The need to screen
Almost one year on, our team’s focus has been to screen and offer assessment and treatment to children and young people affected by the fire at Grenfell Tower. Screening began in the months following the fire, from a range of outreach settings including the official rest centres as well as churches, mosques, youth centres and in hotels where families had been temporarily accommodated. Children residing in the tower, those bereaved and those living nearby were prioritised for screening. The high prevalence of PTSD symptoms found in the first few months was likely exacerbated by the lack of stability many families experienced, for example due to living in a context of ongoing uncertainty, living in small confined spaces like hotel rooms with multiple family members, a loss of connection to their local area and supports, a loss of control over things like cooking their own meals or washing their own clothes at the same time as experiencing grief and loss. Most children were living with parents or carers experiencing daily stressors. Some families went away during the summer; others stayed, waiting for news and some children continued to live in this insecure environment into the new academic year with some not returning to school in September.
Our NHS team supported the community in various ways during the weeks following the fire. We engaged in conversations focused on psychoeducation about trauma, bereavement and general wellbeing to normalise responses to the incident, listened to people who wanted to talk and offered calming grounding strategies. We talked about how to reduce exposure from media for children, and the impact the material might have on them. This community based psychoeducational work continues.
Our approach was informed by relevant evidence from the field of disaster recovery, including the recent London Major Incident Guidelines (NHS, 2017) published following the terror attacks earlier in the year.
The screening team
To form our response team we drew together staff with relevant expertise. In addition to outreach screening and self referrals received through the local CAMHS clinic, a schools based screening approach was developed through collaboration with local schools and their linked Educational Psychologists and in-house therapeutic staff. Psychoeducational support and training was offered to all staff, to help them understand the goal of proactive screening for trauma. A plan to offer a systemic screening programme was developed with the aim of early detection to prevent longer term difficulties. To date our team has screened 336 children, with 172 receiving treatment.
The systemic approach also extends to treatment. Our service offers individual evidence based treatments such as Trauma Focused CBT as well as Eye Movement Desensitisation and Reprocessing Therapy (EMDR) to help children process memories about the fire and address PTSD symptoms. These treatments have been delivered as family focused sessions as well as alongside individual treatment for parents from colleagues specialising in adult mental health. It is perhaps unusual to work with so many families that have witnessed the same traumatic event, within what might be described as a wounded community.
A community-focused model
A context based model aims to engage children, young people and their families in a proactive way recognising the bidirectional influence of each person’s behaviour on the other, which in turn is influenced by the context in which they are embedded. This community psychology approach recognises the significance of the context in understanding individual presentations. The assessment includes the family and school systems, as well as exploration of peer and community perspectives on the child’s difficulties. One young person told me they were ‘sick of their friends talking about Grenfell’ and longed for discussions about more mundane things; she lamented how ‘we don’t joke around or just gossip about stuff; it’s all so deep’. She had begun to avoid her friends, as their conversations about the fire triggered physical symptoms of nausea and dizziness as well as flashbacks. She had not discussed this with her family, as they had all suffered a bereavement and she was worried about burdening them with her difficulties. Each young person’s story is different.
Our presence at pop-up clinics and other events in community venues facilitates such conversations in a more informal and proactive way than the clinic setting might allow. We are available alongside medical colleges offering diabetes advice or blood pressure checking and voluntary sector providers offering information about local services. This approach is in contrast to a passive ‘waiting mode’ treatment approach more traditionally associated with the medical based model and allows the team to work within the community context, in schools, community centres and other locations that support engagement in screening through conversation, guidance and information sharing.
A wounded community?
My view is that everyone working, living and with any degree of connection to the local area has been left with some kind of hurt –reflected in a sense of wishful rumination, wanting to do more, feeling helpless, finding it difficult to watch others suffer, frustration, shame, guilt and a host of other emotional reactions. Some professionals have spoken about this; some have left their posts; others have channelled their feelings into work; others have suffered silently; others have found meaning in their life from doing something to help others. This hasn’t prevented the local communities from mobilising into action for a variety of reasons. Their strength and resilience continues to be a key asset.
