When disaster strikes: the specialists in traumatic bereavement and conflict-related trauma
At lunchtime on Saturday 20 March 1993, two bombs planted by the IRA exploded in Bridge Street, Warrington, with devastating effect. Two children were killed 12-year-old Tim Parry and three-year-old Johnathan Ball. More than 50 people were injured.
Slowly, out of the terrible grief that followed, a counterweight to the terrorists brutality emerged. Tims parents, Colin and Wendy, in an attempt to understand why events rooted in Ireland had cost their son his life, established a charity that would keep alive the names of the two boys.
Now, almost 25 years after the attack, the Tim Parry Johnathan Ball Peace Foundation, based at the Peace Centre in Warrington, plays a vital role in supporting UK survivors of terrorism. And consultant mental health nurse Nikki Lester has become central to that work....
At lunchtime on Saturday 20 March 1993, two bombs planted by the IRA exploded in Bridge Street, Warrington, with devastating effect. Two children were killed – 12-year-old Tim Parry and three-year-old Johnathan Ball. More than 50 people were injured.
Slowly, out of the terrible grief that followed, a counterweight to the terrorists’ brutality emerged. Tim’s parents, Colin and Wendy, in an attempt to understand why events rooted in Ireland had cost their son his life, established a charity that would keep alive the names of the two boys.
Now, almost 25 years after the attack, the Tim Parry Johnathan Ball Peace Foundation, based at the Peace Centre in Warrington, plays a vital role in supporting UK survivors of terrorism. And consultant mental health nurse Nikki Lester has become central to that work.
Since qualifying in 2005, Ms Lester has worked in a range of settings, including the NHS and the armed forces, and has specialised in traumatic bereavement and conflict-related trauma.
Developing a working model
The number of people who died in the Manchester Arena attack in 2017, including the bomber
She was contacted by the foundation soon after the Tunisia attack in June 2015, when a gunman killed 38 people. She was asked to develop a model of practice that would help a small team of non-clinicians, part of the foundation and known as the Survivors Assistance Network (SAN), to maximise the practical and emotional help offered to those affected by acts of terrorism.
Until then, the foundation had a track record of assisting people who had experienced historical trauma, such as the Troubles in Northern Ireland and the 2005 London bombings. But, says Ms Lester, the support given was often focused on group work and developing peer support networks, rather than specific individual or family-focused interventions. Funding from the Ministry of Justice allowed her and the SAN team to consider ways of developing a more evidence-based and trauma-informed approach.
‘Trauma-informed’ is a fairly new concept in the literature, Ms Lester says. ‘It talks about ways services, that are not necessarily clinical, but which work with people who have experienced trauma, might encompass a certain set of principles in their work.’
The principles, she explains, are around safety, choice and control, establishing connections and building strengths. ‘Most of it is common sense, that good organisations are using anyway. It’s about making a proactive effort to offer choice and collaboration to survivors.’
‘In the hours after a traumatic incident, what people need is often just reassurance’
To give structure to their interventions, the SAN caseworkers use a framework called SENSE, devised by Ms Lester and the team, and based on five components:
- Social support.
‘The order of the letters, and the way they create the word “sense”, reflects the chronology in which the interventions are offered in the immediate aftermath of a terrorist incident,’ Ms Lester says.
Caseworkers grow the team
For the past two years, she has spent one day a week with the SAN, initially providing training and development, but more recently offering Donna Craine and Will Roberts, the two SAN caseworkers, clinical supervision and an opportunity for discussion of their own self-care needs.
‘I help guide how Donna and Will manage their cases, which is unusual for non-statutory, non-clinical services – bringing in a clinician not to do the work but to support those who do.’
It was either prescient or fortunate that Ms Lester was asked to become involved with the SAN in 2015. Since then British citizens have been caught in terror attacks at home and abroad that have cost many lives, and caused immense physical and psychological trauma.
‘We’d never worked at this level before. We all worked round the clock for six or seven weeks’
Those attacks include the Bataclan in Paris, Nice's Bastille Day attack, Westminster Bridge, London Bridge, Finsbury Park and, closest to home for the Warrington team, the Manchester Arena bombing on 22 May last year – an event that would provide the greatest test to date for the SAN and the SENSE model of practice.
At 10.31pm, as the audience was spilling out of the auditorium following a concert by Ariana Grande, a suicide bomber detonated a device packed with shrapnel. Twenty three people died, including the bomber, and more than 500 were injured.
'Unprecedented level of working'
In the weeks and months that followed, the SAN would receive in excess of 700 referrals for people affected by the bombing. In the immediate aftermath, however, the priority was, as the SENSE model dictates, stabilisation.
people were injured in the Manchester arena attack
‘In the hours after a traumatic incident, what people need is often just reassurance,’ says Ms Lester. Panic and anxiety are normal reactions to trauma and the simple early intervention of relaying that understanding to people can prevent symptoms becoming chronic.
With only two caseworkers and so many referrals, there was an urgent need to prioritise. Telephone and email were the primary means of offering support.
‘It was unprecedented for us,’ Ms Lester says. ‘We’d never worked at this level before. We all worked round the clock for six or seven weeks.’
Messages the network team received subsequently
The Survivors Assistance Network – team manager Terry O’Hare and caseworkers Donna Craine and Will Roberts, supported by consultant mental health nurse Nikki Lester – handled more than 700 referrals from the Manchester bombing. These are extracts from messages the team received subsequently:
‘You made me feel safe and I thank you for that.’
‘You have made me realise I’m okay to feel the way I do and that it’s perfectly normal.’
‘It was really great to speak to someone who has experience of working with people who have been through what we have been through.’
‘I feel I have made huge steps since I first picked up the phone.’
‘Your staff were amazing tonight at the private viewing of the [Manchester] Arena ahead of its public reopening. It was a tough evening for our girls, returning after 22 May, but your support and sensitivity were hugely appreciated.’
Capturing accurate data became hugely important given the volume of people seeking help. The concert audience had included many young fans of similar ages and with similar names, so the potential for confusion was high.
Before its barbarous end, the concert that night had been a family affair. The team’s usual emphasis on a family-focused approach was therefore particularly appropriate.
Ms Lester says: ‘It wasn’t just the individual who was present that night who was impacted, but their wider families – mum waiting outside, or at home watching on the news.
‘The family has a huge role to play in how we support people after an incident. So mum and dad, brothers and sisters, what do they need? The whole focus is on strengthening the resilience of the family in recognition that a lot of recovery takes place in the family. That’s our starting point.’
Change in support needs
referrals for people affected by the bombing received by the Manchester Survivors Assistance Network
Although the pace of referrals did not slow in the following months, the support people needed changed as people began to consider the future as well as the past – going back to work or resuming their education, for example. So the team worked closely with schools and employers, supporting them to ease an individual’s return.
Ms Lester’s role with the SAN will continue for the foreseeable future. But her work is far removed from common perceptions of what a nurse’s job involves. Does she consider it still to be ‘nursing’?
‘When I talk to colleagues, it feels very removed,’ she says. ‘And it’s easy to be overwhelmed and terrified by the responsibility, especially with Manchester. But everything I do is evidence based, and the Nursing and Midwifery Council code gives me a structure and a sense of confidence in my own practice.
‘Being a nurse is about being pragmatic and getting your job done. At the time of Manchester, we needed to get on with it. We didn’t have time to think how we were going to respond. We just had to do it.’
Daniel Allen is a freelance journalist
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