The psychosocial response to a terrorist attack at Manchester Arena, 2017: a process evaluation

Abstract

Background A 2017 terrorist attack in Manchester, UK, affected large numbers of adults and young people. During the response phase (first seven weeks), a multi-sector collaborative co-ordinated a decentralised response. In the subsequent recovery phase they implemented a centralised assertive outreach programme, ‘The Resilience Hub’, to screen and refer those affected. We present a process evaluation conducted after 1 year. Methods Case study, involving a logic modelling approach, aggregate routine data, and semi-structured interviews topic guides based on the Inter-Agency Collaboration Framework and May’s Normalisation Process Theory. Leaders from health, education and voluntary sectors (n = 21) and frontline Resilience Hub workers (n = 6) were sampled for maximum variation or theoretically, then consented and interviewed. Framework analysis of transcripts was undertaken by two researchers. Results Devolved government, a collaborative culture, and existing clinical networks meant that, in the response phase, a collaboration was quickly established between health and education. All but one leader evaluated the response positively, although they were not involved in pre-disaster statutory planning. However, despite overwhelming positive feedback there were clear difficulties. (1) Some voluntary sector colleagues felt that it took some time for them to be involved. (2) Other VCSE organisations were accused of inappropriate, harmful use of early intervention. (3) The health sector were accused of overlooking those below the threshold for clinical treatment. (4) There was a perception that there were barriers to information sharing across organisations, which was particularly evident in relation to attempts to outreach to first responders and other professionals who may have been affected by the incident. (5) Hub workers encountered barriers to referring people who live outside of Greater Manchester. After 1 year of the recovery phase, 877 children and young people and 2375 adults had completed screening via the Resilience Hub, 79% of whom lived outside Greater Manchester. Conclusions The psychosocial response to terrorist attacks and other contingencies should be planned and practiced before the event, including reviews of communications, protocols, data sharing procedures and workforce capacity. Further research is needed to understand how the health and voluntary sectors can best collaborate in the wake of future incidents.

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium

“…This study covered three high income countries with a relatively high degree of publicly funded healthcare. Even if these countries may be better equipped to provide health services to their citizens than low income countries, the delivery of psychosocial care after terrorist attacks and similar mass casualty incidents remains complex and challenging [ 96 , 97 ].…”

Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs (‘Resilience Hubs’) using normalisation process theory

“…During the pandemic, National Health Service (NHS) England, the executive body which oversees commissioning, funded 40 well-being Hubs to support staff, with a focus on outreach and timely access to interventions 10 11. Hubs were modelled on the Greater Manchester Resilience Hub, set up originally following the Manchester Arena bombing (2017) 12 13. This Resilience Hub used evidence-based ‘screen and treat’ approaches that were used after the London 2005 terrorist attacks 14.…”

A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions

“…A logic model, to show how the Hubs may effect change, was developed. The staff wellbeing hub model was based on that of the Greater Manchester Resilience Hub, therefore the starting point for the logic model from this paper was based on prior work at this Hubs [13]. The model developed rapidly during the course of this study, and amendments to the logic model were led by the team's health economists (GS and AR) in alignment with the shape of economic work developed within the health economic component of the wider mixed-methods study.…”

“…'Screen and refer' models aim to quickly identify need, and provide access to evidence-based interventions, to mitigate symptoms and the risk of longer-term difficulties following disasters [12]. One such model, the Greater Manchester Resilience Hub, found those who completed screening immediately after the 2017 Arena bombing had better outcomes that those who screened nine months after the incident [13,14]. In October 2020, NHS England and Improvement (NHSE&I) funded 40 resilience hubs based on this service model to support staff during the pandemic [15].…”