Research, advocacy and policy support

This Chapter looks in more detail at the research undertaken at the Northern Ireland Centre for Trauma and Transformation (NICTT), in Omagh. This included the randomised controlled trial (RCT) (in partnership with King’s College, London) of its trauma focused cognitive behavioural therapy programme, along with a series of studies undertaken in partnership with Ulster University that examined the epidemiological impact of the Troubles on the population of Northern Ireland. Both provided important new findings relating to the levels of exposure, levels of psychological problems and the social and economic consequences arising from personal experiences of violence linked to the Troubles. The Chapter concludes with a lengthy discussion on the challenges of undertaking research in communities affected by war and conflict, into the mental health and related impacts. This includes a discussion on how methods and approaches to studies in such contexts need to, for example, ask the right questions, if we are to understand and be able to respond to the impact of war and conflict on communities. The challenge of taking findings from research into policy advice, policy formulation, political and service development decisions - particularly in the context of conflict - is also discussed.

The mental health impact of the Troubles, 1969–1999

This Chapter is the first of two that describe efforts to understand the mental health and related impacts of the conflict in Northern Ireland, often referred to as The Troubles. The Chapter covers the period from the outbreak of violence in the late 1960’s up until the period around the peace accord, the Belfast Agreement (or Good Friday Agreement) of April 1998. The early studies reveal little, if any, major effects on the wellbeing and mental health of the population, but as the years go by, evidence starts to build of the impact of the violence, particularly as the ceasefires of the early and mid 1990’s take hold. The developing understanding of the impact was due in part to the evolution of methods and approaches being used by researchers - which is discussed in more detail at the end of Chapter 5.

Introduction

In the Introduction, the author describes the background to the book and his personal experiences of violence in Northern Ireland - as a social worker and health and social services manager in Enniskillen and Omagh. He addresses the impact of loss and trauma linked to conflict and the implications for mental health and well-being. The structure of the book is outlined and the author sets the rest of the book in the argument that the mental health of conflict affected communities should be an early and key consideration in peace talks, politics and post-conflict processes.

Planning for and responding to the mental health impact of conflict

This Chapter seeks to draw together the key messages from the book into a form which the reader can consider, use, adapt or reject, to respond to his or her circumstances. The author shares his own conclusions from the work he and colleagues - and others - have done in relation to Northern Ireland and the years of violence and conflict. The importance of planning with an informed perspective on the impact of major traumatic stressors (such as conflict) on communities is discussed. Also the the contribution of leadership, ritual, politics, therapy, peace making, and the central importance of listening to victims and survivors. Again the author highlights the need to bring considerations about the mental health impact and burden of war and conflict into the early stages of the peace project, when wars and conflicts are being brought to an end.

The development of a trauma-focused therapy programme

This Chapter looks in detail at the establishment of the trauma-focused cognitive behavioural therapy programme at the Northern Ireland Centre for Trauma and Transformation (NICTT) in Omagh, which received referrals from over 650 people from 2002 until 2011. The development of a therapy programme based on a theory of how traumatic experiences impact on the human mind, was central to the the development of its therapy service. The programme relied on the Ehlers & Clark (2000) approach to treating post traumatic stress disorder and related disorders - building on the work that was developed in the original Omagh Community Trauma and Recovery team - described in Chapter 2. The development of the service is presented as an example of how to adapt and build upon existing resources and capabilities in a community that is subsequently affected by major acts of conflict related violence or disaster related tragedy. The challenges of developing and delivering therapy services where there is on-going violence, death threats, sectarianism and politic discord, are discussed. The author makes a case for bringing a trauma-focussed approach to understanding needs and service development. The therapy programme was the subject of a randomised controlled trial (RCT) which is also discussed in Chapter 9.

The Omagh bombing and the community’s response

In this Chapter the author describes the circumstances and impact of the Omagh bombing which occurred in Northern Ireland in August 1998, just as the peace process was beginning to see political progress and violence had significantly reduced. The impact on casualties and their families in Omagh, Buncrana in the Irish Republic, and in Madrid, Spain, is described, as are the distress and traumatic consequences for the wider community. The responses of neighbours and friends, the wider Omagh community, its medical, education, not-for-profit and civic services, are described. The contribution of commemorative and arts based events is demonstrated. The risk to the developing peace process and the Belfast Agreement is outlined and how this impacted upon the development of therapeutic services for the local community. The role of politics and politicians in ensuring services were developed, is described.

Assessing the mental health impact of the Omagh bombing

Following the Omagh bombing in August 1998, the local public health and social care services provider in Omagh undertook four major needs assessments in the local community. The experiences and mental health related needs of adults, younger children, adolescents, and health and social care staff, were assessed through four important studies. These produced valuable findings upon which services and practice were developed and which informed the case made to funders. The studies examined the risks to those caught up in the bombing of acquiring trauma related disorders, such as PTSD. These needs assessments provide valuable information for other communities affected by acts of war, conflict and terrorism.

Postscript: the rupture of loss and trauma

The book concludes with the Postscript - a more personal reflection by the author on the impact of loss and trauma on individuals and the community affected by war, conflict and disaster. Beyond research and research findings, the author draws attention to the importance of empathy, to relationships, to the need for healing, to taking responsibility, to letting go, to social justice and fairness, to the need to invest in future generations after conflicts end, to the importance of hope, and the place of growth and resilience. He concludes with a plea for the human impact of war and conflict to be a key and early consideration, when peace is being made after conflicts end.

The Northern Ireland Centre for Trauma and Transformation: a comprehensive trauma centre

This Chapter picks up from Chapters 2 and 3, and describes the establishment of the Northern Ireland Centre for Trauma and Transformation (NICTT), which was founded to build upon the work and experience of the Omagh Community Trauma and Recovery Team, after its closure in 2001. The author outlines the philosophy behind the new Centre and its programmes, and describes the some of the obstacles and circumstances in creating a distinctive service, in the post conflict period (where nonetheless there was still violence). The Chapter describes the extensive consultations within and beyond the Omagh community. The governance and management of the Centre is described along with challenges in funding and mainstreaming the skills and services developed by the Centre. The development of the Centre’s five key programmes - therapy, research, training and education, policy support and humanitarian relief, are outlined and described further in later chapters.

The Omagh Community Trauma and Recovery Team

This Chapter builds on the previous one by describing the specific response of the the local public health and social care services provider in Omagh to the bombing, including setting up the Omagh Community Trauma and Recovery Team. The Chapter describes how the Team was established, the principles and philosophy behind its foundation and work, and what it achieved - working in partnership with faith communities and churches, schools and the education system, and civic and political entities in the local community. The development of the early therapeutic services for addressing trauma related disorders is described, along with a description of the trajectory of mental health related needs in the months and years following the bombing. The Chapter also describes the managerial and funding challenges and processes necessary to establish an evidence based service, including occupational health services for emergency and other employees of emergency, health and other services. The importance of a trauma focussed approach to understanding and addressing the needs of conflict affected communities is described, and developed in later chapters.