Surrey County Council have been exploring the role of commissioned, publicly funded culture in challenging health inequalities exacerbated by the COVID-19 pandemic with NHS.
Introduction
Across Surrey there is a 15-year difference in healthy life expectancy and the proportion of the population aged over 65 is projected to increase to 25.4 per cent by 2041. We believe that libraries are uniquely placed to be a centre for bereavement support as well as a trusted space where conversations about death and dying can take place with caring staff on hand to help. So we decided to set up Death Café's in Surrey Libraries in response.
The challenge
The COVID-19 pandemic highlighted the need for communities to be prepared for illness, death, and grieving. As a result, the general population and health and social care professionals became keenly aware of a variety of issues connected to mortality and the end-of-life, challenging tendencies to avoid discussions about death and dying.
Almost 80 per cent of British adults find it difficult to talk about death. Not talking about death, not getting the right support and advice at the right time and the suffering that people go through when a loved one dies or when they are facing death themselves, puts enormous strain on mental health and wellbeing.
In Surrey this tendency to avoid discussions about death and dying were confirmed by anecdotal evidence from health professionals, community workers and library staff who engaged with residents as they visited libraries. This is made more acute in some areas in Surrey where there is now a fifteen year’s difference in healthy life expectancy across the county.
The Surrey Joint Strategic Needs Assessment is clear that most deaths are among older residents. It confirms the proportion of the population aged over 65 is projected to increase to 25.4 per cent by 2041, with the proportion of over 85s projected to increase from 2.9 per cent to 5.2 per cent over the same period. This will lead to an additional 112,200 over 65s in total with 34,500 more aged over 85.
Our starting point was that talking about death can only be a good thing: not only does coming to terms with your own mortality mean you're more likely to live life to the full, being open about it means we can support each other, our families and ourselves when death has an impact on our lives. It makes for a healthier, happier community.
We were up for the challenge.
The solution
We wanted to maximise the opportunities for art, culture, and heritage to positively impact mental health and to increase the use of culture in social prescribing. We reviewed the work in the sector and because of the impact of Covid in Surrey, i.e., the higher-than-average death rates, we felt the most effective way we could demonstrate this was by using ‘Death Cafes’ to demonstrate that connectivity and impact. Throughout the work in response to the pandemic there were opportunities to work with senior officers in both Surrey County Council and the NHS. Consequently new relationships, connections and partnerships were forged and that provided the opportunity to ‘pitch’ the concept of ‘Death Cafes’ to the Director of Public Health (PH) at Surrey County Council.
In Surrey the concept of death cafes was not well known or well understood but that immediately resonated with PH and NHS colleagues. In fact the Director of PH also clearly confirmed how much this initiative matched with Surrey Heartlands End of Life Strategy and ‘communities coming together’.
We worked together to design the first one that was also scalable and could be rolled out across the county. As part of that work we also partnered with the Brigitte Trust, a Surrey company that had been awarded The Queens Award for voluntary service, to work with us to deliver the offer on the ground. Those sessions provided information, booklists, honest conversations, and companionship as well as coffee and cake.
The impact
Death Cafes have proved central to fostering compassionate communities which we have seen in Surrey. ‘More compassionate connections within a community, augmented by initiatives like Death Cafes and Compassionate Communities strategies, should result in a better quality of life and death for all ‘(Richards et al., 2020). Death Cafes are reducing the stigma around death and facilitating communities coming together at a local level. We have seen people engage who are diverse across race and ethnicity, gender, age, and experiences. Death Cafes help reduce feelings of loneliness and isolation, particularly among the elderly. They have increased awareness of the importance of libraries to promote community-led initiatives and how powerful they can be at supporting high priority health agendas, particularly in the wake of COVID-19.
Feedback from those attending included: ‘excellent’, ‘relaxed’, ‘comfortable’, ‘helpful’, ‘informative’, ‘enjoyable’. Feedback from staff included: ‘it was a really powerful experience’. ‘The event made me consider what I wanted for my own body and my own death in a way that felt safe and supported. It wasn’t sombre. It was friendly and open, a really lovely morning’. The first session was limited to 12 participants and heavily over-subscribed.
One of the Surrey Libraries staff who was a ‘bright spark’ from the Leading Libraries Programme, funded by the Arts Council, delivered through Libraries Connected with Birmingham University led this work. A good example of how one programme has supported another, creating a strong impact, making best use of resource.
Surrey Libraries shared the success and progress with Libraries Connected South-East Group.
Surrey Libraries demonstrated the power of libraries in tackling health inequalities through groundbreaking initiatives like this one to Public Health and NHS colleagues. That changed the way libraries are viewed and now we work together as key strategic partners to support the prevention work across Surrey.
How is the new approach being sustained?
The pilot was developed in partnership with Brigette Trust who we will work alongside to evaluate the effectiveness of the intervention and its impact on our communities. We will continue to work closely with them to roll the initiative out further and to apply the lessons learned.
We are completing a mapping exercise to identify other potential partners and to explore opportunities for collaboration. It is important we identify and reach people who would benefit from the initiative, so we are also mapping the different services who support or meet the bereaved such as Coroners to increase participation and to support more people across Surrey.
Death Cafes will only get used if people know they are there and when people are ready so we will also invest more time in communicating the initiative more widely. We have learnt a lot through listening, reading, and engaging with others in the space and how best to position this offer in the community, we will continue to learn from our efforts and others to help shape and develop the offer.
Surrey Heartlands End of Life Strategy has been central to supporting this movement.
Lessons learned
We have learnt that having a good working relationship with partners is invaluable and key to progressing outcomes and positive experiences for residents.
It is important that library staff are sufficiently briefed as to what the initiative is trying to achieve, and they are equipped with the right communications and messaging, particularly around such a sensitive subject.
Timing is crucial when developing initiatives such as this and can prove very effective if it is done at the right time and in the right way. We were surprised about how much interest we received from other local authorities, and we continue to share our learnings more widely to help communities near and far.
We have learnt that Death Cafes are an important vehicle to contributing towards community cohesion and can support the mental health and wellbeing of residents which supports the realisation of our corporate priorities.
The power of communities cannot be underestimated, and this initiative has proved strength comes from supporting one another.
End of Life Care - ICS (surreyheartlands.org)
Death positive libraries: A national framework | Libraries Connected
Contact
Susan Wills MBE
Assistant Director Arts, Culture & Libraries
Email: [email protected]