The RCPsych Article of the Month for March is ‘People’s experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017‘ and the blog is written by author John Stancombe published by BJPsych Open.

On 22 May 2017, a suicide bomber detonated an improvised explosive device in the foyer of the Manchester Arena, killing 23 and injuring 239 people. An estimated 19,500 people (including staff and first responders) were present at the event. In the immediate aftermath of the attack, a multi-agency assertive outreach programme (The NHS Manchester Resilience Hub hosted by the Pennine Care NHS Foundation Trust [PCFT]) was set up to support people’s coping and recovery and to screen survivors for mental health disorders. Assessments of need were made with the help of an on-line tool supplemented by telephone contact from a Hub practitioner.

I was one of the first clinicians at the Hub to provide telephone consultation to survivors in the first few weeks after the attack. It became apparent that many survivors were experiencing distress in forms that were not captured by traditional psychopathology. Nonetheless, they were finding it difficult to cope with returning to work or education and the demands of everyday life. Moreover, some survivors with relatively low exposure to the event and so called ‘mild’ initial reactions were struggling to make sense of the intensity and duration of their responses. The vast majority of these people were not suffering from a psychiatric disorder and did not need specialist mental health services. Therefore, the question was how could we best help them?

On turning to the research literature for guidance, it soon became clear that we understand little about the frequency and course of psychosocial distress after major incidents and what people seek to assist them in coping and recovering. Our users’ experiences thus represented a vital opportunity to understand the mental health consequences for this population and learn as much as possible from this dreadful event in order to better support people and inform how services respond in future.

At short notice and without grant funding, the PCFT instituted the Social Influences on Recovery Enquiry (SIRE) with the help of service users and the pivotal participation of Prof Richard Williams and Prof John Drury. The SIRE project aims to understand the impact of the Arena attack on people’s wellbeing and mental health and their experiences of help and support (provided by their families, friends, colleagues and the responding services).

Our paper presents the findings from the thematic analysis of 18 in depth interviews with three subgroups of people who show personal responses typical of three broad patterns (‘mild’, ‘moderate ’and ‘severe ’stress responses) to major events. We were keen to explore the experiences of survivors who had less severe reactions as previously it has been presumed that resilient people and those with milder reactions are likely to recover §quickly, without needing formal services.

Our interviews produced very rich and detailed descriptions of people’s experiences of distress and response services and how this has influenced their coping, adaptation, and recovery in the two-year interval after the incident. We think that the key findings have implications for future policy and knowledge of them is likely to enable planners to take these factors fully into account when they design services for responding to events and implementing them when major incidents occur.

Disaster psychiatry is increasingly important in our current turbulent times. Disasters may occur as ongoing events, such as the COVID-19 pandemic, or single incidents, such as a terrorist attack. As article of the month, BJPsych Open is highlining two articles addressing both forms of disasters.  These articles serve as bookends to thematic issues. 

The first highlighted article – “Narrative review of the COVID-19, healthcare and healthcarers thematic series” – is an overview of 22 articles revealing initial snapshots of the impact of COVID-19.  Many of the studies had methodologic limitations impacting generalisability, symptoms as opposed to (specifically, inability to distinguish distress from disorders) and causality.  The narrative review addressed these methodologic issues in detail emphasizing the need for appropriate sampling with matched controls in longitudinal studies in future COVID-19 studies.

The second highlighted article, the first published in the disaster psychiatry thematic series — “People’s experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017” – is a thematic analysis of semi-structured interviews with 18 physically non-injured survivors of the Manchester Arena attack, who registered with the NHS Manchester Resilience Hub.  This richly detailed qualitative study found that a) distress was ubiquitous with long-lasting health and social consequences; b) initial reluctance to seek help from services was common; c) early and open access to authoritative sources of information and emotional support, and organised events for survivors, were viewed as helpful interventions; d) inappropriate forms of psychosocial and mental healthcare were common and potent stressors that affected coping and recovery.

Both articles comment on the need to place response to disasters in context and the importance of secondary stressors.

Dr Ken Kaufman,

Editor-in-Chief, BJPsych Open

Williams R, Kaufman K.  Narrative review of the COVID-19, healthcare and healthcarers thematic series.  BJPsych Open 2022; 8(2):e34.

Stancombe J, Williams R, Drury J, et al.  People’s experiences of distress and psychosocial care following a terrorist attack: Interviews with survivors of the Manchester Arena bombing in 2017.  BJPsych Open 2022; 8(2):e41.