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Adult Bereavement Care Pyramid

A National Framework

In the absence of a national approach to adult bereavement care in Ireland, we facilitated a national collaborative process to develop a framework to guide those working with and supporting bereaved people across the country.

It places bereaved people’s needs at the centre and shows the appropriate support/services and competence required to meet basic through to complex bereavement needs.

The aim of this tiered framework is to help those who meet people who are grieving in their day-to-day work (general practitioners, citizen information services etc.) and those who provide direct bereavement support (group or individual support, counselling and mental health professional interventions) identify and respond appropriately to adults who have experienced a loss.


Download a larger image of the Adult Bereavement Care Pyramid

How to use it

The framework is based on a pyramid model which suggests that all people who experience a bereavement have some level of need, like the need for compassion and acknowledgement of the death (Level 1). Some will need additional support outside their natural network (Level 2). Some require more intensive support, like counselling (Level 3) and a few require support from a specialist therapeutic service (Level 4).

In addition, pyramid also identifies the supports/services appropriate to meet each level of need and the recommended knowledge/skills required by those providing support at each of the levels.

There are many factors which impact a person’s experience of bereavement. These factors are highlighted within the pyramid under three headings, the bereaved person’s social network, the circumstances surrounding the loss, and time.

Social Network

This is the support provided by people in the bereaved person’s social network, such as their family, friends, work colleagues, cultural community, faith community etc. It’s important the person considers the support they receive from their network as helpful.


Circumstances surrounding the loss include the circumstance of the death itself and the bereaved person. These may include the care received by the deceased and the bereaved person before/at the time of the death, a sudden or expected death, if the death was traumatic etc. Aspects relating to the bereaved person, such as their culture, beliefs, personality, previous experience of loss etc. will also have an impact on the bereavement experience.


Plays a role in the experience of bereavement and can include the length of time since the death or the time in a person’s life the death occurs. In addition, how someone experiences bereavement can change over the course of their lifetime. For example, after the death of a spouse, a person may experience pangs of grief at significant events, such as a graduation, a wedding, birth of a grandchild etc. However, grief may be revisited at any time.

Although many bereaved can adapt to the loss with Level 1 support some need the more intensive supports available at the higher levels. The referral and signposting services at Level 2 are integral to the framework as they can ensure a person accesses the appropriate level of service provision to meet their needs. Thus, good assessment is key to identifying the level of support/ service that would best meet the needs of the person.

Supports/services at all levels should be available and accessible to all that need them and access should not be restricted due to geography or cost. It is important to note that a person’s needs can evolve and change over time.

Development of the framework

The ‘Enhancing Adult Bereavement Care across Ireland’ report was published in 2018 and identified a common set of core concerns among those who encounter bereaved people as part of their work. The lack of a common framework for bereavement care in Ireland was identified and prioritised by the report’s project advisory committee (PAC)3.

In considering the report findings (which included a literature review and consultation with service providers across the country) and the evidence for a public health approach to bereavement care, the PAC adapted the Irish Childhood Bereavement Care Pyramid for adult bereavement care. This tiered pyramid-based framework, along with the report findings, was presented at the third National Bereavement Forum (NBF) in June 2018 hosted by the Irish Hospice Foundation. Forum attendees engaged in a structured feedback process.

Subsequently, a short term project committee was set up in September 2018 to develop this framework further. The committee members stemmed from organisations represented at the 2018 National Bereavement Forum and included representatives of providers at all levels of service provision, both State and NGO sector and from organisations across the country.

The current framework was finalized through a consultation process. The framework, accompanying leaflet and a survey was sent via SurveyMonkey to services/supports at all levels of the pyramid, both the statutory and the NGO sector and national, local and international stakeholders.

This collaborative process was project managed by us here at Irish Hospice Foundation (supported by the Health Service Executive).

For more details about the framework and how to use it download this helpful booklet: