Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis

This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner’s service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved’s distress at an already difficult time, illustrated by a ‘mapping’ of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners’ poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples’ experiences, alleviating stress and overwhelm at a particularly vulnerable time.

本文报告了一项三阶段质性研究（qualitative study）前两个阶段的研究发现，该研究探讨了包括公共、私营及慈善机构在内的服务主体，在回应因亲友药物/酒精相关死亡而陷入丧亲之痛的成年人的需求时所发挥的作用。本研究为首个探索物质使用死亡相关服务格局与角色的同类研究，在英格兰西南部与苏格兰两个研究地点开展。研究第一阶段采用方便抽样（convenience sampling）与目的抽样（purposive sampling）相结合的方法，通过半结构化访谈（semi-structured interviews）收集了106名丧亲个体的经历与支持需求相关数据（n = 106）。研究第二阶段则针对40名经目的抽样选取的从业者开展了6场焦点小组（focus groups）讨论，从业者涵盖警方、验尸官服务（coroner’s service）、苏格兰检察官副手（procurator fiscal depute）部门、医疗服务机构、殡葬服务机构、媒体、神职人员、英格兰公共卫生署、毒品政策部门、丧亲咨询/支持机构以及酒精与毒品治疗服务机构的工作人员，旨在探究各类服务应如何更好地回应此类丧亲群体的需求。对两组数据集开展的主题分析（thematic analysis）识别出两大核心主题。第一个主题聚焦从业者的应对方式，揭示了此类丧亲个体可能遭遇服务机构提供的不充分、不友善乃至歧视性回应的现状。丧亲者不得不穿梭于陌生、分散且耗时的流程，这在本已艰难的时期进一步加剧了其痛苦，相关服务的图谱梳理可佐证这一结论。第二个主题则围绕应对者面临的挑战与机遇展开。服务失灵的根源在于从业者对物质使用相关丧亲问题以及所涉及的其他各类从业者与服务机构均缺乏充分认知。此类丧亲群体是一类鲜为人知、被忽视且遭受污名化（stigmatised）的服务使用者群体。相关服务机构需摒弃评判性态度与麻木不仁的语言，尽管不同机构的工作模式与文化存在差异，但仍需主动提供相关信息、加强沟通并与其他服务机构紧密协作。上述建议可切实改善丧亲群体的服务体验，在其本就脆弱的特殊时期缓解其压力与精神过载状况。