1. The mobilisation phase
Objectives: Obtain an overview of and contact with all close family and relatives who need psychosocial assistance after a murder in order to initiate adequate assistance as soon as possible. Convene and coordinate those who will be responsible for the support offered.
Measures: The objectives can be achieved through written procedures that are clear in on notification and referral, as well as target group of aid measures and criteria for follow-up on relatives and any others affected by the murder.
Notification takes place through updated name and telephone lists of monitoring managers forming the basis for notification procedures:
•The police becomes aware of the murder.
•The police alerts the crises team and informs about the murder in agreement with the relatives.
•The leader of the crises team informs the rest of the team of the situation to ensure a coordinated follow-up.
•The crisis team contacts the relatives and other affected people.
Target group and criteria for follow-up:
The next of kin and other affected people (i.e. the perpetrator’s relatives) are the main target group for follow-up. It is important that the relatives left behind always have first priority, even though other groups are mentioned in the following text.
•The bereaved are defined as the closest people touched by this (parents, children, siblings, partner, boyfriend or girlfriend etc.)
•The people closer to the perpetrator are the partner, children, parents, boyfriend or girlfriend etc.
•In addition to biological closeness (nearest family), there should be mapping of which people were actually closer to the deceased (and the perpetrator).
•If there have been witnesses to the murder who do not belong to any of these groups, they too must be ensured the necessary follow-up.
•Work place, school class and other «mini societies» of which the deceased and the perpetrator were part of, will be ensured follow-up in the process through their own crisis plans.
•The routines enter into force when a murder has been alerted to the crisis team.
•The routines enter into force regardless of the age of the deceased.
2. The emergency phase
Objectives: To calm the emergency reaction and limit the experience of loss of control by reducing stress, do make the emergency reactions possible to control and to re-establish a certain order and structure, so that the next-of-kin and the perpetrator’s relatives can recover and resume previous functions in the long run.
Measures: The objectives can be achieved through clear written procedures for emotional first aid and safeguarding, information and counselling, rituals, mobilisation of social network support and organising practical or legal assistance (counsel) if needed.
Coordination and responsibilities:
•The leader of the crisis team leads/coordinates the follow-up.
•Vicar and/or police notify the next of kin and the perpetrator’s relatives – by personal appearance at the homes of the concerned.
•Police, vicar, doctor, psychologist/psychiatric nurse if needed, go home to the family left behind and to the perpetrator’s relatives immediately after the notification.
•Note! Professionals who do this must feel that they are skilled and competent for the task in the individual situation (ref. able to cope with specific traumatic circumstances).
•Note! The police will constantly be in touch with the next of kin regarding eyewitness testimony etc. The violence coordinator at the police is therefore an important interaction partner for the crisis team, and coordination the crisis team’s work with the police is very important.
•Directly, through conversations aiming to identify what kind of assistance is needed, review of events, and support conversations (see Measures).
•Indirectly, through advising and counselling the involved support services (police, doctor etc.), schools, work places regarding facilitation for the close family left behind, and the perpetrator’s relatives.
•Help mobilising social networks (see Resources/cooperation and Social network support).
•Provide emotional first aid through care, protection and information. Emotional support and stress reduction will be essential before reaching the bereaved and the perpetrator’s relatives with other information (see Measures/emotional first aid).
•A person in crisis team (i.e. doctor, vicar, psychologist, psychiatric nurse) goes systematically through the event with the people immediately affected. NB! It is important that the information given originates from response personnel with first-hand knowledge of the event (or ask the police to come and inform). There should also be conducted a revision of the event for those who found the deceased or were near the drama unfolded. This can be done using the debriefing or defusing model, and can be conducted with individuals or groups (see Measures/debriefing). If any conversations are taking place the same day as the murder, one should not encourage emotional aspects of the incident, as this may reinforce the memories of the event. For the same reason, sleep should be avoided for the first six hours afterwards.
•The conversation should contain the next of kin’s description of events, sensations, thoughts and reactions, and offer the concerned with facts and circumstances surrounding the murder. NB! If one or more of the bereaved, the people affected or others were present during the murder or saw the deceased, conversations about these impressions must be conducted separately from those who did not see anything, in order to avoid unnecessary detail exposure.
•Inform about normal reactions after traumatic events and advice regarding how these can be calmed (see Reactions) and (www.krisepsyk.no /Help).
•Depending on the concerned family’s situation and the individual's age, condition, question and initiative, what to record and what to inform about when will vary. During the emergency phase and follow-up there will be a number of topics to prepare the next of kin of, to understand, learn about or inform of (see Measures/support calls).
•Clarify in advance which occupational group is responsible for what kind of information will be given to the bereaved and the affected.
