**1.5 Management of Bereavement in ID**

Despite the significant incidence of behavioral and mental health issues in people with ID, the evidence supporting the therapeutic efficacy of psychological interventions for persons with ID is sparse [42]. Managing behavioral indications of distress should take into account the long-term repercussions of mourning since ID is a predictor of atypical sorrow [43, 44].

There is no "quick fix" for grief and no "proper way to grieve," but there are methods by which one may assist oneself in accepting the loss [2]. The adequate management of grief and dealing with people having ID is a constant uphill battle. However, formal grief intervention may help grieving people with ID manage their

#### *Searching in Bewilderment: Bereavement in the Lives of People with Intellectual Disability DOI: http://dx.doi.org/10.5772/intechopen.113748*

continuous and unnoticed pain, as people with ID can get an advantage from group or individual psychotherapeutic interventions. Along with it, social support is one of the environmental components that reduces the symptoms [45].

Continuum of Bereavement support model was introduced for the people with ID [46]. The model was modified to system approach in order to help people with ID [38]. It includes number of strategies at different levels. This model supports a long and short-term, reactive as well as proactive techniques with four main domains [38] [46]. The first domain is the "Education" about the death and its effects. It involves the general preparation for death experience, emotions related to the loss, and manifestations toward death phenomenon. This leads to the second domain of "Participation" in cultural rituals of death and the involvement of people with ID in these death rituals. Its main aim is to engage and actively involve people with ID in realizing the finality of death of loved one. It further marches toward the third domain of "Facilitation" which targets acknowledging the loss and provision of adequate support systems to these people. These three domains may reduce the requirement of seeking professional help but if there is a requirement for further assistance, the last domain is based on "Intervention" including professional therapeutic management. These four domains can assist multiple people at different organizational standards [38]. All domains of the system support model can work at interactive levels in a system. It includes [38]:

*Micro level*: This level includes the bereaved person having ID and his/her family or close loved ones.

*Meso level*: It includes the bereaved individual(s), who are receiving assistance other than family members which may involve assistance of teachers, grief counselors, caretakers, etc.

*Exo level*: It includes the institutions or services that may not directly involve the bereaved individuals but influence a person indirectly.

*Macro level*: Macro level strategies are based on policy making or guidelines at the national or international level related to grieving persons with ID.

The interaction of all these domains is illustrated in **Figure 1**.

#### *1.5.1 Education*

The education domain refers to imparting psychoeducation regarding death, emotional manifestations, and the experience of losing a loved one to death and preparation for the upcoming loss in a life of a person with ID [38]. The provision of education on a death process is considered as a facilitating concept in making grieving process easy [47].

#### *1.5.2 Participation*

It is considered healthy to participate in the grieving rituals of a loved one to ease the grieving reactions in people with ID [37]. Such individuals should be supported and encouraged to engage in grieving processes for understanding and realization of death phenomenon [38]. People with ID are not fully informed by their caretakers regarding death [39], and it may increase psychological distress and worsen the outcomes of grief.

It is mandatory to make them prepared for the loss to avoid overwhelming impact of other people's emotional reactions on their grieving processes [39]. The immediate family members or the caretakers who are also dealing with their grief can be involved in receiving support for themselves to assist grieving youngsters with ID [48].

**Figure 1.** *Bereavement support model: an integrated approach (Read & Elliot, 2007).*

### *1.5.3 Facilitation*

It involves understanding, acknowledging, and adapting the adequate coping skills to manage the loss [38]. It aims at reducing the negative grief outcomes. Giving detailed information regarding death process is an important facilitator. The families of grieving youngsters with ID as well as their teachers can assist them in understanding this complex process. Usage of direct explanation or language is thought to be a vital factor in giving education to people with ID about death [49].
