Impact case study database
Developing psychological services and addressing the mental health impact of the Conflict in Northern Ireland
1. Summary of the impact
Ulster University (UU) research has enabled government to address the mental health effects of the Troubles conflict in Northern Ireland (NI). Responding to UU Troubles-related mental health research, a Regional Trauma Network (I1) and a Victims and Survivors Service was established, receiving over GBP100,000,000 in funding and supporting 6,000+ individuals annually (I2). UU transgenerational trauma research led to the commissioning of a EUR6,000,000 EU project targeting emotional wellbeing to promote peacebuilding in deprived areas of NI (I2). O’Neill’s research led to her appointment as the Interim Mental Health Champion for NI, tasked with driving forward mental health service reform (I3).
2. Underpinning research
Researchers from Ulster University’s (UU) Psychology Department, Bunting, Ennis, Ferry, Murphy, and O'Neill, have produced a body of research that has informed and influenced government policy to tackle mental illness arising from NI’s violent sectarian civil conflict, known colloquially as the Troubles. The conflict dominated life in NI in the latter half of the 20th century and resulted in over 3,500 deaths, 34,000 shootings, and 14,000 bombings. Although paramilitary activity continues, the worst of the violence ended with the signing of the Good Friday Agreement in 1998.
In 2008, UU researchers carried out the Northern Ireland Study of Health and Stress (NISHS) as part of the World Mental Health Survey Initiative (WMHSI) ( G1). The UU team worked with the NI Centre for Trauma and Transformation (NICTT), which treated people with trauma-related mental illness. The collaboration investigated the mental health impact of Troubles-related traumatic events. The research found that 39% of NI’s population had conflict-related trauma, and 39% met the criteria for a mental illness. Northern Ireland’s rates of mood, anxiety and substance disorders were among the highest in the world. The rates of PTSD were the highest of all the countries in the initiative, and importantly, the excess PTSD was attributable to Troubles-related traumatic events ( R1, R2).
The NISHS and WMHSI partnership generated four reports and numerous papers describing the impact of trauma, factors associated with Troubles-related PTSD, the cost of PTSD and the profile of the population in terms of adversities, trauma and mental illness. The first additional study was funded by the Big Lottery Fund in 2008 ( G2; C1). The study examined the data on exposure to Troubles-related events and PTSD and included qualitative research on the unique factors associated with the trauma of the Troubles and the ways that they manifest in PTSD. This study established a relationship between Troubles-related event exposure and heightened levels of PTSD in the NI population. In 2011 the same team was funded by the Commission for Victims and Survivors, NI (CVSNI) to further examine the impact of the conflict and the mental health needs of victims and survivors ( G3). This research resulted in the “Troubled Consequences” report, which made recommendations for trauma-focused services due to the levels of PTSD identified in the research. Two further studies were funded to focus on the economic costs of PTSD and the outcomes of the ageing population who had directly experienced the Troubles ( G4, G5). These were published in a series of international, peer-reviewed outputs (incl. R3 - R5).
In 2014 O’Neill received further funding from the CVSNI to examine the transmission of trauma and mental illness between generations, broadly described as intergenerational trauma. In 2015 O’Neill and the team completed a spin-off study from the NISHS, a survey of NI college students (resulting in papers such as R6). These studies indicated that children and young people who had “secondary” exposure to Troubles-related trauma displayed heightened levels of mental health problems. This research was used to develop briefings on the impact of trauma and childhood adversities. The papers and reports recommended that those with psychological problems and mental illness resulting from the conflict should receive programmes of support including evidence-based treatment.
3. References to the research
Outputs can be provided by Ulster University on request.
All research references have been subject to blind peer review by international editorial boards.
( R1) Bunting, B. P., Murphy, S. D., O'Neill, S. M., & Ferry, F. R. (2012). Lifetime prevalence of mental health disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and Stress. Psychological Medicine, 42(8), 1727-39. doi: 10.1017/S0033291711002510.
( R2) Bunting, B. P., Murphy, S. D., O'Neill, S. M., & Ferry, F. R. (2013). Prevalence and predictors of 12-month DSM-IV disorders in the Northern Ireland Study of Health and Stress. Social Psychiatry and Psychiatric Epidemiology, 48(1), 81-93. doi: 10.1007/s00127-012-0518-5.
( R3) Bunting, B. P., Ferry, F. R., Murphy, S. D., O'Neill, S. M., Bolton, D. (2013). Trauma associated with civil conflict and posttraumatic stress disorder: evidence from the Northern Ireland Study of health and Stress. Journal of Traumatic Stress, 26(1), 134-41. doi: 10.1002/jts.21766.
