By Dr John Green, Clinical Director
The Grenfell Tower fire caused a great deal of psychological disturbance and the NHS response has been complex and wide-ranging..
We worked with the Metropolitan police to take the bereaved and survivors back into the tower.. We carried out community screening for trauma at events and door-to-door, to identify those who have been badly affected and offered treatment. We supported those giving evidence at the public inquiry and those listening. Our staff worked with police Family Liaison Officers to support relatives who were receiving the belongings of those they had lost.
Engagement with the local communities has been an essential part of our work; not just health organisations but faith groups, and voluntary organisations offering everything from social events to practical advice on debt. We have worked with them to provide help to individuals, supported events they were holding and provided training and advice, something we continue to do.
Immediately after a major incident there is usually widespread psychological disturbance; a large proportion of those who witness something like Grenfell will be affected. Over the weeks after the event many people will find that the symptoms they are experiencing gradually reduce in severity, it is not that being reminded of what happened is ever going to be pleasant, but it becomes more bearable and they are able to think about other things. However a large minority of people continue to experience symptoms of psychological trauma, and in some cases these get worse rather than better.
It is difficult to tell if people will develop post-traumatic stress disorder (PTSD) or will recover without formal treatment, which is why we are cautious about making a firm diagnosis in the first month or so; we offered advice to those who contacted us or we contacted and where people’s symptoms were particularly distressing or were increasing in severity, we offered treatment.
By this stage, two years down the line, anyone who is still getting trauma symptoms really needs to seek treatment.. In fact there are a lot of people in exactly that situation, and that is why we continue to carry out community screening; we know that we have not reached everyone. However people do not need to wait until we reach them, can refer themselves to our services, although if they wish they can get their GP to refer or even a voluntary organisation.
Trauma is not the only problem. Grief after bereavement is a normal reaction. Most people immediately after a death are sad and low. They find that they are thinking about the person they have lost much, or pretty much, all of the time, and the memories are painful. Over time, weeks, perhaps months, many of the bereaved begin to feel better. It is not that the pain disappears, but they find themselves having good days and bad days, or good hours and bad hours instead of constant unhappiness. The pattern is very variable, but month by month there should be a definite, if sometimes gradual, reduction in unhappiness. Unfortunately not everyone goes through this course of events. A minority of people who are bereaved become depressed, rather than feeling better they feel worse and find it difficult to cope with their feelings and, sometimes, with everyday life. The pattern is sometimes called complicated grief reaction. Certainly anyone who is not starting to feel better, or feeling worse six months or more after being bereaved should seek help. Complicated grief reaction is more common where a death has been sudden, traumatic and unexpected.
Most people who develop PTSD are also depressed. However plenty of people who do not reach the threshold for a PTSD diagnosis develop depression or anxiety problems as a result of a traumatic event. Rates of depression and anxiety tend to increase after a major incident and can continue rising for a considerable period. Dépression can be a very serious condition in its own right, which disrupts lives, relationships and the ability to work. It is possible to be seriously physically ill and still enjoy a good quality of life, it is not possible to be depressed and enjoy a good quality of life. We offer treatment for both depression and anxiety disorders.
Children can also be badly affected. They are no less resilient than adults, however there are critical periods in a child’s life. They may change school and not make friends early on because they are upset or distress associated with a major incident may interfere with their school work. That makes it important to intervene where a child has been badly affected because the impact of a major incident can have long term consequences which last long far beyond the immediate psychological reaction.
Providing screening and treatment after a major incident is an important element in helping communities recover. Community recovery is not quick, it can take years for a community to fully recover after a major incident. And it is harder for a community to recover if there is a large continuing burden of mental health problems. But community recovery is not just about treating PTSD or other anxiety conditions or depression. A good quality of life is about having decent housing, enough money to ensure your family can live a decent life, the opportunity to socialise, to get decent education for your children, these are all important elements in someone’s mental state. And there is evidence to suggest that communities which lack these things for many of their members are slower to recover.
Over the next five years we want to see the North Kensington community recover as much as possible. Mental health and wellbeing services are only one part of that process, but they are an important part. People who have mental health problems, whether as a result of a tragedy like Grenfell or not, don’t always seek help. Mental health problems are still seen by many people as something to be ashamed of, rather than something that can affect anyone. If there is one good thing that has come out of Grenfell it is that people in the area are actively engaged with the idea of mental health, it is something that is widely discussed rather than being hidden and avoided. We want to provide the local community with the knowledge and the support necessary to recognise when someone they know has a mental health need, to understand how they can best help that person and to know how to help that person to access services, both those provided by the NHS and other services.