Responding to Mental Health and Safety Concerns as a Bereavement Doula

As bereavement doulas, we are privy to the intense reactions that grief can provoke. Amidst these reactions, we encounter situations where we are trained to prioritize concern for a client’s safety or the safety of those around the client. It is crucial that, in such cases, we act quickly and confidently to expand the mental health care team available to the client. Here are some potentially lifesaving steps to take when you are concerned about someone’s safety. 

#1. Noticing 

The first key to assisting someone who may be a threat to themselves or others is to notice the signs. As bereavement doulas, we are attuned to this as we provide emotional support. 

The problem is, many of the warning signs you’ll hear about are also really common grief indicators. For example, one commonly cited warning sign is “a recent interest in death.” That is also a side effect of experiencing a loss through the death of a little one. Similarly, refusing to shower for days on end could be a sign of potential threat to self, but it also could be a normal depressive response to grief that does not indicate any future escalation into self-harm. 

However, we should not dismiss or ignore warning signs of suicidality or threats toward others. The Suicide Prevention Resource Center lists three red flags that should prompt you to immediately pull more people onto the client’s mental health support team: 

• “Talking about immediate harm to oneself or others

• Planning to attempt suicide (for example, searching online for information about how to attempt suicide)

• Acting in such an erratic manner that you are concerned about their safety”.

Remember that in most places, you can contact a local helpline or hotline for immediate support. (Here are some resources for our U.S.-based doulas: U.S. Hotlines and Warmlines for Emotional First Aid.) 

#2. Assessing 

If it is possible and you judge it wise to talk to the client alone, try to arrange for that immediately. If you are worried about your own safety or if it is impractical to talk to the client alone, creating a private space for conversation is not necessary. 

A private conversation can be useful if your client is part of cultures where mental illness is considered weakness or otherwise shameful. For example, your client may be more likely to explain their suicidal feelings to you if they are not in the presence of their mother in law. 

Whether privately or in a group, you may find it helpful to ask directly about the threat you’ve observed. Use open-ended questions that are phrased neutrally rather than judgmentally. For example, you might ask, 

“I’m noticing that you’re talking a lot about death today, and I’m worried about your safety; how are you feeling mentally?”

“I want to check with you about what you just said about holding X accountable, whatever it takes. Have you been thinking about hurting X?” 

“It sounds like you’ve been having some really scary thoughts. I’m so sorry. Can you tell me more about them?” 

#3. Listening

Listen and attend to both what is said and what is not said. Avoid suggesting solutions or dismissing feelings you might think are unreasonable. 

#4. Expanding support 

If there is still any doubt in your mind that this person and those around them are safe, it is time to expand the support network this person has available to them. Express your concern and remind them that help is available and is designed exactly for this purpose. Ask them if you can help them call for help. Then contact the appropriate hotline or mental health emergency resources. 

If you are absolutely certain that this person and those around them are safe, you might still be wise to encourage the person to expand their support network. You can help them find a therapist, a warmline, a support group, or other resources. Further, you can help them develop a safety plan: a written plan for what they will do if they experience unsafe urges. This plan should include emergency resource contact information. 

If you are unsure how to proceed in expanding support, keep in mind that you can often call hotlines or warmlines and ask for expert advice about the situation you are in. 

#5. Continuing care 

If emergency services take over, or if you have successfully made a preventative plan with the client, plan to follow up with the person very soon, possibly even within a few minutes of their departure or yours. Remember that every conversation should start this checklist again; just because someone was safe this morning does not mean that is still the case this afternoon. Follow ups can not only provide important check-ins on someone’s mental health but can also destigmatize mental health struggles, as you are demonstrating that you will not drop or abandon the client because they are having scary thoughts. 

And...

Keep in mind that you will need to prioritize self care alongside the care of your client. This may be particularly true if you have your own history of dealing with frightening and intrusive thoughts, or if someone you love has experienced the same. Remember that you are never alone as you care for your clients.