( R4) Ferry, F. R., Bunting, B. P., Murphy, S. D., O'Neill, S. M., Stein, D., & Koenen, K. (2014). Traumatic events and their relative PTSD burden in Northern Ireland: a consideration of the impact of the ‘Troubles’. Social Psychiatry and Psychiatric Epidemiology, 49(3):435-46.
( R5) Ferry, F. R., Brady, S. E., Bunting, B. P., Murphy, S. D., Bolton, D., & O'Neill, S. M. (2015). The economic burden of PTSD in Northern Ireland. Journal of Traumatic Stress, 28(3), 191-197.
( R6) McLafferty, M., Lapsley, C. R., Ennis, E., Armour, C., Murphy, S., Bunting, B. P., & O'Neill, S. M. (2017). Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PloS one, 12(12), e0188785.
Grants
( G1) Individual and family differences in mental health: An epidemiological study.
Funding source: Department of Health and Public Health Agency, Research and Development Division. Total amount of award: GBP896,399. Dates: 2007-2010. Grant holder: Prof Brendan Bunting.
( G2) Troubles-related trauma in Northern Ireland: Extent of the problem, associated factors and effects. Funding source: Northern Ireland Centre for Trauma and Transformation (NICTT) through the Big Lottery Fund. Total amount of award: GBP91,200. Dates: 2006-2009. Grant holders: Prof Brendan Bunting, Dr Sam Murphy, Prof Siobhan O’Neill.
( G3) Mental Health Among Victims of the NI Civil Conflict. Funding source: CVSNI. Total amount of award: GBP14,181. Dates: 2011-2012. Grant holders: Prof Brendan Bunting, Dr Sam Murphy, Dr Finola Ferry, Prof Gerry Leavey, Prof Siobhan O’Neill.
( G4) The economic costs of psychological trauma in Northern Ireland. Funding source: NICTT. Total amount of award: GBP8,712. Date: 2010. Grant holders: Prof Brendan Bunting, Dr Sam Murphy.
( G5) An economic analysis of trauma in Northern Ireland. Funding source: NICTT. Total amount of award: GBP108,754 Dates: 2010-2012. Grant holders: Prof Brendan Bunting, Dr Sam Murphy, Prof Siobhan O’Neill.
4. Details of the impact
Services for Victims of the Troubles
The NISHS ( G1) highlighted high rates of mental illness in NI ( R1, R2) and indicated that exposure to conflict-related trauma increased the risk of mental illness. NI had higher rates of PTSD than all the other countries involved in the World Mental Health Surveys, including other countries with a history of conflict, and this was a cause of concern ( R1, R2). The survey data were presented in the form of reports including the analyses of trauma and mental illness ( R3, R4) presented in a “Troubled Consequences” report, and a report on transgenerational trauma. These reports were disseminated through the NI government and to policy makers, politicians and clinicians. Psychological therapies and support for those with mental illness resulting from the conflict were specific recommendations of the papers based on the NISHS and were highlighted in the UU reports.
( I1). As a direct result of the NISHS ( R1 - R5), the establishment of a Regional Trauma Network to provide treatments for people with trauma-related mental illness was announced. The need for such a service was set out in the 2014 Stormont House Peace Agreement ( C1), which referred to the Commissioner for Victims and Survivors’ recommendation from their Comprehensive Needs Assessment ( C2) which cites UU’s “Troubled Consequences” report (based on R1 - R5). When the Department of Health formally announced that the service was to be established ( C3) it cited the NISHS data as justification for the need for the service ( R1 - R5). In 2016, GBP175,000 funding for the service was announced ( C3) citing NISHS figures to emphasise the importance of the continuation of the service ( R1-R5).
( I2). The NI Victims and Survivors Service (VSS) was established as a result of a 2012 recommendation from the Commissioner for Victims and Survivors, to meet the needs of victims and survivors of the Troubles ( C2). These recommendations, and the service itself, drew on specific findings from the UU NISHS ( R3, R4) citing the “Troubled Consequences” report that was directly based on R3 and R4. In 2013 the VSS began to work with clients, delivering funding and support on behalf of the NI Executive to victims and survivors, including those who have mental illness (described as “psychological injuries”). As evidenced in the testimonial from the CEO of the service ( C4), the service has received over GBP100,000,000 in funding since 2013, and from 2017-2020 directly supported approximately 6,000 people annually. In the year 2019-2020 the service provided support and services directly to approximately 6,500 victims and survivors. Through a network of 50 community partners, approximately 2,700 individuals availed of counselling, approximately 3,000 received complementary therapies and approximately 34,000 talking therapies were delivered. In addition, in 2019-2020 approximately 2,100 individuals received an individual needs consultation with a Health and Wellbeing Caseworker, resulting in a bespoke package of care based on their unique and individual needs. In a survey of service users 94% of respondents stated that they felt they were treated well and 91% felt the support the Service offered was very helpful. Information on approximately 1,500 clients who completed therapy in 2019-2020 showed that 57% found therapy beneficial demonstrating improvements across all four domains (subjective well-being, problems/symptoms, life functioning and risk/harm) assessed using the CORE outcome measure ( C4).
