TC/1569

Many traumatised by bomb have never returned to town centre, health meeting told
By Anne Palmer

MANY people traumalised by the Omagh bomb have not yet returned to Omagh to do their shopping, it was revealed at the annual public meeting of the Sperrin Lakeland Health and Social Care Trust.
Speaking about the work of the Omagh Trauma Centre, Mr David Bolton, director of Community Care, highlighted the fact that children were reliant on adults, parents and teachers to spot their needs and to bring them forward for help. Those in attendance listened in silence and with great attention to Mr Bolton's address as he described how the Trauma team was set up about 10 days after the Omagh bomb, in response to the needs arising from the tragedy.
One of the strengths of the team was that it was comprised of occupational therapists, art therapists, psychiatric nurses, community psychiatric nurses, cognitive behavioural therapists, psychiatrists, social workers, as well as many other health professionals who worked well together, he said. The team provided a focal point for the public to access services, he added.
The director of community care said that the accessibility and visibility were considered very important especially for people who were not used to using health and social services
The trauma team was located in High Street initially, but then moved to Campsie in November 1998.
"Its creation was symbolic, it was about saying this is a significant event in the life of this community," said Mr Bolton.
"It was about making a symbolic response to the bombing, that is why, in the fullness of time the team should close at some point," he added.
Mr Bolton profiled work undertaken by the trauma centre.
He revealed that 622 individuals had been referred or had referred themselves to the trauma team. In addition, he said that the age range was 2-84 years of age and that 396 female and 226 male had sought help.
"It has often been assumed, and through research, maintained that that women and females are more likely to suffer traumatic consequences of traumatic events," he pointed out
"Whilst this is true, it is also important to note that the Omagh bomb affected the female population much more so than many of the other tragedies of the troubles," he asserted.
"It is interesting to note that men have been coming to use the service, in a proportionate proportions, and it is important that men feel able to come along to use the service," he said.
Further statistics collated by the team indicated that 131 out of 622 were under 18 years of age. And almost 150 people are still attending sessions, he said.
Referrals
Examining the pattern of referrals, Mr Bolton said that some referrals received, related to previous events, associated with the troubles, but he pointed out that a small number related to non 'troubles' related incidents as well.
Key events like the first Christmas, the first anniversary and the inquests which were happening at the moment, had impacted on the levels of referrals, he added.
The director expressed grave concern at the trend which had emerged in which adult referrals peaked with the key events and particularly in August 1999, while the level of child referrals had remained quite low.
"We think that this is due in part, because children rely on adults, on parents and teachers to spot their needs and to bring them forward for help, and so were keeping a particular eye out for youngsters in the long term," he said.
Mr Bolton told the audience that the impact on people who were using the services of the Trauma team had been significant, in fact many have come back for booster sessions and indeed had regressed in their progress.
"We also expect that there will be an increase in the level of referrals after the inquest, what the level of that will be remains to be seen," he said.
He said of referrals that, by far, the greater proportion of people corning to the centre had either come of their own volition or have been referred by relatives and it was the same for most of the children who had come to the centre.
Mr Bolton reiterated that what was important was that the public had been able to identify when they needed help, been able to find and seek it out.
"There was a very important lesson to learn about making services available in an accessible way," he said.
He added that the health and social services, family, social workers, and GPs had made a valuable contribution to the referals.
The status of those who sought help from the centre was classified according to whether the individuals had suffered serious physical injury or moderate or mild physical injury.
In all 91 people attending the centre had suffered mild injuries, while 35 had moderate and 38 serious injuries.
He said that the the study also looked at how witnesses and bystanders had been affected by the bomb.
"Witnessing events has a very powerful psychological effect on many people," a fact borne out by the Trust's clinical practice, he indicated.
He pointed out that those people who had suffered traumatic bereavement had to cope with added additional complication to grief.
He said that a number of emergency services staff came to the Trauma centre as the event, may have reawakened previous trauma suffered in a previous bomb.
Trauma caused by car accidents, personal assault or rape had also caused individuals to seek help at the trauma centre, it was revealed.
Various therapies were provided, perhaps the most important at the leading edge, was cognitive therapy he said.