•The information should be transmitted both verbally and in writing.
•It is advisable to print and distribute information about normal reactions after "abnormal events" and "safeguarding surviving children" as written material to those who are affected the most (see www.krisepsyk.no / Theme pages - "When a family member is murdered").
•Offer to accompany survivors when they are going to identify the deceased and receive information at the hospital. Access to information about the results of the autopsy report must be given through the police. This does not happen automatically and must be done with the assistance of the police, the emergency team or the counsel, or through the next-of-kin themselves contacting the department for forensic medicine.
•Advice the next of kin about the opportunity to see the deceased person, and about how to carry out a memorial service and a funeral (see Rituals).
•NB! If there are children among the next of kin:
•Advice regarding children as bereaved, and children and rituals (www.krisepsyk.no / Theme pages / Grieving (and see Rituals).
•Inform parents and the perpetrator’s adult next of kin about childrens’ reactions and need for support after traumatic deaths (www.krisepsyk.no / Theme pages / Grieving).
•Help informing the children of the bereaved and the perpetrator about the event that has taken place (www.krisepsyk.no / Theme pages / Hvordan snakke med barn om (selv)mord? How to talk to children about suicide and murder).
•The perpetrator’s children must be given thorough information and be well taken care of after the murder. If father has killed mother or the other way around, the child must be taken care of by the child welfare services’ institutions or other well suitable close relatives. Further follow-up will then be carried through by these authorities (see Hendriks, Black, & Kaplan, 1993).
•The perpetrator’s relatives must be informed about which rights children whose parents are in prison have.
•Find out if near family/social networks have been sent for to help the bereaved/those strongly affected during the first days. Many of those left behind after a murder can during the first days need someone from their close network present 24/7 to help them take care of simple physical needs, like eating, drinking, and resting.
•House and homes may be closed in order to help an ongoing investigation, and it is therefore important that someone take responsibility for resolving practical needs like housing, clothing, money, etc.
•Assess the need for practical help with demanding caregiving for the affected parties.
•Medical consultation/treatment may be necessary. Situations with hyperventilation, acute anxiety states, fainting etc. may occur. Sedative treatment may be necessary, but it is important that people are not medicated unnecessarily.
•Asses the need for referral to the specialist health services, and assess the need for further follow-up (see Mapping).
•The crisis team should also appoint a media contact person who can cooperate with the police regarding how to make statements to the media in connection with the murder (see Media).
•If the deceased was employed somewhere, one should see to it that his/hers work place, and the work places of the bereaved, be informed. This must happen with the cooperation with the bereaved, so that the work places may initiate their own crisis plans for murder. If handled correctly, colleagues at the work place can become an important support for those affected the most (see Resources/cooperation – the work place).
•Trauma specific mapping conversations may be necessary in the network of friends (see Mapping).
•Practical help with minor children, housework, cooking or assistance with caring work may be absolutely necessary for some bereaved after murder the first few days after the event. The crisis team should see to it that chores like these are being taken care of by the social networks, and if that doesn’t happen, take necessary home care measures. If the deceased was killed by shooting inside the home, it will be of critical importance that the crisis team, in accordance with the bereaved, make sure that someone is responsible for cleaning and clearing (i.e. undertakers). If those who are left behind are entrusted with this without any help, this cleaning and clearing may become very traumatising for the bereaved, both in the long and short run.
•To guide and support the bereaved while meeting the perpetrator’s next-of-kin if the bereaved want to and may find it useful.
Measures for the network of friends (suggestions):
•Measures for friends when young people have been murdered. There are far more people than the victim’s family who are affected by homicide in general, and especially for young people. Young people rarely seek help for themselves, and they may struggle with many painful reactions to a murder. Some murders could moreover provide fertile ground for gang shooting or thoughts about revenge. Measures for youth groups can thus be of great deterrent effect in several ways. Relevant measures to safeguard affected adolescents may be:
•Review of events, normalisation of reactions and information about self-help methods (www.krisepsyk.no / Theme pages – Self-help methods).
•Spotting young people who need closer follow-up (see Mapping).
•Information about the murder and how it happened (if the family thinks it's okay), also to prevent any rumours. Many young people will gladly support the immediate family of their deceased friend, but may be unsure of how to do this, and help to get over the first barrier may be important. There are big differences between different kinds of youth groups.
•Offer information to the school and work place if there is one (in consultation with the bereaved and the police) to reduce rumours and anxiety.
•- Advice on implementation of rituals, e.g. organising visits to the place of death (if the adolescents haven’t done this already) (see Rituals / "spontaneous shrine").
•– Preparing the memorial and the funeral, help working this out (if the next-of-kin want help).
