Responding tolarge-scale
traumatic eventsand acts of terrorism

Position Statement PS03/16
August 2016

Royal College of Psychiatrists
LondonApproved by Policy and Public Affairs Committee: July 2016

Disclaimer
This guidance (as updated from time to time) is for use by members of the Royal College ofPsychiatrists. It sets out guidance, principles and specific recommendations that, in the view of theCollege, should be followed by members. None the less, members remain responsible for regulating
their own conduct in relation to the subject matter of the guidance. Accordingly, to the extentpermitted by applicable law, the College excludes all liability of any kind arising as a consequence,
directly or indirectly, of the member either following or failing to follow the guidance.
© 2016 Royal College of Psychiatrists

Purpose and context
The Royal College of Psychiatrists wishes to encourage the UK government,
statutory agencies and the media to do all they can to ensure that the psychological impact of large-scale events, including terrorism, is mitigated as
far as is reasonably practicable, on the basis of what is now known about
how such experiences affect people.
The 2005 London bombings led to large-scale loss of life, with many
people seriously injured. The attacks in Sousse and Paris in 2016 havehighlighted the potential for UK nationals to become involved in large-scale
traumatic events outside the UK. Furthermore, there have been several
major incidents, such as the 2015 Shoreham Airshow crash, that also havethe potential to detrimentally influence the mental health of those affectedby these events. Although the future is never certain, the current unstablegeopolitical situation suggests that further major terrorist incidents will occur.

The impact of traumatic events onindividuals
Over the past 20 years, much has been learned about the effects oftrauma, the mechanisms by which people cope, the range of illnesses that
may occur and how trauma-related disorders can be effectively treated(Greenberg et al, 2015). Most people exposed to traumatic incidents copewell (Greenberg, 2015). Where distress occurs, it is usually short-lived anddoes not require any professional intervention.
However, a minority of trauma-exposed individuals will develop mental
health disorders including, but not limited to, post-traumatic stress disorder(PTSD). As with all mental health problems, failure to recognise that one issuffering from a disorder is common; further, stigma and other barriers tocare prevent many people from seeking help. There is good evidence thatin England, around 70% of people with PTSD do not seek any help at all(Woodhead et al, 2011).
After the 2005 London bombings, a ‘screen and treat’ programme wasimplemented. It encouraged many people with trauma-related disorders,
who had not previously consulted their GP, to attend specialist centres,
where they received evidence-based care that in the main was successful(Brewin et al, 2010). Given that the aim of terrorism is to undermine the willof the people being terrorised, it follows that provision of timely and effective
support and, when needed, mental healthcare should be an importantelement of the UK’s preparedness to deal with terrorist threat.
Effective early treatment of trauma-related conditions can prevent
longer-term difficulties for the nation, including criminality, unemploymentand presenteeism. The economic argument for proactive delivery of earlyintervention, delivered within a few months of the incident, is persuasive.

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Recommendations

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1

Media coverage of terrorist incidents should be balanced and not exaggerate the risk of developing conditions such as PTSD. Psychiatrists
and other mental health professionals with relevant experience can becalled upon to provide a balanced view to the media and encourage
those who do develop severe or persistent mental health problems toseek professional advice.

2The use of ‘psychological debriefing’ or ‘trauma counselling’ immediately after an incident should be stopped, as it has the potential tocause harm (NICE, 2005).

3In the short term after a traumatic incident, the UK government, andwhere appropriate, employers and/or travel companies, should provide
brief, evidence-based information about the nature of traumatic events
to everyone involved in the event. Where possible, appropriate information should also be made available to the family members of those
directly affected by the incident (for example, the leaflet produced by
Royal College of Psychiatrists (2014)).

4The UK government should implement an evidence-based ‘screen andtreat’ approach (Royal College of Psychiatrists, 2014) a suitable period(such as a few months) after the event, as people frequently do notseek help. This is in line with the drive to achieve parity of esteem
between mental and physical health as most cases of PTSD are highlytreatable. Effective treatment can restore mental health and employability and help to sustain relationships with family members, friends
and colleagues. Chronic PTSD, left untreated, is debilitating for boththe individuals and their families.

5Current NHS trauma services need to be better provisioned. For
instance, the Improving Access to Psychological Therapies (IAPT)
programme provides treatment for PTSD, but its successful recovery
rate is just 36%. NHS treatment services for more complex traumarelated conditions are scant and frequently have extensive waiting lists.
There should be no substantial geographical limitations to accessing
such services after large-scale traumatic incidents; these should beevidence-based and demonstrate good recovery rates.

6Emergency planning exercises should specifically include consideration of post-incident psychological consequences for both emergency
responders and the affected public. Planners should ensure that evidence-based approaches for preparing emergency responders for thepsychological effects of their work and supporting them become partof routine practice (Greenberg, 2013; Hunt et al, 2013).

http://www.rcpsych.ac.uk

References
Brewin CR, Fuchkan N, Huntley Z, et al (2010) Outreach and screening following the 2005
London bombings: usage and outcomes. Psychological Medicine, 40: 2049–57.
Greenberg N (2013) Fostering resilience across the deployment cycle. In Building Psychological Resilience in Military Personnel: Theory and Practice (RR Sinclair, TW Britt).
American Psychological Association.
Greenberg N (2015) Military and disaster psychiatry. In International Encyclopedia of theSocial and Behavioral Sciences (2nd edn) (vol 15) (ed. JD Wright). Elsevier.
Greenberg N, Brooks S, Dunn R (2015) Latest developments in post-traumatic stress disorder: diagnosis and treatment. British Medical Bulletin, 114: 147–55.
Hunt E, Jones N, Hastings V, et al (2013) TRiM: an organizational response to traumaticevents in Cumbria Constabulary. Occupational Medicine, 63: 549–55.
National Institute for Health and Care Excellence (2005) Post-Traumatic Stress Disorder:
Management. NICE.
Royal College of Psychiatrists (2014) Coping After a Traumatic Event. Royal College ofPsychiatrists (http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/copingafteratraumaticevent.aspx).
Woodhead C, Rona RJ, Iversen AC, et al (2011) Mental health and health service use amongpost-national service veterans: results from the 2007 Adult Psychiatric Morbidity
Survey of England. Psychological Medicine, 41: 363–72.

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