Addressing the consequences of conflict and trauma in Northern Ireland
Author: David Bolton

Conflict poses considerable challenges for services that support communities, and in particular those affected by violence. This book describes the work undertaken in Omagh against the background of the most recent period of violent conflict in Ireland, and specifically it draws upon the work following the Omagh bombing. The bombing came just four months after the Northern Ireland peace agreement, known formally as the Belfast Agreement of 1998, and more informally as the Good Friday Agreement. The book describes the impact of the bomb and the early responses. Local trade unions, employers and the business community played key roles at times, particularly in underlining the need for solidarity and in identifying themselves with the desire for peace. The book looks at the outcome of needs-assessments undertaken following the Omagh bombing. The efforts to understand the mental health and related impact of the violence associated with the Troubles in Northern Ireland over the period 1969 to 2015 are focused in detail. The later efforts to build services for the benefit of the wider population are described, drawing upon the lessons gained in responding to the Omagh bombing. The developments in therapy, in training and education, and in research and advocacy are described with reference to the work of the Northern Ireland Centre for Trauma and Transformation (NICTT). The book draws together key conclusions about the approaches that could be taken to address mental health and well-being as an essential component of a peace-building project.

Abstract only
David Bolton

This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book describes the outcome of needs-assessments undertaken following the Omagh bombing. It explains that the mental health and wider needs arising from loss and trauma must be incorporated as early as possible into the peace-making and peace-building project. The book looks in some detail at the efforts to understand the mental health and related impact of the violence associated with the Troubles in Northern Ireland over the period 1969 to 2015. It considers the Northern Ireland Centre for Trauma and Transformation (NICTT) and also describes developments in therapy, in training and education, and in research and advocacy. The book draws key conclusions about the approaches that could be taken to address mental health and well-being as an essential component of a peace-building project.

in Conflict, peace and mental health
David Bolton

This chapter outlines four major needs-assessments undertaken to better understand the impact of the bombing and the way in which the findings helped in the development of services for psychological and mental health needs. It includes Omagh needs-assessments, adult needs-assessment, children's and adolescents' needs-assessments, and health and social care services staff needs-assessment. In the history of the Troubles in Northern Ireland there had not been an incident with a combination of so many deaths, so many injuries and so many exposed to highly traumatic experiences. The chapter describes the Sperrin Lakeland Trust under the leadership of its occupational health consultant in collaboration with the University of Northumbria. The adult study was undertaken by the Trust with the support of Professor David Clark and his colleagues, based then at Oxford University.

in Conflict, peace and mental health
David Bolton

This chapter charts a pathway from the early days of the Troubles and the efforts to understand the mental health impact of the violence. D. O'Reilly and Des Browne reported upon the Northern Ireland Health and Social Wellbeing Survey of 1997 focusing on health service use. In 2002, P. McConnell reported upon their epidemiological study of mental health disorders and needs for treatment of the general population in the city of Derry/Londonderry. Between 2008 and 2012 a partnership of the Northern Ireland Centre for Trauma and Transformation and the Psychology Research Institute at Ulster University published a series of studies that examined the mental and associated physical health impact of the Troubles. The Commission for Victims and Survivors for Northern Ireland (CVSNI) was established in 2008, following the passing of legislation by the Northern Ireland Assembly in 2006.

in Conflict, peace and mental health
David Bolton

This chapter describes the Northern Ireland Centre for Trauma and Transformation (NICTT)'s training development and delivery programmes over ten years, focusing in particular on vocational training. It aims to build the skills base of existing practitioners by providing a number of cognitive behavioural therapy (CBT) and trauma-related skills courses. Through a research-based explanatory model of trauma and how it could be addressed in the life of the individual a trauma-focused approach offered a way of understanding the experience and needs of the individual. The experience of the Centre suggests that commissioning for conflict-affected communities needs to be informed by evidence-based models of trauma and related needs. In terms of services, there would be sufficient appropriately trained and skilled practitioners, with commissioning and funding of services, and training, intelligently reflecting the changing needs of the post-conflict community.

in Conflict, peace and mental health
David Bolton

In mental health terms, perhaps the most immediate and significant contribution that politics can make is to bring violence to an end. In terms of mental health and related needs arising from conflict it is important to review how and to what degree therapeutic measures address and improve the well-being of conflict-affected communities. The experience of Northern Ireland shows that policy and services need to be developed as conflicts unfold, end and transform in the post-conflict period. Community leaders, and civic and governmental bodies have key roles and tasks to undertake in the context of specific and on-going violence. As the example of Northern Ireland has demonstrated, the attrition of conflict on populations should be regarded as a significant risk, of public health proportions, for well-being, resilience and mental health.

in Conflict, peace and mental health
David Bolton

This chapter describes some of the key responses by the Omagh community and its agencies to the crisis of the bombing and its anticipated long-term implications. Within minutes of the bombing, the local hospital in Omagh, The Tyrone County Hospital, which was located less than a kilometre away from the scene, began to receive casualties. To convey where the bombing registered as a community tragedy, reference was made to a framework developed some years earlier to reflect upon the impact of the Enniskillen bombing of 1987. As a result of the highly charged political context of the tragedy, additional expectations became apparent, with politicians and community leaders being concerned that services should be provided for those affected by the bombing. It was clear that the bombing posed a serious mental health risk for those who had been involved in the care, treatment and support of casualties and the bereaved.

in Conflict, peace and mental health
David Bolton

Northern Ireland had a significant and developing publicly provided mental health service that served the general and more specialist needs of the population. The trauma team focus on the community and personal health consequences of the bombing formed part of a raft of responses by key sectors in the Omagh community. This included the Christian churches and other faith communities, which were coordinated largely by the local Churches' Forum. The links between the schools and the Community Trauma and Recovery Team were very important, especially in the first 12-18 months when many referrals were received in respect of children, young people and families. Understanding the needs of people affected by the bombing was central to the development of therapeutic services by the Team. The bomb scares also interfered with help-seeking and engagement in therapy, undermining the confidence of individuals to engage in or continue with therapy.

in Conflict, peace and mental health
David Bolton

This chapter provides an overview of the unfolding understanding of the psychological impact of the violence, with reference to key studies, research reviews and other key reports published between 1969 and 1999. One of the earliest studies to investigate the mental health impact of communal violence in Northern Ireland was reported upon shortly after the large-scale violence began. The study focused on three family doctor practices in west Belfast, one of the areas most affected by the early violence. The parties to the Belfast Agreement looked forward to the results of the work of the Northern Ireland Victims' Commission. In 1999, Lost Lives, a chronicle of the deaths associated with the Troubles in Northern Ireland, was published. The form and approach of studies that have investigated the mental health impact of the Troubles varies considerably.

in Conflict, peace and mental health
A comprehensive trauma centre
David Bolton

This chapter describes the origins of the Northern Ireland Centre for Trauma and Transformation (NICTT). It briefly outlines the philosophical and theoretical foundations of the Centre and the evidence base upon which its mission and work was developed. The chapter also describes the role of a not-for-profit agency working in conventional public sector funding and administrative structures in the context of the Troubles. The development of ideas about recognising the mental health impact of the Troubles, and responding effectively, was part of a wider debate about addressing the adverse impact of the years of violence on individuals, families and communities. The original Omagh Community Trauma and Recovery Team had involved practitioners from a wide range of roles and disciplines and was directly linked into the wider range of services provided by the Sperrin Lakeland Trust.

in Conflict, peace and mental health