The Minister of Health ( C5) confirms the importance of UU research in shaping NI’s trauma-informed health policies and services:
“Their findings have directly contributed to the development of a range of trauma-informed mental health policy initiatives including the Victims Service, the Regional Trauma Network...”
Reforming NI’s Mental Health Services and establishing interventions for children and young people
( I3). In December 2020 NI’s Department of Health launched a consultation on the draft 10-year mental health strategy for NI ( C6), citing figures from the NISHS as evidence of the need for the strategy (the figures originate from NISHS R1 - R5, and are reproduced in the UU report “Making Parity a Reality” authored by O’Neill and a colleague from Social Sciences), which called for such a 10-year strategy. The strategy document advocates for the need for trauma-informed approaches, reflecting the recommendations in the research papers ( R1 - R5), reports and briefings from the NISHS study.
( I4). O’Neill’s research expertise in mental health sciences led to her appointment as the region’s first Interim Mental Health Champion, announced in June 2020 and commencing the role in August 2020 ( C5). In the press release supporting the announcement the Minister of Health (NI) described O’Neill as “ a pre-eminent expert in her field” and “ at the forefront in developing responsive services for those affected by trauma and mental illness” (C7). The Office of the Champion includes five staff and has an estimated total budget of GBP500,000 per annum. The Minister’s testimonial ( C5) cites R1 - R6 and attests to the importance of this research, and O’Neill’s role as Champion, in directly shaping the Mental Health Strategy:
“Since her appointment in August 2020, Professor O’Neill has drawn upon this research to deliver impactful advice to the Mental Health Strategic Reform Board that directly shaped the 10-year Mental Health Strategy, and implementation of the Mental Health Plan.”
The testimonial from the Minister also ( C5) confirms the importance of the Champion’s role under Covid-19: in advising government on management of the mental health impact of the pandemic and in promoting positive mental health regionally: “raising awareness, championing the need to care for our Mental Health and highlighting the support available through partners”. “In response to the Coronavirus pandemic, Professor O’Neill has been advocating caring for our mental health across social media. The Mental Health Champion has delivered a regional social media, radio and TV advertising campaign to promote positive mental health and wellbeing of people. Siobhan has also been a member of the Silver Cell Covid response Government Advisory Group and has provided guidance in relation to managing the mental health impact of the pandemic”.
( I5). In response to a report led by O’Neill focusing on transgenerational trauma (based on R1 - R5) and the evidence from the Ulster Student Wellbeing study ( R6), the Special Programmes Board of the EU commissioned a programme of regional intervention projects in deprived areas affected by the Troubles, to address resilience and transgenerational trauma and to also promote peace: Building PEACE through Emotional Resilience for Today and the Future. Over EUR6,000,000 has been allocated to these projects ( C8) and by the end of December 2020, 2,300 children and young people had experienced some service provision ( C9).
5. Sources to corroborate the impact
( C1) Stormont House Agreement.
( C2) Comprehensive Needs Assessment, Commission for Victims and Survivors.
( C3) Two press releases from the Department of Health (NI) on the announcement of the Regional Trauma Network; and, BBC news item detailing associated departmental investment.
( C4) Testimonial from the Chief Executive Officer of the NI Victims and Survivors Service and Victims Service Annual Report 2018 - 2019.
( C5) Testimonial from the Minister of Health for Northern Ireland.
( C6) Draft Mental Health Strategy, Department of Health (NI).
( C7) Ministerial announcement of Interim Mental Health Champion for Northern Ireland (DOH (NI) press release).
( C8) SEUPB programme call: Building PEACE through Emotional Resilience for Today and the Future.
( C9) Testimonial from the Chief Executive of Action Mental Health, confirming the numbers of children and young people experiencing service provision.
Additional contextual information
Grant funding
| Grant number | Value of grant |
|---|---|
| n/a | £896,399 |
| n/a | £91,200 |
| n/a | £14,181 |
| n/a | £8,712 |
| n/a | £108,754 |