After Christchurch: Voices from the front line - how do we effectively meet the needs of deeply affected communities?
The National Remembrance Service last Friday represented a much needed coming together as part of the many communities of New Zealand - to remember those who were killed and as part of a process of healing and ensuring that nothing like this can ever happen again.
Now that we are into hard work of assisting those who have lost loved ones in the attack, we must also tackle some difficult issues. One of these issues is capacity to respond effectively to the needs of the affected communities and families.
A terror attack such as this is can 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, even though they may not have been directly affected themselves. This means that the coverage of services available needs to be wide - both geographically, but also to make sure that all get a chance to put their hand up for assistance, and with an effective triage system that makes sure that there is a needs assessment early on after a request for help, and that the affected person or family can be matched to the right assistance at this point in their recovery.
Outreach work will play a key role here, and it will need to be maintained over time. Often people choose not to ask for help because they think others need it more than them, They can then come forwards later on, but there is a risk that things may have got significantly worse for them in the interim period, meaning more misery for them, and more intensive support needed than otherwise might have been the case.
Research after the attacks in Norway in 2011 have documented the 16% increase in psychiatric case admissions in the neighbouring country of Denmark in the 1.5 years after the attack. And it is critical to realise that a bimodal distribution of cases showed that the court case media coverage triggered a second wave of psychiatric disturbance in the community so serious that this led to an increase in psychiatric admissions, as well as the impact of the attack itself. In this way, once can see that the attack in Christchurch may well play out in a similar manner unless extreme care is taken in how the court case is reported. Even then, the best scenario might be to try to prevent as much harm as possible rather than expecting no public mental health consequences to the machinery of our Justice system and the Royal Commission of Inquiry too.
These terrible attacks seem to have been targeted at very specific communities in New Zealand: our Muslim community, and by implication, our non-white immigrant communities. There may also be others who perceive that they themselves were targeted or could have been targeted in this attack, or who fear further attacks. Or perhaps they have been carrying, and continue to carry a significant burden of intolerance, aggression, marginalisation and discrimination that has been ignored by the wider population in New Zealand.
There may also be dynamics at play as those who request assistance come into contact with a system of care that they may unfamiliar with, and a system of care that may be unfamiliar with the needs of these affected families and communities from a cultural and social point of view. And this is a system of care that has been through a lot in recent years, with the Canterbury Earthquake sequence response and extended recovery, as well as other major incidents such as the Kaikōura earthquake.
In the spirit of attempting to name and design solutions to some of the issues that are starting to rise in trying to heal the wounds of those attacked in Christchurch, a number of people have written to me and shared their stories and ideas with the hope that through giving voice to their ideas in a public space through my blog will help to start conversations about how services are going about delivering the care that is needed, and some of the institutional, cultural and social factors that come into play might be addressed.
1. Support for families of victims of the Friday terror attack (Maan Alkaisi, 21 March 2019)
Having been through the Earthquake and losing my wife in the CTV building and in addition, I have represent the families of the earthquake victims for the past eight years, my immediate response to the Friday terror attack was, what the families of the victims including those injured and in hospital need right now. I can see the huge amount of media and politician interest in this and the reported donations, support and generosity of the kiwis, but wanted to see how much of that has actually reached the people in need most.
I have four people whom I know, three in the hospital and one passed away. I have visited the hospital intensive care unit, talked to the victims, and asked them about their needs and how I can help.
One of them is my PhD student’s husband Rahimi Ahmad, he is badly injured and in ICU unconscious. His wife had to pay for baby-sitting her two kids, an 11 years old boy and a daughter 8 years old while she is staying with her husband in the hospital. The 11 years old son was with his father in the mosque during the shooting. He managed to run away and tried to climb the mosque fence and an unknown person helped him and took him to safety. The son is now traumatise and does not want to talk about what happened. He definitely need immediate counselling services. I recall it took about a year to organise for my daughter regular counselling sessions after the earthquake. I feel those victims’ families do not need to go through this delay process and need immediate action.
The other case is a friend of mine who was visiting Christchurch from Dubai to surprise his twin son/daughter birthday. He arrived Thursday the night before the tragic event. His son was with him in the mosque prying. He run into his father when the shooting started, his father was shot in the back protecting his son. The son got traumatise by the horrible event, by witnessing his father shot, by witnessing many injured, many dead including friends and people whom he knew.
His mother realised that her son will need counselling and asked me that counselling has to be on the agenda for any help to those affected.
I must say that the counselling sessions that were offered to me after the earthquake event back in 2011 and the years after has helped me tremendously in overcoming the difficult times and in recovering from the stress and disturbing experience that we went through
It is with this in mind, I highly recommend providing immediate counselling services to the victims’ families and especially to children and young ones. We have to be mindful that the recovery process will take time and it is important that we have plan and act now to ensure successful outcome.
2. About that, that must be named (Rashi Gadekar, 21 March 2019)
There has been outpouring in the media from so many of us, these last few days. Journalists putting their anguish into words, doctors putting the images that they have seen into words, educationalists writing about the about the courage of children, the first responders putting their experiences into familiar word. Me? I’m no hero.
