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Evaluation of mental health outcomes following major incidents

What are we trying to do?
In Manchester, on 22 May 2017, a suicide bomber killed 22 people and himself, physically injuring 239 children and adults. The resilience hub, or ‘hub’ was established to facilitate a screen-and-treat assertive outreach model with public health and clinical components. This was supported by clinical care pathways that were developed for children and young people and adults (public and professionals). The overall aim of this project is to maximise learning from the mental health response to the Manchester Arena attack in 2017.


Why is it important?
The chance of developing posttraumatic stress disorder (PTSD) within one year of a major incident is 33-39% for those physically present, 17-29% for those close to the killed and injured, 5-6% of emergency and 4% of recovery workers. Children are particularly vulnerable. The economic burden of mental health care is substantial and evidence of considerable unmet need. A small number of studies have assessed the medium- to long-term trajectories of people’s mental health following a major incident, but few studies have assessed needs beyond 12 months or evaluated factors that influence long term recovery. 


This project has direct benefits for Greater Manchester as well as sharing learning nationally and internationally. The current COVID pandemic has also highlighted interest in research and learning related to major incidents and pandemics. 


How are we doing it?
To date over 3670 people have engaged with the hub, which facilitates interventions on the basis of need and in line with NICE recommendations. The screening measures are completed when a person registers with the hub, emails are then sent at multiple timepoints (3, 6, 9, 12, 24, 30 and 36 months) inviting people to repeat the measures. 


The mental health response to the Manchester Arena attack is to be assessed by:


1. Enhancing our understanding of the development and expression of distress among participants following the attack through longitudinal follow-up:


  • Identify individuals by both mental health trajectory (resilient, slower recovery, deteriorating/prolonged stress, high stress) and client group (children and young people (under 18 years), adult (over 18 years) or professional (affected in professional capacity rather than as a member of the public).
  • Collect demographic and clinical information from clinical notes, including response to screening questionnaires at multiple time points up to 36 months post event to evaluate longitudinal trajectories of participants’ responses to the arena event.


2. Identifying what psychosocial, contextual factors and post-event experiences of social support have helped or hindered participants’ recovery, including how informal social support processes in participants’ groups and networks may have served to mitigate some of their distress:


  • Undertake an online survey (36 months and 48 months) of all those in contact with the hub asking them for factors that they perceived helped or hindered their recovery including the quality of care and service user experience of the hub and other key support.
  • Undertake semi-structured qualitative interviews to assess the acceptability of the hub and services provided and how multiple group memberships become salient and shape our expectations of support. 


Who are we working with



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Programme Manager
Gill Rizzello

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