Sudden and Unexplained Deaths

Most of the information below has been taken from our booklet ‘Sudden and Unexplained Deaths’ which can be downloaded and printed here.

Family members who have lost a loved one from alcohol or drug-related death have written this booklet with the support of Scottish Families.

  1. What is bereavement?

  2. How does grief affect families?

  3. Secondary loss

  4. Finding out about the death

  5. What happens after the death?

  6. Telling people what has happened

  7. Self-care following bereavement

  8. When to ask for professional help

What is bereavement?

cartoon candleBereavement (sometimes referred to as grief), is a term used to describe the sense of loss that’s felt when a loved one passes away. This sense of loss can have a range of emotions such as sadness, anger, guilt, frustration, and anxiety.

Just because you have lost someone you love does not mean that you should forget about them or change how you feel about them.

People who are bereaved through drugs or alcohol may have to deal with:

  • The stigma around alcohol and drug use
  • The media
  • A belief that the death was premature and avoidable
  • Feelings of guilt
  • A challenging relationship with the person before the death
  • Police and court involvement
  • A loss of hope that the person would stop using alcohol or drugs

Bereavements from alcohol or drugs can be more complicated than most because of the nature of the cause of death. If the death was drug-related, it can be more challenging for families to grieve because of the stigma from others about alcohol and drugs.

Because of the behaviours of the person who died, friends and families are often given stigmatising comments rather than sympathy and support. This can leave families feeling that their grief is unacknowledged and feel shame when they talk about their loved one. Families may feel they cannot talk about the death which in turn means they cannot find support and become isolated.

‘I felt as though I had to hide the feelings of hurt and utter grief and despair that was tearing me apart as it made others around me uncomfortable. I felt if I told people about how my son died they looked at me thinking – what else did you expect? I have a lot of friends and family but felt like no one understood me and that’s a very lonely place to be.’ – Family Member

How does grief affect families?

Grief affects everybody differently and it can have an impact on your whole body. It creates different emotions such as sadness, anxiety, shock, guilt, and anger. It affects you physically and can lead to low energy, loss of appetite, poor sleeping patterns, general fatigue and motivation, and struggling to do everyday things. It affects your day-to-day behaviour making you forgetful, having a great desire to visit places with memories to feel closer to your loved one, social withdrawal/isolation by not wanting to talk about the loss of your loved one, and denying facts of the death as they are too difficult to death with.

Grief can cause a strain on family relationships because people experience grief differently. A family member may find it more difficult to cope and other family members may not be able to understand as they are not experiencing it.

Grief can have many effects on relationships within the wider family. Families may grow closer as they need each other for support or would like to spend more time together. Some family members may grow apart if the grieving individual retreats into themselves or if any family member loses patience with grief or a combination. Some family relationships may not experience any changes. Every family is different.

Children who experience the sudden and unexpected loss of a loved one sometimes grieve in a different way to adults. Younger children often do not have the language to share their feelings and emotions with their family and friends which makes it harder for them and the people around them to understand what’s going on.

Signs of children experiencing grief could be changes in eating patterns, not wanting to eat and disturbed sleeping patterns. Children can become shy and introverted or bossy and confrontational. They may refuse or have difficulty engaging in day-to-day activities such as attending school or socialising with others. These could be signs of a child struggling to cope with the loss but when asked why they are behaving that way, children may not understand why they are doing it. If you are a parent/guardian/teacher etc. try and look out for these signs and ask the child how they are feeling.

Secondary loss

In addition to the grief experienced by the death of a loved one, you may also experience a ‘secondary loss’. Families may find they have been coping with the frustration, stress, and pain of the person’s drug or alcohol use for a long time. They may feel that they ‘lost’ the person they knew many years before the actual death.

Families often say they felt the death was inevitable as there have been overdose situations before the actual death, or the person was not getting or engaging with the support they needed.

