If there is one book that should be required reading for our MLAs, it is David Bolton’s Conflict, Peace and Mental Health: Addressing the Consequences of Conflict and Trauma in Northern Ireland, published this year by Manchester University Press.
The book is a timely reminder that while the Assembly remains suspended and political progress remains stalled, victims and survivors of violence continue to live with the consequences of the past. Bolton eloquently describes their plight (p. 3):
In Ireland, whilst the dead of our civil conflicts are held sacred by one side or another (seldom by all), the suffering survivors run the risk of being abandoned because we cannot politically agree on how they ought to be helped. Whilst the rest of the world moves on, those who are disabled by their experience of hostility, loss, injury or trauma are caught in an unsatisfactory present. Left in a liminal state – a no-man’s land between the past and the emerging future with nowhere to go back to yet feeling unable to go forward – surviving victims of the conflict become, also, victims of the peace.
Bolton is right to use the provocative phrase ‘victims of the peace.’
This is because trauma- related mental health issues often present themselves years after the traumatic event(s), and because trauma can be passed on from one generation to the next. These two facts alone should instil a sense of urgency among those with the power to invest in our mental health services as part of a broader project of ‘dealing with the past.’
Bolton is a retired social worker and senior manager in the health service in Northern Ireland. He was integrally involved in shaping the immediate response to the Enniskillen and Omagh bombs and establishing the Northern Ireland Centre for Trauma and Transformation (NICTT), which addressed the Omagh bomb’s longer-term legacies.
Bolton draws on these experiences to great effect, providing a balanced account of what has worked well in responding to trauma in Northern Ireland, as well as highlighting the need for mental health issues to become a greater priority in the present.
Bolton’s account of the response to the Omagh bomb describes how it drew on earlier experiences of the Troubles as well as contemporary research about the needs of those affected by it. This is a powerful example of good practice. Likewise, the NICTT worked effectively with clients over the course of its life (2002-2012).
Regrettably, it seems when NICTT closed due to lack of funding, there was still a need for its services for some people. Having said that, Bolton’s book does provide reassurance that there are still good services available for those who seek them out.
Bolton also lays out sobering empirical evidence about the mental health impact of the Troubles – a subject about which there is much speculation and misinformation. Over two chapters, he outlines the major research studies in this area.
Between the mid-1960s and 2006, more than 3,700 people died and about 50,000 were injured. A 2010 study by the Northern Ireland Statistics and Research Agency concluded that about 500,000 [out of a population of 1.8 million] have been affected by the Troubles, while a 2008 survey estimated there are 34,000 people in Northern Ireland with Post Traumatic Stress Disorder (PTSD).
In the 2000s, NICTT and Ulster University formed a partnership for research on the impact of the Troubles on the population. The studies found that 39% of adults had experienced one or more distressing events relating to the Troubles. Some 17% of adults had witnessed someone being killed or seriously injured. Fifteen percent of those who had experienced distressing events met the criteria for PTSD at some point in their lives. This is a higher rate of PTSD than other violent regions, such as South Africa, Israel and the Lebanon. [In other countries there were higher rates of other mental disorders, suggesting that ‘different contexts and cultural settings might lead to different patterns of mental health disorders’, p. 160].
Additionally, Bolton presents evidence that the legacy of the Troubles contributes to the relatively high rate of suicide in Northern Ireland (p. 94ff), and explores the inter-generational impact of Troubles-related violence (p. 91ff). Citing a 2012 study by the Commission for Victims and Survivors, he observes that (p. 92)
[The researchers] concluded that adverse experiences of conflict-related violence, consequential mental health problems, and other socio-economic disadvantages and stressors on adults, impact on the parenting of their children. Harsh, neglectful and otherwise poor parenting styles, especially when worsened by economic and social stressors, impact on the developing child … These then place the child at increased risks in a range of disadvantages in childhood, adolescence and later in adulthood – including poorer mental health, which is made worse by poverty and other basic deprivations. …
In the context of societal conflict, this sequence of disadvantage can also be the means through which unresolved narratives of the conflict, laden with fearful, aggressive or sectarian sentiments, are conveyed across generations. This cyclical transmission of adverse experiences and their consequences can, if it reaches a critical mass in a community, contribute to new episodes of organised violence.
If such words cannot motivate us to address the consequences of conflict and trauma, I don’t know what more can be said.
The book is also designed to appeal to an international audience. There is much to be learned and applied from the examples of good practice developed in the aftermath of Omagh and in the research/evidence-based approach of the partnership between NICTT and Ulster University.
In its review of the book, the Irish Times revealed that Manchester University Press had distributed free copies to local mental health professionals and religious and community leaders in Manchester in the aftermath of the Islamic State attack in May.
I am heartened that people in other parts of the world may learn from those who have suffered in Northern Ireland. But I hope that the learning in Northern Ireland itself has not stopped, and that our politicians and policy makers heed Bolton’s message about what remains to be done.