Collaboration with schools
Many children attended schools close to Grenfell Tower. Staff at these schools often encountered outpourings of grief or confusion, as parents talked to teachers at the school gates. The network of trusted people focused strongly around schools. Our team recognised this and worked closely with local schools, Educational Psychologists and school nurses to disseminate information about normal responses to distressing events, how to seek help, how to answer questions children might have and utilised the trusted network of the school system to ensure as many parents as possible received this information in the summer of 2017. The collaboration with schools has continued.
Community health and wellbeing is our focus
Destigmatising mental health is a key aim in supporting the children and young people to talk about how they are feeling and to provide a safe space to talk, if they want to. Continuing to keep routines and normal activities is also important and is achieved through collaboration with youth services and other local providers, as these activities help young people stay connected with other people rather than withdraw (NHS, 2017).
One of the goals of community psychology is to empower individuals and groups in society and so we have focused on those groups we already know under-utilise mental health services. For example we know that for a variety of reasons, many people from BME communities are often reluctant to seek help from mental health services and may delay contact until a crisis point is reached (Reid-Galloway & Gillam, 2006). According to Glasby and Lester (2005), access to appropriate language services can also promote access to mental health services and in recognition of this factor our staff team comprises bi-lingual therapists in a range of local languages ranging from Arabic, Farsi, Greek, Albanian, French among others to avoid the use of interpreters wherever possible.
We continue to work with local community groups to provide psychoeducation, with the goal of improving knowledge about signs, symptoms, referral routes and services available for a range of presenting difficulties. This has also extended to partner agencies and to staff groups in frontline roles coming into relevant contact with people sharing distressing stories. We did not anticipate this need at the outset but acknowledged very quickly how hard it might be for people without relevant training or clinical supervision to engage with people in distress on a daily basis.
Collaboration with voluntary and charitable sector groups has been pivotal to ensuring children receive the right type of support as well as referring children to community provision when this might be better suited to their needs. Place2Be and the Catholic Children’s Society are two key providers in local schools. Specialist bereavement charities have worked alongside our team including Winston’s Wish, Child Bereavement UK, Grief Encounters and close working relationships have been fostered with charities that formed in response to the fire including the Latimer Community Art Therapy Service and Grenfell United. Recently, our team supported bereavement charities, the Metropolitan Police and Action for Children to hold a Remembering Together event for bereaved children and former residents of Grenfell Tower.
Feedback is important to us and we have adapted our plans according to what we are told, whilst embedding our work in evidence based practice from the field of trauma and post disaster recovery. We have engaged all of these systems in supporting individual, family and school based interventions. Support by the team also extended to professionals. Over time, the line between “community” and “helpers/professionals” blurred and reminded us that there isn’t always a clear dichotomy. Some helpers live in the local area, some have historical links to the area, some also suffered from trauma and loss. Our service continues to offer support in response to the changing needs of the whole community, who are at different stages in their journey to recovery.
The children have shown great resilience. Often at organised events, they quickly shift from the sombre mood of the adults to what they know – playing laughing, teasing one another and showing us all the hope to resume to increasingly more moments of normality whilst not forgetting. Our screening programme, aims to reach out to the children and young people in Kensington and Chelsea, and support their families, schools, community groups to learn more about mental health and increase their self-help skills and general wellbeing on the journey to recovery.
- Glasby, J. and Lester, H. (2005) ‘On the inside: a narrative review of mental health inpatient services’, British Journal of Social Work 35, pp863–879.
- NHS (2017). London Incident Support Pathway for Children and Young People. Multi-agency support pathway for children, young people and families affected by the London Bridge terrorist incident. Available online: http://www.londonscn.nhs.uk/wp-content/uploads/2017/06/mh-incident-support-pathway-children-guidance-062017.pdf
- Reid-Galloway, C. and Gillam, S. (2006) Mental health of Chinese and Vietnamese people in Britain, London, MIND.
This is an independent article and the views are not necessarily those of ACAMH.