Whether you are grieving before or after your loved one’s death, it all has the same emotions. You need to grieve for any secondary losses you may have had and cope with the difficulties experienced from those losses.

‘After years of heroin use my son became very different from the quiet shy little boy I brought up. I used to long for his cuddles and the love that he used to have for me. He changed so much through his drug use but I still loved him. He was my boy, he struggled with life and it destroyed me when he died. It’s been 5 years since I lost him and with the help I received from the recovery community I am adjusting to life without him.’ – Family Member

Finding out about the death

arms claspedWhatever the situation, a family finding out their loved one has died will always come as a shock. If you did not know that your loved one used drugs and/or alcohol, you may feel disbelief and feelings of ‘this can’t be true’, ‘how could this happen to my family?’

The circumstances of the death may be unclear and if drugs are suspected, it changes what families have to face as police will be involved.

Depending on what has happened, some families may experience emotional and psychological trauma in the situation.

Emotional and psychological trauma is the result of very stressful events that can make you feel frightened, helpless, overwhelmed and may lead to isolation. The more frightened and helpless you feel, the more likely you are to be traumatised. Families often say that the recurring feeling of being helpless to make their loved one’s drug and/or alcohol use go away leads to increasing stress levels and helplessness.

When we are in shock or frightened, our body’s natural survival response triggers to protect us. This is the body’s automatic response that you cannot control. This is usually called the ‘flight or fight’ response but in cases of emotional or psychological trauma, this response is actually ‘flight, fight or freeze’.

Your brain decides you can’t run away from the situation, you can’t fight your way out of it, therefore it is best just to freeze. This slows down time and allows you time to figure out what you should do next.

To freeze is a useful survival response but the problem is that sometimes when the ‘freeze’ response has been switched on, it can take a while to switch back off. This can cause intrusive thoughts about what happened to your loved one, flashbacks and emotional numbness, feeling on edge, difficulty sleeping and feeling anxious.

If your feelings are overwhelming, you can always speak with your GP. Support from friends, your family, the wider community and support from services can help you work through your feelings and trauma.

What happens after the death?

During the first week after the death of your loved one, there is a lot to take in. There are official procedures that have to take place and these can take a few days, sometimes weeks. The circumstances of the death may be unclear and if drugs are suspected, the first thing that will take place is police involvement and an investigation.

                Investigation

Police have to attend all unexplained deaths where drugs may be involved. Until they investigate and understand what has happened, the death is treated as suspicious.

There will be investigations carried out to identify what has happened and preserve any evidence. This is the reason why they may have to treat the place where your loved one died as a potential crime scene. This may mean that you will not get access to the premises during this time. This can be very upsetting and hugely inconvenient, but it is essential to the investigation, and it’s also important to remember that the police are only trying to understand what has happened to your loved one and find out if a crime has taken place.

Until the police are satisfied that they know all the facts about the death, they need to preserve the location where your loved one died to make sure no potential evidence is lost. They will take photographs of the area and allow this to take place, no one will be permitted access to the area.

Officers will remove items that they feel hold potential evidence or information from the location. This may include mobile phones, laptops, clothing, etc. and any drug-related items and drugs found at the scene. This can include property that may belong to other family members or friends if your loved one passed away in their home.

For all sudden and unexplained deaths, the police have to send a report about the death to the Procurator Fiscal (PF).

                Role of the Procurator Fiscal (PF)

The Procurator Fiscal has to investigate all sudden, suspicious, accidental and unexplained deaths. This is completely different from the role in the investigation and prosecution of crime.

In most cases, a death certificate cannot be issued until the cause of death has been confirmed. The funeral cannot take place until a death certificate has been issued. In any death where there is a possibility of drugs in the toxicology report, the Procurator Fiscal will likely call on a post mortem to identify the exact cause of death.

                Post Mortem

You will be told if a post mortem (sometimes called an autopsy) is to take place. Every effort will be taken to carry it out as soon as possible. The timescales for a post mortem can vary around the country and local police officers may be able to give an approximate date of when this will take place.

