After Christchurch: Focus on 'problems of living' as well as psychological issues

After the Christchurch terror attacks, there has rightly been a focus on trying to address the psychological issues of trauma as a result of having been affected directly by the shootings. This has had a dual focus on both the directly affected family members and friends of those killed in the attacks, and the wider impacts on those who witnessed the weaponised social media broadcast and subsequent videos of the attack that have been circulating, as well as the wider community who may be fearful and anxious about what this attack and its consequences means for them, their families and their communities.

However, one of the issues that has come into clearer focus as a result of research conducted over the past decade is that the psychological impacts on families and communities may not be limited to the incident itself. Instead, there may be cumulative effects of secondary impacts, that are themselves causes of stress, that may add up to become significant contributors to psychological disorders and distress themselves.

The psychological impact of secondary stressors (eg, issues with uncertainty, anger associated with injustice, and loss of health, friends, family, whānau, property, employment) can be serious.

I led the team that developed the Ministry of Health’s (2016) Framework for Psychosocial Support in Emergencies. On page 21, we offer this definition:

“Secondary stressors are circumstances, events or policies that are indirectly related to, or are a consequence of, an emergency event, which result in emotional strain among affected individuals and make it more difficult for them to return to what is perceived as normality. Examples of secondary stressors include ongoing financial strain, conflict in families and couple relationships, job insecurity and/or loss, difficulties in insurance claim settlement, repeated relocations, and having to give up pets when moving to other accommodation.

“For some people, the secondary stressors that follow from the disruption and dislocation an emergency creates may have a greater impact than the primary event. These ongoing, unresolved factors may result in emotional distress and hinder people as they try to reconstruct their lives, livelihoods, families, social attachments and communities. Research indicates that the role of secondary stressors in developing and maintaining significant distress may have been underestimated and may significantly delay and complicate people’s adaptation after an emergency. It is critical to understand secondary stressors as a significant risk factor and to take steps to learn about their nature in each emergency so that they can be reduced effectively.”

What can we do?

As well as taking the time to understand the psychological impacts of these attacks on those most closely affected by it, we need to also look through the lens of “problems of living”.

One way to organise our approach might be to ask this question:

What is it that has become more difficult in these people’s lives, and how can we assist to make sure that the cumulative impacts do not then become significant additional stressors and burdens that then go on to increase the psychological burden that people are already carrying?

This may include issues such as, but not limited to; sustainable income support, help with driving and transport (for example, the the family member that has been killed held the only driving license for that family), accommodation support, help and assistance with insurance claims and other paperwork and administrative tasks, issues of racism and discrimination, difficulties with communicating and other relationships with the wider family and community networks, both within New Zealand, and in other countries.

It’s only by looking through the lens of problems of living that we can perhaps get some insight into the world the the families and communities may be struggling to navigate through at the moment, most possibly in a traumatised state with the associated problems of lack of concentration and focus that may come along with this too.

If we urge people to come forwards only on the basis of appearance of psychological disorder or distress, we may end up assisting much later on than we may have done if we focused on trying to relieve the burden of the secondary impacts of this terrible event.