Each of us seems to start the story from where our thread joined up with the NZ psyche…some of us born here, some of us travelled here, some long ago, some recently. Regardless, we all seem to be feeling the tug on that thread on that Friday and since…our sense of loss of innocence, loss of the city we thought we had, the city that we had invented in our hope and hearts, our loss of a way of life in these peaceful pacific isles. But some of us are even without this meagre luxury – they are grieving and mourning loss of life, kindred and kin, fear and terror in the eyes of family members, the scars their children will carry, loss of limb and capacities, loss of places to gather, loss of immigration status, loss of breadwinner, further marginalisation and ongoing worldwide islamophobia – no sanctuary cities for them.
Let me then start at the other end and say I would like for us more fortunate at this time to respond first and foremost to those directly impacted, the children, men and women.
From talking to some people in the affected communities – this is what would be most helpful right now:
Childcare issues – schools and ECEs may need extra support for those who are affected themselves, or close to those who are. Whole schools may need education about how to best support someone who has experienced a loss.
Isolation problems – taxi chits for people who cannot drive places. Workers willing to do home visits for those not yet comfortable to leave their houses.
Money for extra groceries/hotels for extended families who need to stay and support. Visas to be fast-tracked wherever possible.
Requests for psychological or social supports to be met first, and then the appropriate agencies followed up to ensure funding is provided.
For lead professionals/navigators working with each affected family: these people need to be competent and well-resourced to access the right supports. It may be that existing services are not able to meet the need within current referral pathways and funding pots. Negotiation to support this sits within the governmental response, not for individuals to have to fight.
That trauma focussed therapy is offered as people seek it
I make no pretention to expertise myself. These are the words of a psychotherapist and social worker, trying to do something with my powerlessness. I want to join with others to do what it takes to tautoko those who have lost so much. Please add your knowledge, suggestions, expertise and then let’s do it.
Registered Psychotherapist, Registered Social Worker & Clinical Supervisor
3. We are all so devastated (Sarah Whitcombe-Dobbs, 21 March 2019)
We are all so devastated those of us working with children and families in Christchurch. The fear while driving to pick up my children was familiar, as was the grief expressed by a city in the immediate aftermath. Yet this tragedy is different – there is someone to blame, and it does not affect all of us equally. There are families and a community for whom this tragedy is permanent and its shadow will be long. They are our highest priority right now.
Having a white face and a kiwi accent has meant that I have never walked the streets of Aotearoa in fear of being a target due to the colour of my skin. I have also been aware, and had the luck to be made aware by others, that New Zealand is, to quote one of our pre-eminent sons, racist as fuck. This is fundamental to the founding and the fabric of our society, and wherever the perpetrator has come from is irrelevant: the soil upon which this nation was built has nurtured white supremacist beliefs alongside all the other values that make our country good and great.
Our Muslim kiwi children and teenagers grow up in this context. The actions of the few may not reflect the values of the many, but how are kids supposed to know that? If someone is cruel to them and others say nothing – complicity is assumed.
This backdrop is not irrelevant to the terrorist act because it directly affects people’s ability to recover and connect with others. We have heard already that some of our international students and migrant communities have been too scared to leave their houses and walk the streets. We have also heard that religion-based discrimination has continued towards Muslim children following the shootings. That is our shame.
What to do?
The ongoing support should be based on what the children and families directly affected say that they want and need, not on what agencies had planned to provide. When you have a hammer, everything you see looks like a nail.
Links and relationships need to be built with the right people, by people who are competent to engage appropriately and respectively. Health and education professionals from the community affected will be invaluable, but they will also need extra support themselves and should not be asked to bear the brunt of the load.
Government agencies may need to re-think their approach, and ask the questions “how can we best support you?” and “what do you need?” before making decisions and acting. Then, they need to check-in again with families that they are indeed receiving the supports, and if not – adjust accordingly. Bureaucratic delays and barriers should be the problem of the organisations, not for the families to solve. This requires a high level of flexibility and responsiveness, and is a wonderful opportunity for government agencies to increase their capacity for nimble, inter-sectoral work.
Practical and emotional responses need to be timely and matched to the need. Some kids will want to have an iPad and play Minecraft rather than draw pictures of their trauma (for example) – make sure that’s an option. Children need to play and get back into a routine, adolescents need to see their friends, everyone needs the pressure taken off them. Parents need the chance to talk over any worries about their children with someone who understands child development, trauma and parenting.
As a society, we must avoid behaving like the proverbial abusive partner, who is initially sorry and ashamed, who then over time becomes dismissive and expects gratitude, then eventually reverts to criticism and attack. While the mood is right, let us put in place structures to give some accountability. A formal set of governmental action points in response to the concerns raised by the Islamic Women’s Council would be a good place to start.
And let us be accountable to the families themselves: put in place avenues of communication so they can complain when they are not being helped, and be heard by those with power to make changes. In the end, they will be the judge of whether what we are doing is useful, not us.
Kaimātai hauora hinengaro mō whānau
Child and Family Psychologist
NB; all persons named in these letters gave their permission for their names to be used.