It may be necessary for family or friends to formally identify their loved one before the post mortem takes place. The process may take place through a TV monitor or a glass window. You will not be allowed to touch your loved one’s body at the time because of ongoing investigations and the need to preserve any evidence. It may be possible after the post mortem for you to be allowed private time with your loved one without the need for a glass window. This depends on the mortuary staff and the police will update you on the result of the post mortem as soon as they can.

‘Waiting for the post mortem and all the bits that go with what seems like years. Time seems to stand still. I was angry with everybody at the time and thought the police were just getting in the way of me getting my boy back. Looking back now, I can understand why things are done the way they are. If it wasn’t for the thorough investigation by the police, we would have assumed my son was another unfortunate overdose but it turns out it was someone else’s fault. I don’t believe he meant to harm my boy, I think he just thought he was helping him out. It’s a tragedy for all involved.’ – Family Member

                Cause of death

If the post mortem shows the final cause of death, a death certificate will be issued. If it is inconclusive or requires the results of forensic samples then a provisional death certificate will be issued. Unfortunately, a funeral cannot take place until the Procurator Fiscal has agreed that your loved one’s body can be released following an investigation. But during this time, police officers from the Criminal Investigation Department will be your main contact and will keep you updated on timescales.

                Registration of death and funeral arrangements

Waiting for your loved one’s body to be released can be a lengthy process and it may feel to you that time is standing still. The police and the Procurator Fiscal are doing everything they can to progress the release of your loved one’s body and this unfortunately takes time. Even though you are waiting for your loved one to be returned to you, there are some things that families need to do.

Any death in Scotland has to be registered within 8 days of the date of death. It can be registered in any district in Scotland. Information on the registration process can be found on the National Records of Scotland website.

You do not have to wait for your loved one to be returned to you to contact a funeral director. You can contact any funeral director of your choice and discuss provisional plans for the funeral.

Telling people what happened

Telling family members and your friends that your loved one has died is a very upsetting time for everyone. Your wider family and friends may not have known that your loved one was using alcohol and/or drugs. This information can cause a shocked reaction. You may find it easier to tell one family member and then ask them to let the rest of your family and friends know.

Families who have lost a loved one from alcohol and/or drugs are often stigmatised and feel shame. This adds to the upset during a difficult and stressful time. You have nothing to be ashamed of. For that very reason, we encourage you to only tell your family and friends what you feel comfortable sharing.

‘My wider family and friends knew my son used drugs and had a problem with them for years. When he died I felt I couldn’t cope with their judgement on his life. We shouldn’t be judged but it happens. I chose to tell my wider family and friends that he died from a heart attack in his sleep. It made my life a little easier at the time. I wasn’t looking for their pity, I was just looking for acceptance that I had lost my son, my only child, and how hurt I was feeling.’ – Family Member

               Media Enquiries

Sometimes suspected drug-related deaths are reported in the media – often reported in a judgemental, insensitive and degrading way by journalists. This can be very hurtful to families and friends when their loved one is being spoken about in such a manner.

Your family is under no obligation to talk to the media about your loved one. Try not to read any media coverage if it does happen because it will only upset you, especially if the facts are not reported on properly. Over time the media will lose interest, but if you feel they are harassing you for a comment or interview, you may want to consider legal advice.

             Significant Clinical Incident Review (SCI)

When your loved one has died because of drug-related death and they were receiving treatment from a clinical professional (not a GP), you may be invited by the NHS to a Significant Clinical Incident Review. The NHS appoint a team who were not involved in your loved one’s care to carry out the review. It usually involves senior clinical staff such as a Consultant or Lead Nurse with support from clinical risk staff. They gather information on exactly what happened with your loved one and decide if appropriate care was delivered and explore any areas where it was unclear.

