Where you live matters: differences in children's bereavement services

We could find no country that counts, area by area, whether a child whose parent has died can get bereavement support near home. Where services have been mapped, in Wales and in the US state of Michigan, support clusters in some places and runs thin in others^[1], and in Michigan it did not reliably follow where deaths, and so bereaved children, were most common^[2].

For a family whose mum or dad has just died, one of the first questions is practical: is there anyone nearby who works with grieving children, and can we get there? In one town the answer may be a children's bereavement charity running groups after school. In the next county it may be a waiting list, a long drive, or nothing that takes children at all. In the UK, as in many countries, most children's bereavement support grew up in charities and hospices, so where it exists reflects local history and fundraising as much as local need. This study sets out what the evidence shows about those differences within countries, why they are so hard to see, and what has been tried to close them.

Almost nobody maps where children's bereavement support is

The first finding is an absence: very few places publish where a bereaved child can find help. A 2025 study of Michigan, one of the few to try, opens by saying that “little is known about the availability and distribution of bereavement services at the state and local level”^[2]. Its authors had to build their own list of agencies across Michigan's 83 counties before they could compare it with anything.

The reason lies partly in how support is organised. The only national survey of children's bereavement services in the UK we could find dates from 2003. Researchers mailed 127 services and heard back from 108, a response rate of 85%. They found that 85% of childhood bereavement services sat in the voluntary sector, and only 14% were dedicated childhood bereavement services. The other 86% ran as one part of a larger host organisation, and 44% of those hosts were hospices. One service in seven (14%) relied entirely on unpaid staff^[4]. A picture like that has no single owner. No public body plans it, so no public body has a reason to count it, and a map has to be pieced together from charity directories.

That 2003 survey is now more than twenty years old, and we did not find a national update with comparable figures. We also looked for published maps of children's bereavement services, by area, in Australia, Ireland and Canada and did not find one. Networks in several countries keep searchable directories, which help families find a service, but a directory of who exists is not a measure of who is covered.

Where services have been mapped, they cluster in the south and the cities

Wales offers the most detailed picture we found. In 2019 Cardiff University, working with Marie Curie and the Wales Cancer Research Centre, surveyed bereavement services across the country for the Welsh Government. The survey sorted support into three tiers taken from NICE guidance: information and everyday support for everyone (Component 1), non-specialist support for people with moderate needs (Component 2), and specialist mental health and psychotherapy services (Component 3)^[1].

The report found that “the highest number of services providing Component 1 support were available in the South East of Wales and the least numbers were available in the West, North and North West.” Rhondda Cynon Taf had 18 responding services offering this general support, and Cardiff, Newport and the Vale of Glamorgan had 17 each. Gwynedd had 6, the Isle of Anglesey 7, and Conwy and Denbighshire 8 each. The report itself cautioned that service counts broadly track population, and that the clearer gap for mid, west and north Wales is geographical distance and rurality. For specialist support there was less variation, though “the lowest numbers were reported in mid and North West Wales”^[1].

Respondents described the gap in their own words. One national charity wrote that “most support is concentrated in the populated areas and therefore others have to travel extensive distances to get the help they need.” A hospice in South West Wales put it more bluntly: “Bereavement services do not have equity across Wales.” On children specifically, a children's hospice serving North Wales reported “a severe shortage of organisations that offer specialist bereavement support for children and young people who are bereaved by the death of a parent or grandparent”, and respondents named bereaved children and young people after an unexpected death among the groups that eligibility rules left out^[1].

These are counts of services that chose to answer a survey, covering all ages and all kinds of death, not only children whose parent died. A single large service can cover many areas, and the count says nothing about how many children each one can see. But the direction matches what respondents said, and it matches what is known about distance and rural life more widely, which our study of bereavement in rural and remote communities covers.

Need is not spread evenly either, and services do not track it

Uneven services would matter less if bereaved children were spread evenly. They are not. In the United States, the Childhood Bereavement Estimation Model (CBEM) estimates that 9.1% of children, about 6.6 million, will experience the death of a parent or sibling by age 18. By state, the estimate runs from 6.8% in Utah to 14.7% in New Mexico^[3]. These are modelled estimates built from CDC death statistics, not counts of children, and they include sibling deaths as well as parents'. The model is produced by Judi’s House/JAG Institute, a children's grief organisation, which created it in partnership with the New York Life Foundation, an insurer’s charitable foundation. It now also publishes estimates for every US county and by how rural or urban a county is^[3].