"The Trust was very in a very fortunate position to have already in place a significant amount of cognitive therapy training and cognitive professionals working in this field," he said.
Rapidly
"We subsequently learned very rapidly that cognitive therapy is the preferred response on the basis of medical evidence.
"Over the last 2 two years we have built up our capacity in cog therapy," he added.
"We also used art therapy, particularly in children but not exclusively so," he disclosed.
Mr Bolton revealed that the art therapy was very helpful for people who could not put into words what they felt.
He described how it could be seen very clearly in their art work that they progressed from very dark images with no colour and no light with broad thick lines to much more colourful and interesting healing pictures.
Family therapy had also been used to help in the recovery work at the Trauma Centre, he said.
"There is no point in putting somebody who is recovering from a traumatic event, back into a family who is unable to support that person," he said.
The team also provided advice to many other people who had suffered trauma, including the fireworks fire disaster in Enschede in the Netherlands.
Mr Bolton described trauma as a serious psychological reaction or serious psychological injury.
In its clinical form it is often referred to as post traumatic stress disorder (PTSD).
"The stress of PTSD is very disabling, and those who have suffered it will tell you just how disabling that is," he added.
"The stress that comes from reliving or from being terrifying or of wanting to avoid anything that reminds you of the bomb is very powerful," said Mr Bolton.
A practical way of demonstrating this was the fact that a number of people had not yet gone into to Omagh town to do their shopping, he said.
"It can have social consequences as well for people," he added.
"It can have life-long consequences if untreated, and those of us who remember people from the first World War will know this," said the director.
He said it can also have family and work consequences.
However, Mr Bolton pointed out that post tramatic stress distorder and related conditions were increasingly treatable.
Mr Bolton pointed out that, sadly, the Trust had acquired through the tragedy, knowledge and experience that did not exist elsewhere.
Because of the bombing happening in the wake of the Bloomfield Report and the wake of the Good Friday Agreement. The Trust was in a position to provide and there was an expectation that the Trust would provide, services to meet the needs of those affected by the bomb, he added.
That was not possible previously, mostly due to societies silence around the troubles.
"The knowledge that the Trust now has compiled as a result of the bomb is unique in the history of the Troubles
"We intend to conserve the learning and experience gained and We would like to be able to extend it to others affected by traumatic events including the troubles of the past.
"We are actively exploring ways in which this might be achieved." added Mr Bolton.
He paid tribute to members of the team and its leader Mr Michael Duffy who he said had taken on an exceedingly difficult job.
It has been hard in the past for the team who has been in the eye of the public, no other Trust department has experienced such close scrutiny nor has had to give an account of itself in such a public way, he told those in attendance at the meeting.
"They have made a major contribution in dealing with the consequences of the bomb," he said.
The psychological trauma of the Troubles is only beginning to be addressed, he said.
"'The cost of the Troubles' a major study suggested that between 12 and 42 per cent of the population of Northern Ireland had been traumatised
The Omagh study by contrast suggests that over 55 per cent of those who were present when the bomb exploded were traumatised
In the months following the bomb there was generally a natural improvement in those suffering from PSTD. It has been projected that over a five year period the percentage of those suffering the disorder would have fallen from 60 per cent to 40 per cent, with further reduction in a ten year period, he related to the people at the public meeting.
The Trust's study shows that there were 614 people in the Market Street area at the moment the bomb exploded and a further 555 were in the vicinity reaching from the Court house to Market Street. Another 441 people were in the adjacent car parks
Of the 614 people in the immediate are 55 per cent were traumatised, which equated to 423 people, he said.
In five years time there will be another 169 people who remain traumatised if no help is offered.
"If we include those who were traumatically bereaved and those who came along and witnessed the scene afterwards, then that figure doubles," said Mr Bolton.
Looking to the future of the centre, Mr Bolton said that the service wanted to make it clear that the service had already been funded until March just past, additional funding had been sought to continue the service until December this year, as yet that additional funding has not been approved by the department for Health Social Services and Public Safety, he revealed.
"We are clearly actively reviewing the needs of the community especially in the light of the inquests," he added.
"Following the inquests we will have an analysis of needs up to and beyond December," he said.
Mr Bolton said that the Trust would be keeping an open mind.

Publisher: TYRONE CONSTITUTION

Ref: TC/1569

Published Date: 28-Sep-00