Improving the management of the psychological consequences of disasters and terrorism

Research at UCL developed a 'screen and treat' model for dealing with mental health problems in the aftermath of disasters.

After a major disaster, many of those affected will suffer psychological consequences. The majority of these will resolve naturally, but a substantial minority may go on to develop serious mental health problems such as posttraumatic stress disorder - and these may go unrecognised for a long time.

For many years, all survivors of a disaster would be offered psychological debriefing, but the evidence suggested that this was ineffective. Researchers led by Professor Chris Brewin (UCL Psychology & Language Sciences) have developed a new approach, based on a different strategy, recommending not intervening in the short-term to reduce psychological symptoms, unless the person's coping resources were clearly inadequate. Instead, resources should be devoted to active outreach and screening to detect the minority of individuals who were failing to make a good recovery, and to providing them with effective, evidence-based interventions.

Professor Brewin and colleagues from UCL, Royal Holloway and Imperial College London developed a Trauma Screening Questionnaire (TSQ), which was based on a simple set of 10 yes/no questions, which provided excellent screening performance.

On 7 July 2005, the London bombings seriously affected areas in the immediate vicinity of UCL, with students and staff members among the injured and killed. Two weeks later a Psychosocial Steering Group, which included Professor Brewin among its membership, was convened by the Camden & Islington Mental Health and Social Care Trust and the London Development Centre for Mental Health. The Steering Group approved proposals based on the screen and treat model described above. As expected, most Londoners were resilient but a minority were seriously affected. The screening team undertook active outreach, identifying survivors and screening them some months after the bombing with the TSQ. Those screening positive were referred for evidence-based psychological therapy.

The evaluation of the London Bombings programme funded by the Department of Health found that 30% of those screened were referred for treatment and, of those referred within the programme, over 75% completed treatment. The clinical outcomes of this group were excellent, with more than 80% achieving a clinically significant improvement, and were well maintained among those followed up after one year.

The TSQ has now been incorporated into UK government guidance, including planning for the 2012 Olympics. It has been implemented around the world, for example in a US school after a suicide and in the Netherlands. Professor Brewin has been consulted on the subject after major disasters such as the 2011 Norway summer camp shootings, and the 2010 Christchurch earthquake.

The US Fire Service has now implemented the TSQ as a key part of their response to major incidents. Kim Lightley, a former fire service volunteer, was involved in a dealing with a major forest fire in 1994 in which 14 of her colleagues were killed. "I didn't know a darn thing about trauma or what it could do to my brain," she says. "I wish I had seen this 'Trauma Screening Questionnaire' in 1994. I wish I knew it was 'normal' to have adverse reactions to trauma. I didn't see this questionnaire until January 2007. Guess what? I sobbed. For the first time, I realized that someone else 'Got-it'."