The NHS welcomes family involvement in the process. Families have a lot of information about what happened to their loved one and other background information that may be relevant to the investigation. It also gives you the chance to ask questions that you want to be answered in the investigation. If the questions you ask are not relevant to the investigation, you may be advised on how to best go forward. This is a good way for families to be heard and to get closure by getting your questions answered.

Self-care following bereavement

People will respond differently to bereavement and there is no ‘right way’ to grieve. We must experience whichever emotions we have as this is a natural part of the grieving process. It can bring exhaustion, lack of sleep, loss of appetite and physical aches and pains. You must focus on your self-care during this time. Eat healthily, take light exercise and spend time with people you are comfortable with.

                Tip 1: Get moving

As well as burning off adrenaline and releasing endorphins, exercise and movement can help your nervous system regulate and improve your mood.

Try to exercise for 30 minutes or more on most days. If it is easier, three 10-minute bursts of exercise per day as just as good.

An exercise that is rhythmic and engages both your arms and legs such as walking, running, swimming or even dancing, works best.

Instead of focusing on your thoughts or distracting yourself while you exercise, really focus on your body and how it feels as you move. Notice the sensation of your feet hitting the ground, the rhythm of your breathing or the feeling of wind on your skin.

                Tip 2: Talk to others

Following the loss of a loved one, you may want to withdraw from others but isolation may make you feel worse. If you have a supportive friend or family member who you feel comfortable talking to, tell them how you are feeling and try to avoid spending too much time alone. Why not catch up for coffee or go a walk together?

You can also join a support group for bereavement families. Being with others who are facing the same problems can help reduce your sense of isolation and hearing how others cope can help inspire your recovery.

As well as helping others, volunteering can be a great way to challenge the sense of helplessness that often accompanies bereavement. Remind yourself of your strengths and reclaim your sense of power by helping others.

If you live alone or far from family and friends, you could take a class or join a club to meet new people with similar interests.

                Tip 3: Self-regulate your nervous system

No matter how agitated, anxious or out of control you feel, it is important to know that you can calm yourself. Not only will it help relieve your anxiety, but it will give you a greater sense of control.

If you are feeling disoriented, confused, or upset, a quick way to calm yourself is through mindful breathing. Take 60 breaths and focus your attention on each out-breath.

There are other ways to calm our body down. Maybe a sight, smell, noise or taste makes us calmer like eating chocolate, listening to music, cuddling our pets, etc. Everyone responds to sensory input a little differently so experiment to find what works best for you. Simple grounding techniques can also make our bodies calmer. Sit on a chair with your back straight and feet firmly on the ground, take deep deaths in and out, look around you and pick out six objects that have red or blue in them (or any colours you want) and you’ll notice your breathing starting to get deeper and calmer.

                Tip 4: Take care of your health

purple heartHaving a healthy body can increase your ability to cope with the stress of bereavement.

Feeling sad and emotional can be tiring. Try to sleep when you can. If you are struggling to sleep there are a few things you can try to make sleep easier. Avoid caffeine, avoid anything too stimulating before bedtime like TV and social media. Try reading or mindfulness to relax the mind before you go to sleep.

Avoid things that ‘numb the pain’. Alcohol and drugs and other substances will make you feel worse when their effects wear off.

Eat healthily, a well-balanced diet can help with mood. If you want to have something unhealthily, allow yourself that, but try where possible to make healthier choices.

Try relaxation techniques such as meditation, yoga, or deep breathing exercises to reduce stress. Schedule time for activities such as favourite hobbies, or even try a new hobby.

When to ask for professional help

Recovering from the loss of a loved one takes time. Everyone heals at their own pace. If you feel you are not coping it can really help to reach out for support. Maybe you are struggling to sleep or your intense feelings are not going away. Maybe you are struggling to get back into a ‘normal’ routine or have symptoms of depression and anxiety. You can speak to your GP or contact a support service to find the support that is suitable for you.

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