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Lessons learned from the Manchester bombing

Learing from the Manchester Bombing - Prof. Prathiba Chitsabesan

Background to research

  • The blast killed the attacker and 22 concert-goers and parents who were in the entrance waiting to pick up their children following the show; 119 people were initially reported as injured. This number was revised by police to 250 on 22 June, with the addition of severe psychological trauma and minor injuries. In May 2018, the number of injured was revised to 800*;
  • Greater Manchester Health and Social Care Partnership formed to develop a support offer for young people for adults and professionals;
  • 19,500 people at the concert – spread across the whole at the north of England;
  • 3,500 young people adults including professionals who registered as part of that screening program; and
  • Professionals and the impact of major incidents finding is that they are less likely to identify themselves as having mental health needs:
    • less likely to engage in a mental health screening program and
    • less likely to kind of take up traditional mental health support offers or wealth and well-being support offers.

Reasons for that might include:

  • concerns around “getting on with the job at hand” because we know there’ll be lots of kinds of needs and demand on professionals; and
  • concerns around stigma and what colleagues or other professionals might think if they’re identifying themselves as having mental health needs.
The Recovery Pyramid

Learning from the impact

  • Most are going to recover and particularly with support from friends and family members and colleagues;
  • The pyramid identifies people with needs at different levels;
  • some individuals and some professionals are going to develop some mental health symptoms and a proportion of those are going to develop mental health needs;
  • seeing high levels of anxiety and distress with some concerns around PPE, concerns about their own health and the potential impact of the exposure with worries about how family members might be affected;
  • people may develop potential anxiety disorders or generalised anxiety disorders e.g. PTSD – post-traumatic stress symptoms, depression with a whole range of symptoms and needs. For some the primary presentation might be an impact on sleep rather than presenting with physical or somatic symptoms;¬†and
  • some professionals may smoke or drink more as a kind of coping mechanism – the presentations can be quite varied.

It is very important as a system to think about identification and support for professionals at all of those different levels 

The 5 key principles illustrated as blocks in a circle
  1. Think about a graduated or stepped approach – Clinical care pathways were redeveloped by thinking about needs at different levels: how do you continue to support staff remaining resilient though all the psycho-education information?
  2. There is a need to provide flexible and culturally sensitive support – there is not going to be at one-size-fits-all offer so the idea has to be to listen and co-produce the type of support that we provide. It is known that not everyone wants support within their organisation – some professionals prefer support that’s external. Also provide support anonymously – there is an important role for national helplines.
  3. Think about a system response – support the resilient response:
    • real risks are that we are anticipating that needs and demand on services is going to increase very quickly and they will be a real pressure on professionals and organisations to get back to “business as usual”.
    • the challenge for system leaders is really giving staff and teams support and to space to “decompress” to process what’s happened, to listen, to reflect and with no touch.
    • Real compassionate support is very important.

When you work in a team, and you know colleagues well, you know which colleagues are not doing well: the colleagues that do need a little bit of support. Some are able to recognise that, and able to provide support in a in a kind of reflective and flexible way. Support these who are supporting others.

Supporting more vulnerable staff members

The next key principle is supporting staff members that we may describe as being more vulnerable. Research suggests there might be particular groups that might be more at risk: professionals that have pre-existing mental health needs are professionals or who might be new to their role but also people who may be new to teams. Also professionals that have experienced secondary stresses – it might not be the initial primary event that causes the problems as people tend to store up difficulties e.g. problems with finances, relationship difficulties, childcare issues, It is important that people ask (and are able to ask) those questions about secondary difficulty.

Support BME colleagues who might be at greater risk for lots of different reasons: BME colleagues are maybe more exposed to trauma racial discrimination and also less likely to access traditional kind of mental health support offers. It is important to identify and support those colleagues.

Delayed impacts

The impact on professionals tends to be generally more delayed in comparison to the public. It has been found that it can take three to seven years before we get a peak in the rise in mental health needs for professionals so ensuring the system thinks and plans long-term I think is going to be really important to discuss this nationally and locally.

*Source: https://en.wikipedia.org/wiki/Manchester_Arena_bombing#Casualties

All support offers provided must be flexible and culturally sensitive