In the aftermath of a terrorist incident, there is often confusion amongst front-line professionals and those who have been affected as to when and how to provide social support to victims of terror, and when a referral to clinical services should be made. This confusion may lead to variation in the care and support that is offered to those who have been affected, depending on their location and the organisations and professionals they encounter following the incident.
Encouragingly, there is evidence emerging from experts in the field who suggest that the rates of post-traumatic stress disorder amongst victims of terror is no higher than those who are affected by other traumatic events. These same experts urge that a shift in focus is required, from an emphasis on vulnerability to reinforcing the resilience of those affected; rather than assuming high levels of trauma we should recognise the potential for coping, adjustment and recovery.
At the same time, the National Institute of Clinical Health and Care Excellence (NICE) recognises the need for the ‘active monitoring’ of symptoms and for early referral to mental health services should symptoms worsen or not improve within a four to six-week watchful waiting period. Drawing on the recommendations of the NICE guidelines and the growing literature on trauma-informed practice, the SENSE model was established in response to the Manchester Arena attack in May 2017. It provides a framework for social support in the immediate aftermath of a terror incident and over the longer term, and is referenced by our survivors assistance network in their support of victims and survivors. The model comprises of five key interventions in working with victims:
- Social support
The order of the letters in creating the word ‘sense’, also reflect the chronology in which the interventions should be offered. The five interventions focus on addressing the immediate practical and emotional needs of those affected and providing education and information to enable and empower people to monitor their own symptoms (or those of their family members). The next stage is to reassure victims and survivors that their experiences in the immediate aftermath are entirely normal, to reduce any sense of panic or feelings of distress.
In addition, the model seeks to encourage the rallying of a person’s wider social support networks in recognition of the key role that friends and family will play in a person’s recovery. The final stage, ‘engagement’ is focused on facilitating the early referral to specialist support services (such as mental health services) as part of the ongoing process of active monitoring. This would be initiated after the watchful waiting period has passed and the first four interventions have been offered to enable a focus on resilience, building strengths and supporting coping in the first instance.
The increasing attention which has been paid to mental health and psychological wellbeing following an incident of terror may cause confusion and panic amongst survivors, their families and front-line professionals about if, when and how to intervene. This lack of clarity (often exacerbated by the media coverage) may serve to disempower front-line professionals, giving rise to a tendency to concentrate on the vulnerability of victims rather than helping them to strengthen their resilience. The SENSE model provides a framework for a series of interventions which focus on recognising and building resilience, empowering survivors and their families and initiating a process of active monitoring. Likewise, it is expected that adopting the approach may serve to empower front-line professionals at a time when they themselves may feel overwhelmed and helpless, as they bear witness to high levels of distress amongst survivors and bereaved families.
Written by Nikki Lester – Mental Health Consultant
If you or anyone you know has been affected by a terror attack, our survivors assistance network provides free, practical support. You can email or call us on 01925 581 240. Please don’t suffer in silence, we’re here to help.