A Guide For City-Led Response

Chapter 4: Psychosocial Support

While the experiences of those who have survived acts of terror, hate or violent extremism are deeply personal and context-specific, research has uncovered common layers of trauma and stages of grief among survivors and witnesses. These span from physical and medical effects to intrusive, long-term psychological trauma.

In the aftermath of an attack, fear has long-lasting implications on public health, safety and the economy. It is therefore crucial that all individuals impacted can access psychosocial support. 

Local authorities should not necessarily develop or oversee such mechanisms themselves. However, they often have the necessary reach, resources and credibility to co-ordinate the diversity of relevant actors, one of the most important (and challenging) tasks in emergency situations. This chapter outlines the various steps local authorities should undertake to build a co-ordination mechanism to provide tailored and comprehensive psychosocial support to the local population following an attack or other crisis situation.

Situation Analysis 

Local authorities usually have a good understanding of the various actors operating on the ground (e.g., social services, counsellors, mentoring initiatives, extra-curricular clubs, non-formal education). Nonetheless, there may be resources and providers that are particularly grassroots, less well known to officials, or likely to be overlooked when there is an emergency. Local authorities may therefore find it helpful to establish a local psychosocial support working group, open to all service providers and supporting actors. Ideally, the local authority would assemble this group as a prevention effort and mobilise it in an emergency such as a terrorist attack, a natural disaster or a health crisis.

Establishing a Local Psychosocial Support Working Group

1. Assign an employee (or more, depending on needs) from the local authority as focal point(s) for partners and to administer the working group (e.g., maintaining related documents and databases, organising and leading meetings, liaising with partners).

2. Secure a space for the working group’s meetings and determine their recurrence.

3. Start collating the necessary documents, including:

• Terms of reference that set out ‘membership’ criteria, principles to abide by (e.g., ‘do no harm’), roles and responsibilities (including actors outside the working group such as national agencies and the police), meeting guidelines, ways of working, etc.
• A database of service providers and supporting actors including their main target audience or beneficiaries, the areas of support, their geographic reach, their method and the languages spoken (e.g., hotline, in-person counselling, social activities, group support circles).
• A database of beneficiaries not necessarily including names and contact details, but rather various groups that might need psychosocial support (e.g., parents of victims in neighbourhood X); this will feed into a matrix that cross-checks that all groups needing support are covered by a service provider or support actor.
• An evaluation log to continuously review the support available and challenges experienced by service users to improve provision. This review should take place at the regular meeting, where you can gather feedback from the various members of the working groups on demand for services, capacity and resource issues, equal access and so on. For example:
  • Is suitable support available across the city?
  • Are there any individuals who need support but are not currently receiving it?
  • Are services adapting to the cycle of trauma?

Identifying Service Providers and Support Actors 

1. Organise an open meeting for all stakeholders who can provide a frontline service or support people in need of psychosocial support in other ways (e.g., providing meals, keeping them company, contacting relatives, running errands). In larger cities, various meetings should be organised in different neighbourhoods to ensure the local authorities are aware of all potential partners.

2. Reach out directly to partners the local authorities are already aware of.

3. Use community engagement activities to identify other potential partners.

4. Set up a regular town hall for official partners and anyone willing to volunteer their time or expertise.

ResilienceNet – OneWorldStrong.org 

A mobile application that connects individuals, survivors, first responders and refugees to relevant practitioners, services and resources, regardless of geographic location. ResilienceNet offers a range of services, including educational, peer support, violence prevention and secure chat services. The platform is dedicated to providing survivors, first responders and refugees with the help and support they require to move forward with strength and resilience.

Learn more: ResilienceNet Mobile App | OneWorldStrong

Unbroken Cities

Greater Manchester Mayor Andy Burnham and Liverpool City Region Mayor Steve Rotheram (United Kingdom) launched a network of cities and charities to support the recovery of Ukraine after the war. It came as a response to a request for support from Lviv (Ukraine) Mayor Andriy Sadovyi to support his vision for a national rehabilitation programme, Unbroken, to help his country recover from the trauma of war. The two UK mayors have offered to convene mayors from some 20 cities across the UK and US to provide Lviv and Ukrainian organisations with strategic and technical support from cities that have experienced terror attacks and extremist violence, as well as opening up their medical and charitable networks in support of Lviv.

Learn more: Unbroken Cities Network | OneWorldStrong

Initial Identification of Beneficiaries

Identifying beneficiaries should start as soon as possible, and the list of names should be reviewed regularly at the working group meetings. The following groups can serve as a starting point to identify potential beneficiaries:

• Direct victims and survivors. Those physically injured and other individuals present at the scene; a report on victim support following terrorist attacks in the United Kingdom argues that those “who are ordinarily classified as ‘witnesses’ who were in close proximity to the incident or at the scene shortly after should be considered and treated as survivors by all of the agencies involved in assisting victims, and be able to access adequate support services”.
• Next of kin. Families and other individuals close to the direct victims or survivors.
• Emergency services. Law enforcement officers, fire department and ambulance personnel and other first-line responders, who need to be educated about the potential long-term effects they might experience from such events.
• Secondary victims and survivors. Individuals and members of communities who relate to the victims (e.g., the Jewish community following the 2018 Tree of Life Synagogue attack).
• Government employees. Staff within the local authority who may be in any of the categories above, especially those most closely involved in crisis management and response. 
• Other considerations: 
  • Cross-border survivors. For example, individuals who were visiting your city at the time of the attack. The International Network Supporting Victims of Terrorism and Mass Violence provides comprehensive guidelines to address their specific needs. 
  • Diasporas. Nationals living abroad or individuals living in your city whose hometown has been hit by a terrorist attack. These people will require information and potentially psychosocial support and will have specific needs such as translation.
  • Multilingual. The working group should ensure it has professionals speaking different languages, to translate or interpret information and provide remote support.