Within countries, the death of a parent or sibling also follows disadvantage. The Growing Up in Scotland study followed 2,815 children from infancy to age 10 and found that “children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households”^[5]. Areas with more low-income households can therefore expect more bereaved children, so a service map that favours better-off places would point the wrong way, and our study of how many children are bereaved of a parent sets out the national estimates.

The Michigan study tested the fit between need and supply directly. It compared county mortality rates with the bereavement agencies it found and described “bereavement service deserts”: “areas with disproportionately high mortality rates compared to the availability of bereavement services.” The mismatch was not only rural. Its authors found “urban counties often lacking adequate bereavement services despite high mortality rates, while rural counties demonstrate limited services and significant variation in accessibility.” They also noted that many agencies offered general support that “may not address the diverse needs of grieving individuals based on age”, among other things, which is the gap children fall into^[2]. The study covers services for all ages in one US state, and we could see only its abstract, so its county figures are not reported here.

Services themselves say some communities are not reaching them

Geography is not only distance: a service can sit in the middle of a town and still not reach the families around it. In a UK survey of 147 bereavement services, published in 2023, 67.3% said there were groups with unmet needs who were not using their services before the COVID-19 pandemic. The groups named most often were people from minoritised ethnic communities (49% of services), sexual minority groups (26.5%), people living in deprived areas (24.5%) and men (23.8%)^[6].

The survey also found that 25.2% of services did not collect ethnicity data at all^[6], which shows how hard it is to check who is and is not being reached. The services in this study worked with adults as well as children, and they chose to take part, so the figures describe services' own views rather than a measured gap. Even so, a quarter of services naming deprived areas sits uncomfortably beside the Scottish finding that children in the lowest-income households are more likely to be bereaved of a parent or sibling^[5].

In Wales, the 2019 survey adds a further reason that local supply and local need come apart. Its authors concluded that “the data on waiting lists, perceived inability to meet demand for services and lack of access to specialist support, would suggest inadequacies in the current level of provision”. Among services that provided support, the largest challenge reported was lack of access to funding, and the second was “an inability to meet demand”. Only half of services said they carried out formal risk or needs assessments, the step that identifies who most needs specialist help^[1]. Our study of who gets bereavement support looks at unmet need more widely.

A duty or a national framework sets a floor that does not depend on postcode

Where support depends on whichever charity happens to be local, a national rule is the main tool for evening it out. A few countries have one, though each covers only part of the picture.

• Norway places a duty on health personnel everywhere in the country. Since 1 January 2018, section 10 b of the Health Personnel Act has required them to help meet “the need for information and necessary follow-up that minor children may have as a result of a parent or sibling dying” (our translation)^[7]. The duty attaches to the health professional, not to a local charity, so in principle it applies wherever the child lives. Our study of who gets bereavement support covers Nordic legal duties in more detail.
• The United States sets a national floor for one group of families. US federal rules for hospices in the Medicare programme require each one to “make bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient”^[8]. That reaches children whose parent died in hospice care, but not children whose parent died suddenly, or outside hospice care.
• Wales answered its own mapping with policy. After the 2019 survey, the Welsh Government made “an additional £1m available for bereavement support from 2021-22” and committed to a national framework, which it said would “provide equity and access to appropriate levels of support responsive to local need”^[9]. The National Framework for the Delivery of Bereavement Care in Wales was published in October 2021. A health board report from 2024 records a £3m Bereavement Support Grant for third-sector organisations over 2021–24, with 21 organisations funded, and £60k for each health board in 2022–23 and 2023–24 for bereavement co-ordination^[10].

None of these measures has yet been shown to close the gap between areas. We found no follow-up map of Welsh services to compare with 2019, and no study of whether Norway's duty is carried out evenly across municipalities. A floor is an important start, but without counting, nobody can say whether it holds.

What the evidence asks of us

The figures in this study are few, and that is itself the main finding. They point to a handful of things that funders, governments and the services themselves could do.

