What New Zealand Mental Health services can learn from the aftermath of the Norway attacks in 2011

Since the terror attacks in Christchurch on 15 March 2019, there has been much activity in trying to ensure that those who are may be affected by these attacks have access to quality comprehensive care to meet their health and wider social needs. This includes mental health care for those affected. But what about the wider population? How might we expect them to be affected? 

One possible indicator of the increased need for mental health care and services comes from a study that took place in Denmark after the terror attacks in Norway in 2011.

Having recently documented increases in the incidence of trauma- and stressor-related disorders in Denmark after the 9/11 attacks, the researchers hypothesised that the Norway attacks—due to their geographic proximity—would be followed by even larger increases in Denmark.

Using population-based data from the Danish Psychiatric Central Research Register (1995–2012), they conducted an intervention analysis of the change in the incidence of trauma- and stressor-related disorders after the Breivik attack. 

What they found was astonishing and has implications for service preparation and delivery in New Zealand.

The incidence rate increased by 16% over the following 1½ years after the Norway attacks, corresponding to 2736 additional cases. In comparison, 9/11 was followed by a 4% increase. Remember, this increase wasn’t in Norway itself, but in a neighbouring and geographically close country with arguably similar language and cultural values. 

The research team also presented evidence of a subsequent surge in incidence stimulated by media coverage. They argue that the media penetration into people’s lives and how invasive it can be is different to even the 9/11 attacks in 2001 and that this can play a role, though there are many other differences between the two events that could also account for the role of the media. However, one of the reasons the research team think that media coverage is important is that they saw a bimodal pattern in psychiatric admissions, with a second spike just over a year after the attacks, that seemed to correspond with the court case and sentencing of the attacker, and attention to the case tracked by the number of times the attacker’s name was mentioned in the media. The effect upon the rate of psychiatric admissions was about as large as if they were terror attacks in their own right.

You can hear my podcast interview with one of the research team that did this study here.

What are the lessons that the research team think we can draw from this?

  1. Psychiatric services can perhaps expect and prepare for an influx of people feeling traumatised and showing symptoms that can be diagnosed as mental health disorders as media coverage of the subsequent court case begins.

  2. Terror attacks such as this trigger a large fear reaction in the wider population, and this can be so large that people can develop mental health disorders that require treatment. 

  3. Rates of psychiatric disorder admission seem to be highly correlated with media coverage. So care needs to be taken to moderate the language and type of coverage in the media, and services can also expect that as media coverage increases then the level of disturbance in the community also increases, possibly resulting in increased need for appropriate mental health services.