Support service providers should not be restrictive in who can have access, as attacks or crises can have a mental health impact on individuals not directly affected by the violence. Following the 9/11 attacks (United States), people as far as Denmark reported symptoms of post-traumatic stress disorder related to the terrorist attack in New York, with similar findings following the 2011 attacks in Norway. 

In the early stages local authorities may need to prioritise, so those in greatest need can access immediate care. However, in the longer-term, cities should aim to serve a wider constituency, emphasising community outreach and engagement in order to identify additional people in need of psychosocial support.

Response

Needs and Risks Assessments

Psychosocial support should be tailored to the needs and risks of each individual as much as possible. The Local Working Group should collaborate to identify needs and conduct risk assessments, determining which care pathway is most appropriate in each case and who will take ‘ownership’ for that individual. The local authority can provide a joint framework to conduct and compile these assessments, as well as ensure regular updates from providers (in line with privacy restrictions and doctor–patient confidentiality). 

There are at least five dimensions related to well-being that should be included:

• Psychological or social. Such needs can range from those requiring medical follow-up for syndromes such as post-traumatic stress disorder or depression to less severe issues linked to emotional well-being, where beneficiaries might need an external actor (e.g., a community support group) to help them cope.
• Information and advice. The aftermath of an attack or incident may be very disorienting and overwhelming. Individuals might simply need advice on legal issues, how to deal with their employer or professional commitments, or how best to manage attention from media and journalists, and public visibility.
• Physical health. While this category could encompass mental health, we refer in particular to visible injuries, especially long-term ones, and the associated effect on self-perception or identity. Such injuries can be a persistent reminder of trauma, require significant changes to a person’s lifestyle and capabilities, or make them identifiable in public.
• Practical and safety. Practical problems, ranging from damage to property to difficulty in accessing a phone or accommodation, “often act as reminders of what people have been through and make it harder to get their life back together”. It is crucial to consider the digital aspects of addressing practical and safety concerns, and the potential for victims to become targets of hateful abuse, accusations, and misinformation and disinformation online (as, for example, took place for parents of children killed in the Sandy Hook shooting in Newtown (Connecticut, United States). Basic e-safety measures, such as limiting public access to social media accounts, should be introduced, and broad privacy guidance and advice given on reporting harmful content.
• Financial. There are various potential financial dimensions related to wellbeing after an attack, for example, direct victims and next of kin may suffer from financial difficulties due to funeral costs and lost wages, as well as damage to personal property.

Ensuring a Comprehensive Support Package

The OCHA Inter-Agency Standing Community’s intervention pyramid for mental health and psychosocial support in emergencies illustrates that a “key to organising mental health and psychosocial support is to develop a layered system of complementary supports that meets the needs of different groups”. Through continuous collaboration and regular meetings, the Local Working Group can identify what aspects of support are being addressed and by whom, and what gaps remain.

Survey

• Identify which working group actors are covering which needs, as per the risk assessment. This should be added to the database.
• Determine what other support mechanisms exist and which needs they are covering (e.g., national level compensation schemes).

Identify Gaps

• Using the survey, determine whether all needs from the assessments are being addressed through current service providers and support actors. If you identify specific gaps, explore whether you can organise training for community providers or grassroots groups to fill them.
• Revise your assessment continuously, using the regular meetings to evaluate the response and identify new trends or challenges.

Long-Term Support

The Local Working Group should consider ways to commemorate or remember the events as a community. Public outreach is central here, as memorial mechanisms should be guided by the victims and wider community:

1. At the individual level, “crisis counselling related to birthdays of victims, holidays, important family anniversaries, and [at least] the first anniversary of the event” will be important.
2. At a collective level, symbols “have the ability to strengthen identity and generate solidarity to encourage proper conduct, order and confidence. Symbols may be cultural emblems such as flags, logos, places or buildings, or events and performances such as rituals of mourning, candlelit demonstrations, wreath-laying ceremonies, memorial processions, etc.”.

Communicating Services & Supporting Vulnerable Groups

The Local Working Group should take a proactive approach to ensure the whole population is aware of available support, including more hard-to-reach communities. While each service provider will publicise their specific offer, the local authority can ensure it has a centralised platform to facilitate coordination among service providers. Communications should be clear and disseminated widely, to “help address any confusion over where people should go to if they need assistance” and there should be common information across all partners’ platforms including websites, social media and direct engagement.