• Count what exists, area by area. Wales showed that a national survey of services, broken down by local authority, is possible and useful^[1]. Repeating it, and doing the same elsewhere, with children's provision reported separately, would let anyone see where the gaps are and whether they are closing.
• Set supply against need. The Michigan study's comparison of services with mortality^[2], and the US county estimates of bereaved children^[3], show how this can be done. Planning children's bereavement support by the number of children likely to be bereaved in an area, not by where a charity happens to be, would put help where the deaths are.
• Look first at poorer and more remote areas. Children in the lowest-income households are more likely to be bereaved of a parent or sibling^[5], services name deprived areas among those they do not reach^[6], and in Wales general provision was thinnest in the North and West^[1].
• Fund the floor, and check it. Wales's framework sets an aim of equitable access and has put grant money behind it^[10]. Norway's legal duty applies nationwide^[7]. Both would gain from routine reporting of who is actually reached.
• Record who uses services. A quarter of UK services surveyed did not collect ethnicity data^[6]. Collecting basic details, including the child's age and home area, is the only way a service can show whom it is missing.

The organisations doing this work, many of them small and stretched, did not design the map they sit on. Closing the gaps is a question of planning and funding, and the evidence says it should start with counting. The wider library on children bereaved of a parent sets this study alongside research on need, outcomes and what helps.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer.

Why we're publishing this

Childhood bereavement charities and services often know from experience that a family's support depends on where they live. They rarely have figures to show it, because nobody collects them. We have gathered what evidence exists, from Wales, the US, Scotland, Norway and UK-wide surveys, so that the organisations working with bereaved children can make the case for planning and funding support by need. The case is theirs and the families'; we have tried to set it out clearly.

How to read this data

Almost nothing here is an official count of children's services. The Welsh figures come from a 2019 survey of services that chose to respond; they cover all ages and kinds of death, count services rather than capacity, broadly track population, and one service can cover several areas^[1]. The UK services survey of 2023 is also a self-selected sample reporting providers' views^[6]. The Michigan study covers one US state and all ages, and we saw only its abstract^[2]. The US state percentages are modelled estimates of bereavement by parent or sibling death, not counts, and they measure need, not services^[3]. The Scottish finding comes from a nationally representative cohort and describes household income, not areas^[5]. The 2003 UK survey is old and may not describe services today^[4]. Figures from different countries and years are not directly comparable. We found no area-level mapping of children's bereavement services for Australia, Ireland, Canada or most other countries.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual child or family. If you are worried about a child or about yourself, please speak to a GP or another qualified professional.

Sources

1. Cardiff University, Marie Curie and Wales Cancer Research Centre, for the End of Life Care Board. Bereavement scoping survey project: final report. Welsh Government, 2019. gov.wales/sites/default/files/publications/2019-12/scoping-survey-of-bereavement-services-in-wales-report.pdf
2. Giang CW, Kcomt L, Truchan J, Dickinson K, Evans-Polce RJ, McCabe SE. Bereavement service deserts: A 2024 statewide assessment of bereavement services. Death Studies, 2025. europepmc.org/article/MED/41348086
3. Judi’s House/JAG Institute. Childhood Bereavement Estimation Model (CBEM): 2026 national highlights. Judi’s House/JAG Institute, in partnership with the New York Life Foundation, 2026. judishouse.org/research-tools/cbem/
4. Rolls L, Payne S. Childhood bereavement services: a survey of UK provision. Palliative Medicine, 2003. europepmc.org/article/MED/12882261
5. Paul S, Vaswani N. The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement. Palliative Care and Social Practice, 2020. europepmc.org/article/MED/33313505
6. Selman LE, Sutton E, Medeiros Mirra R, et al. ‘Sadly I think we are sort of still quite white, middle-class really’: inequities in access to bereavement support: findings from a mixed methods study. Palliative Medicine, 2023. europepmc.org/article/MED/36337051
7. Norway. Lov om helsepersonell m.v. (Health Personnel Act), section 10 b, as amended by law of 16 June 2017 no. 53. Lovdata. lovdata.no/dokument/NL/lov/1999-07-02-64
8. United States. 42 CFR 418.64(d)(1), Hospice conditions of participation: bereavement counseling. Electronic Code of Federal Regulations. ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/section-418.64
9. Gething V, Minister for Health and Social Services. Written statement: Scoping study of bereavement services – Welsh Government response. Welsh Government, 13 February 2020. gov.wales/written-statement-scoping-study-bereavement-services-welsh-government-response
10. Swansea Bay University Health Board. National Bereavement Framework implementation: progress report. Swansea Bay University Health Board, Performance and Finance Committee, April 2024. sbuhb.nhs.wales/…/3-2-nhs-performance-framework-policy-assurance-assessment-bereavement-framework-docx/