Intended for healthcare professionals


Responding to mental health needs after terror attacks

BMJ 2019; 366 doi: (Published 13 August 2019) Cite this as: BMJ 2019;366:l4828
  1. Kate Allsopp, research associate1,
  2. Chris R Brewin, emeritus professor of clinical psychology2,
  3. Alan Barrett, consultant clinical psychologist3 4,
  4. Richard Williams, emeritus professor of mental health strategy5,
  5. Daniel Hind, reader in complex interventions6,
  6. Prathiba Chitsabesan, consultant child and adolescent psychiatrist7 8,
  7. Paul French, clinical researcher9 10
  1. 1Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  2. 2University College London, London, UK
  3. 3Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Manchester, UK
  4. 4School of Health Sciences, University of Salford, Salford, UK
  5. 5Welsh Institute for Health and Social Care, University of South Wales, Pontypridd, UK
  6. 6School of Health and Related Research, Sheffield, UK
  7. 7Young People’s Mental Health Research Unit, Pennine Care NHS Foundation Trust, Manchester, UK
  8. 8Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
  9. 9Research and Innovation Department, Pennine Care NHS Foundation Trust, Manchester, UK
  10. 10Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
  11. Correspondence to: K Allsopp

Serious problems identified after the 2005 London bombings still remain, argue Kate Allsopp and colleagues

Mental health responses for people caught up in terror attacks are often inadequate. Internationally, existing services repeatedly fail to identify those with short and long term needs, resulting in an increased prevalence of post-traumatic stress disorder, depression, and anxiety disorders compared with the general population.1 Health services should plan for short and longer term psychosocial care and mental health treatment for the substantial minority who need interventions.2 But the UK has been slow to learn. Many shortcomings in the response to the 2005 London bombings remained at the time of the 2017 Manchester Arena bombing, despite proposals for a new approach. Here, we discuss how services have evolved since 2005 and what still needs to be done.

Planning a mental health response

The demographics of the affected population are central to the design of any mental health response (box 1). The organisational challenges include specifying a responsible lead and chain of command; obtaining funding; providing reassurance, guidance, and messaging on trauma responses aimed at health services, other organisations, and the public; and identifying those affected and creating information handling arrangements that are flexible but compliant with data protection legislation. Coordination of a cross-agency response, involving health services, the third sector, and voluntary organisations is necessary to identify people who may develop mental health needs, arrange equitable access to evidence based care, and monitor use and outcomes.

Box 1

Matching the mental health response to the population affected by mass casualty incidents

  • Localised versus dispersed populations. Dispersed populations require extensive efforts to identify people affected. The effects on geographically localised communities should be carefully considered; dispersed populations may form important virtual communities.

  • Demographic factors such as age and ethnicity may determine the agencies and groups that need to be involved in the response

  • The effect on exposed professional groups, including telephone operators and first …

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