Distressed firefighterFollowing the 10th anniversary of the 7/7 London bombings, consultant clinical psychologist Mary Robertson, who works within the London Traumatic Stress Clinic at Camden and Islington NHS Foundation Trust (C&I), reflects on the way healthcare professionals helped people cope with trauma following the terrible attacks:

When the bombs happened we realised very quickly, ourselves and other specialist services, that there would be a massive group of people who would be affected as a result of the atrocity. There has been a lot of research looking at other terrorist incidents which suggests around 30-40% of people who are directly exposed to an attack of this nature go on to develop Post-traumatic Stress Disorder (PTSD) or other mental health problems.

The attacks saw four suicide bombers strike central London on Thursday 7th July 2005, killing 52 people and injuring more than 770. The bombs hit rush-hour traffic and underground trains near Edgware Road and Liverpool Street stations. The attack also hit a train traveling between King's Cross and Russell Square and a double-decker bus was targeted in Tavistock Square.

Responding to the atrocity was a real challenge because there were no commissioning arrangements to provide for something like this – the longer term needs. The 7 July assistance centres were set up as the immediate support for survivors and victims of the bombings and they provided information and advice and short term counselling. But there was nothing set up for the long term mental health needs of people.

We pulled together a steering group led by the London Development Centre which included Emergency responders, Department of Health officials and a range of multiagency services to address this gap. The result was a public health programme, the first of its kind - a screen and treat - hosted by C&I’s Traumatic Stress Clinic.

There was a large scale screening over a two year period where we contacted more than 900 people who had been involved in the bombings and screened around 600 of these people over a 3, 6, and 9 month period to ensure we picked up people whose responses may have been delayed. Roughly 50% of those screened met criteria for a diagnosable mental health condition as a result of the bombings, the most common diagnosis being PTSD, followed by travel phobia.

Symptoms of PTSD include having flashbacks of what you have witnessed, what you have heard, and not being able to get the memories of what you experienced out of your mind. It can involve constantly reliving it, even if you don’t want to think about it, nightmares, sleeplessness and more. Avoidance is very common afterward. Avoiding anything which might remind you of what happened.

Typically a lot of the people we saw then developed travel phobias, they didn’t want to travel on public transport, they didn’t want to use the bus system and others stopped going to work.

Patients who screened positive for mental health problems were fast-tracked into evidence-based psychological treatment provided by specialist NHS trauma services. Trauma-focused cognitive behavioural therapy involves gradual exposure to the traumatic memories and the thoughts, feelings and situations that remind you of the trauma. Therapy also involves identifying unhelpful thoughts or misrepresentation you have about an experience. This helps you gain control of your fears and negative ways that you think about yourself and replacing them with a more balanced picture. EMDR (Eye Movement Desensitisation and Reprocessing) incorporates elements of cognitive-behavioural therapy with eye movements or other forms of rhythmic, left-right stimulation such as hand taps or sounds. This is thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.

The majority of people who received treatment made a good recovery and demonstrated the effectiveness of this sort of outreach programme in providing rapid treatment of mental health problems after terrorist attacks.

It’s estimated that around 4000 people were affected and therefore there may be many people who haven’t yet even accessed help. We are encouraging anyone who has been affected to speak to their GP and ask for referral to local trauma services for treatment. There may be people who coped well after the incident and only developed symptoms several years later. These delayed reactions are not uncommon.

If you are struggling to cope with the effects of the attacks please seek help. It may be 10 years down the line but you can get better with the right kind of treatment.

For more information please go to C&I’s website: www.candi.nhs.uk