•Inform about literature adapted to the relevant age group (e.g. Ranheim, U. (2002). ”Vær der for meg”, and Bugge, K. (1997). ”Også unge trenger støtte i sorgen”).
•Encourage young people to find their own expression channels, for example through music by suicide (www.krisepsyk.no / Theme pages - Adolescent situation by suicide/coping strategies) or via creating a web page to express their grief and despair.
•Friends of murdered young people are a high-risk group, and one should be wary of the needs for surveying and help with depression and PTSD, possibly through clinical interviews (see Mapping).
Measures for school/nurseries of children of the diseased (suggestions):
•Measures should be coordinated with the school's or nursery's own plans for crises and fatalities. Relevant measures include:
•Inform the class or the nursery group (in agreement with parents and next of kin) to start processing, to make it easier to know how to behave around the next of kin, and limit the rumour spreading.
•Conduct rituals to commemorate the deceased (see Rituals and Resources/cooperation/school) (www.krisepsyk.no / Theme Pages – Grieving children).
•Preparation for participation in funeral and memorial service.
•Activities in class rooms and nurseries to let the children express thoughts and loss, for example through drawing, group talks or making something together for the family of the deceased.
•Assess the needs for adapted teaching and exemption from examinations for next of kin children (see Children/Youngsters).
Measures conducted at the school and the workplace may in some cases also be appropriate for people close to the perpetrator. If so, this should be done in agreement with them.
Measures for emergency personnel/helpers:
In single murder cases, follow-up of emergency personnel is seldom required. However, it is important to review regularly how the relief measures function. (In cases where the crisis team is especially involved, see "Measures for helpers" under Transport accidents.)
Time frames and transfer to further follow-up:
•The emergency phase, when the crisis team initiates appropriate measures, often ends after one week (after the funeral).
•If the municipality is small and has few residents, follow-up is done by the crisis team's specialists, because the municipality probably won't have many specialists available. In that case, the crisis team makes a plan for further follow-up of the affected family, individuals or groups. If the municipality's population is spread out (for example in rural municipalities), it might be appropriate to follow the instructions below if there are specialists anywhere in the municipality.
•If there are many residents living close together in the municipality (for example in cities), the crisis team establishes contact with the municipality's specialists who are responsible for the area in which the affected live. The crisis team makes recommendations for the extent of measures and further follow-up based on what kind of measures already have been carried through or initiated towards the affected.
•Guideline criteria for determining who is especially in need of follow-up include:
•Next of kin to the deceased (adults and children/youngsters).
•The perpetrator's next of kin (adults and children/youngsters).
•Persons who have found the deceased or who witnessed a dramatic course of events.
•Involved emergency personnel.
•Guideline criteria for increased need for further and more intensive follow-up:
•Exposure to extreme sense impressions or a high degree of posttraumatic reactions.
•Individuals, families or groups struggling with psychosocial difficulties or domestic violence prior to the murder.
•If an adult is unable to fulfil their daily care duties, for example taking care of minors, elderly or sick people in their family.
•Next of kin to the deceased or the perpetrator with poor or small social networks.
•People who have struggled with psychiatric disorders or painful loss.
•To ensure stability for the affected, the person from the crisis team with whom they have had the most contact should also be their contact in the further follow-up. This person should communicate closely with the GP, who is central to the further follow-up of individuals. One might also contact the Child Welfare Services about the perpetrator's children.
•The leader of the crisis team (or another responsible member of the team) should be responsible for making sure further follow-up is initiated, and for possible transfer to other services.
3. Further follow-up
Objectives: Provide necessary psychosocial aid and support over time to the next of kin of the victim (and possibly also the perpetrator), so that they may gradually return to everyday life. Contribute to the normalization of thoughts, emotions and reactions as an important part of the mourning process. Prevent the traumatic experience from consolidating as physical or psychological illness or causing unnecessary suffering for the affected, so that it doesn't hinder participation in work, school or social life.
Measures: Objectives are gained by clearly written routines for regular contact with the next of kin and, in cooperation with them, assess the needs for measures, further examination and provide necessary aid and support. Contact and offers of help should be available for the first year after the murder, maybe even longer for some.
Coordination and responsibilities (suggestions):
•The telephone contact routine should be followed for all next of kin in a murder incident by a clearly defined contact person from the crisis team or the GP.
•Schools and workplaces should follow their routines as outlined in their respective plans. Schools are responsible for taking care of affected pupils, while workplaces should take care of employees who have lost a colleague/friend.
•The crisis team arranges meetings for next of kin one month after the murder.
•The crisis team arranges meetings for next-of-kin approximately three months after the murder.
