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.

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.

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.

This chapter considers the benefits of, and an approach to, undertaking research as part of the task of a trauma centre. Ongoing research into the changing needs of communities affected by emergency or conflict is fundamental to informing policy, advocating for service development, supporting the needs-directed commissioning of services and training, and to developing practice. Once the Northern Ireland Centre for Trauma and Transformation (NICTT) therapy team was established, a research working group was formed to guide the development of the research programme. As the work of the Omagh Community Trauma and Recovery Team was drawing to a close, the proposals for what became the NICTT were being developed, and from an early stage included research and development as one of the key programmes. Some practitioners and agencies had expressed anxieties about the use of such tools for those who sought help with trauma-related needs.

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.

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.

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.

Experiences of tragic loss and overwhelming trauma divide our lives into what went before and what came thereafter. The paradigm of loss and trauma, of altered views of oneself, others and the world, of the crisis of adjustment, can be found in the struggles of Northern Ireland in the wake of the Troubles. To tragic loss and the distress of traumatic events is coupled the crisis of how to cope with or survive this deeply unfamiliar landscape, where friendship, faith and other consolations fail us. Entering into the existential crisis and its intolerable consequences is the erosion of well-being and mental health presented in psychological problems, mental health disorders, substance misuse, addictions and wider family and social problems. The capacity of individuals, families and communities to adjust and recover, to regain well-being and build resilience to face future stressors, can be significantly impaired.

This chapter describes the establishment of a trauma-focused approach to the needs of those seeking help with emotional, psychological and mental health problems linked to traumatic experiences of the civil conflict in Northern Ireland. It outlines the development of a therapy service based upon trauma-focused cognitive behavioural therapy (CBT). The chapter describes and discusses key issues relating to the origins, principles, aims and challenges of this development. The new Centre's programmes were to deliver trauma therapies, undertake research, train practitioners in trauma-related skills, and support other communities affected by war and conflict. The Centre continually documented its therapy protocols, which had been developed initially in the original Omagh Community Trauma and Recovery Team. In the early years, the therapy programme was managed by the Centre's therapy team leader who coordinated the allocation of the referrals.

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.