Ireland, and in making international comparisons. Method This mixed method study was carried out using two questionnaires. The first was used to study national service and organisational approaches to bereavement. The second questionnaire (based on Murray et al. 2000) was used to study a staff group working in Ireland, assessing staff knowledge and understanding of the grieving process. The results were compared with a UK staff group who were assessed using the same questionnaire (Murray et al. 2000). Results Staff and service attitudes were found to be very positive in supporting people with intellectual disabilities who have been bereaved. There is considerable understanding of the needs of bereaved individuals, and there is a high level of support in the participation in grief rituals. When compared with a UK staff group, Irish staffs were more inclined to encourage individuals to take part in bereavement rituals, though they had less actual experience in supporting bereaved people. Only one service had written bereavement guidelines. Conclusions There appears to be cultural differences in the experience of bereavement for people with intellectual disabilities. This is important in the context of staff training and policy development in grief and bereavement.

Objective:The general population has been involved in considerable debate about communication and awareness within the context of death and dying. However, there has been little research on how matters of communication on this topic are handled for people with life-limiting illness and intellectual disabilities. This qualitative study explored how staff managed communication about death and dying with people with intellectual disabilities in a Health Service Executive area in Ireland.Method:Ninety-one individuals took part in 16 focus groups. Interviews were analysed using framework analysis.Results:Participants infrequently discussed death and dying with people with intellectual disabilities. Participants operated most commonly in suspicious awareness environments with people with mild-to-moderate intellectual disabilities, and closed awareness environments with people with severe intellectual disabilities. The majority of participants did not hold absolute opinions that talking about illness, death, and dying with people with intellectual disabilities was “wrong.” Rather, they were concerned that their lack of skill and experience in the area would cause harm if they engaged in open conversations. Relatives had an influential role on the process of communication. Participants were strongly motivated to provide quality care and were willing to consider alternative approaches to communication if this would benefit people with intellectual disabilities.Significance of results:Although there has been a shift toward conditional open awareness of death and dying in Western society, people with intellectual disabilities have not been afforded the same opportunity to engage in open discussion of their mortality. This study points to the urgent need to engage in debate about this issue in order to ensure that people with intellectual disabilities receive high quality palliative care toward the end of life.

The aim of this article is to present and synthesize recent research on grief and bereavement in people with intellectual disabilities, incorporating relevant studies with the general population.Work in the general population is currently focusing on achieving greater clarity in our understanding of typical and atypical reactions to grief. Although much of this research is relevant to people with intellectual disabilities, this group also presents unique challenges. These include variation in understanding of death, a continuum of grief reactions including pathological or complicated grief, and additional demands faced by professional carers and staff working in this area. However, the research activity is somewhat limited in that it has relied on small-scale studies.The possible recognition of prolonged grief disorder as a distinct clinical entity will have a significant impact on research and intervention of people with pathological or complicated grief. To date, no prospective study of grief and bereavement has been conducted among people with intellectual disabilities. This is essential to best understand the course of grief and complicated grief in people with intellectual disabilities and minimize the levels of functional impairment.

Background Our knowledge and understanding of grief and its consequences have grown rapidly in recent years. There is a growing understanding that bereavement and loss represent a very significant event in the lives of people with intellectual disabilities (IDs). To date, there is no systematic review of the literature on the emotional, psychiatric and behavioural responses to bereavement in people with IDs. Method This comprehensive literature review firstly examines the current opinion regarding the phenomenology of pathological grief in the general population. Research examining the ability of people with IDs to understand the concept of death is explored. In addition, a systematic review of the literature looking at the emotional, behavioural and psychiatric responses to bereavement is carried out. Results Bereavement and loss have distinct effects on the mental health, behaviour and emotional lives of people with IDs. Following a bereavement, symptoms of depression and anxiety increase, and general behaviour is altered. Traumatic grief symptoms have not yet been specifically studied and quantified. Conclusions Particular difficulties are associated with researching the effects of bereavement on people with IDs. Further work needs to be done to more accurately describe the nature, time-scale, severity and frequency of the symptoms of traumatic grief in people with IDs, in order to improve assessment and treatment of affected individuals.

What kind of thing do you imagine when you are promised a film, TV drama or a book which deals with ‘traditional’ working-class experience? Have you been schooled to expect the world of the Hovis advert with unemployment thrown in: cobbled streets, hunched figures, northern accents, children in oversize cloth caps and a brass band playing somewhere in the distance? Perhaps you carry around gendered images, either of male working-class labourers, coal miners, ship builders, steel workers-or of the working-class housewife, beloved of northern comics, with or without teeth, on the doorstep in her pinafore, having a laugh with her neighbour. Or coming south, it may be the world of Minder or EastEnders that comes more immediately into focus: the labyrinthine street-world of east London, small-time crooks, cockney wit or ‘er indoors.

‘The words of the dead are modified in the guts of the living’: to read Anthony Crosland’s The Future of Socialism, in Blair’s Britain, is to recognise the justice of Auden’s words on the death of W.B. Yeats. It is uncanny how easy it is to read parts of Crosland’s classic book as a commentary on New Labour’s project. At times it seems he is simply Our Man in the 1950s, conjugating arguments and debates that are still unresolved. This is of course not to pretend that there are not major differences between now and then. The Future of Socialism was first a matter of very urgent debate within the Labour Party in the second half of the 1950s, a time when the Party had been out of power for some years; when the UK was overwhelmingly working class, at least in numerical terms (72% as late as 1951); when the Cold War was at its height, with the brutal suppression of the Hungarian uprising; and when Britain was trying (and failing) to negotiate a post-colonial identity, in the aftermath of the Suez debâcle.

It is said that when Chou-en-Lai was asked what he thought of the consequences of the French Revolution, he replied: 'It is too soon to tell'. Apocryphal or not, this remark with its recognition that the Revolution of 1789 still reverberates in the modern world, makes an appropriate opening to an essay which sets out to explain why contemporary writers and film-makers adopt the 'time-honoured disguise' and speak the 'borrowed language' of the French Revolution. These famous phrases are, of course, from The Eighteenth Brumaire of Louis Bonaparte (1852) by Karl Marx who, in analysing the revolutionary events in France from 1848-5 I, said the following about the appeal to past authority: The tradition of all the dead generations weighs like a nightmare on the brain of the living. And just when they seem engaged in revolutionising themselves and things, precisely in such periods of revolutionary crisis they anxiously conjure up the spirit of the past to their service and borrow from their names, battle cries and costumes in order to present the new scene of world history in this time-honoured disguise and this borrowed language.1