•Telephone contact routine: For example 2–4–8–12 months after the murder.
•If close next of kin have different needs for help (medical, trauma therapeutic, intervention, family counselling, specific professional child care, spiritual guidance, support talks or practical, economical or legal advice) through the crisis team's routine contact, the crisis team contact person should turn to the relevant services in the municipality and provide the desired help.
•Preparation for and support through the encounter with the justice system.
•Continue support talks initiated by vicar, psychologist, psychiatric nurse etc. Continue medical treatment/consultation, practical relief etc. that has been started in the emergency phase.
•Continue prevention of psychosocial issues through repeating/supplementing information from the emergency phase (see Measures / support talks) at the crisis team's meeting with the next-of-kin one month after the murder. The support talks during the long-term follow-up depends in part of what has been talked about in the emergency phase, and what has felt appropriate to postpone talking about. At any rate, the following issues will be important during long term follow-up:
•Social expenses and feeling alone in their sorrow.
•Other people's expectations of how one should relate to the loss/trauma.
•Realistic time frames for mourning, reactions and difficulties.
•Relationship wear and tear.
•How the murder might influence further life together (if partner didn't die).
•Worries about affected minors' development and reactions.
•The deceased, the loss and the emptiness.
•How to cope with everyday life.
•Further needs for practical help/relief, possibly initiate preventive child care services if needed.
•How the family functions in the new situation.
•Questions about the post-mortem report and trial.
•How to cope with red-letter days and reminders.
•Trauma specific surveying/screening of PTSD, anxiety, depression and complicated grieving should be initiated at the next-of-kin meeting three months after the murder (see Mapping).
•Assess the need for extended sick note.
•Ensure that the next-of-kin is kept informed about the investigation and the following trial.
•Ensure that the next-of-kin are taken care of before and during the trial.
•Offer support talks after the trial.
•Establish contact with other in the same situation, for example through contact with others who have had similar experiences (for example Stine Sofies stiftelse).
•Information about the importance of accepting help from friends, family and other social networks.
•When young people have been murdered:
•Follow-up meeting for friends (for example by youth leader, teacher or priest) focusing on getting on with life, how to handle own reactions, criteria for getting help and identify youth who need further referral (see Children/Youngsters).
•Encourage friend networks to keep in touch with left behind siblings/parents.
Contact with next of kin of the deceased and the perpetrator should last at least until one year after the murder. Important criteria for termination of contact is that the affected feel they can partake in everyday life and leisure time without having reactions from the murder hindering their participation and self-expression.
•Ideal frequency: The crisis team's meetings with the next-of-kin one and three months from the murder, supplemented by the telephone contact routine, for example 2–4–8–12 months after the murder. This might be followed up by the GP in cooperation with the crisis team.
•If the affected show a lack of interest in making contact, for example in the beginning or at one of the suggested times of contact, one should respectfully back off after asking permission to make contact at a later (given) time. The affected should be informed about the knowledge one has about variations in perceived need for help over time, and that it is normal to have fluctuating feelings of sorrow after sudden deaths. If the affected doesn't want further contact, they should be informed about where to turn if they should feel the need for help at a later time.
•After one year, the crisis team and GP should be able to reduce the scope and amount of psychosocial follow-up of the next-of-kin and continue client contact / doctor–patient relationship as normal. However, in case there are signs of isolation or other forms of passivity, the long-term follow-up phase should be extended beyond the first year.
Further follow-up consists of, among other things, follow-up talks spread out over time. During these talks, topics should include family communication about the murder, sibling reactions, family dynamics, aspects of meaning, and self-help methods. In addition to grief, a murder causes great trauma, often connected with anger towards the perpetrator. Therefore, it is important to assess the needs for follow-up by psychologist to get help with more specific problems (see Reactions/complicated grief).
In many cases, the perpetrator is related to the next of kin. For example, father kills mother, the next of kin of the deceased will also be the perpetrators next of kin. Services should be initiated as needed, by having the skilled personnel or crisis team who is responsible for the follow-up follow the municipality's routines and determine necessary psychosocial aid in cooperation with the next-of-kin.
Frequency of contact should be assessed on a case-by-case basis, but try to aim for making contact during holidays and red number days. The skilled personnel should be realistic about the duration of the mourning process, and should actively offer aid and support. Research shows that next of kin need to:
•Try to understand the murder's motive and causal factors. (NB! Communication with children and young people must be adapted to their age.)
•Talk about the murder and related experiences.
•Sort out and put into words their feelings and thoughts, especially anger, reproach, what they could have done to prevent the murder, etc.
•Discuss and get advice on how to handle children's reactions and problems.
•Get advice on how to handle practical and social problems.