Help and support during and after a major traumatic incident

The London Major Trauma Psychology Network provides mental health support for patients with major trauma injuries, their families, local communities and staff who care for them. The Network has embedded psychology teams at each of London’s four major trauma centres: King's College Hospital, Royal London Hospital, St George's Hospital, and St Mary’s Hospital. This is helping to ensure NHS staff can identify major trauma patients who have psychological support needs early - and provide ongoing specialist support both inside and outside hospital, alongside existing community services.

Our Network also provides for vital support to be stepped up in the event of a major incident, such as a natural disaster, significant accident or terrorist attack – and will support patients, their families and staff in major trauma teams, as well as start the coordination of psychological support for the wider community and professional responders.

Read more about this work on our website, on the BBC and the Standard.

The Network is funded by NHS England’s London Violence Reduction Programme.

Key contacts

• Dr Idit Albert, Consultant Clinical Psychologist and Clinical Lead for the Pan London Major Trauma Psychology Network, London Violence Reduction Programme, NHS England and West London Trust
• Dr Ruth Dennis, Head of Psychology for the Psychological Medicine Service Line, West London NHS Trust
• Claire Ruiz, Senior Programme Manager, London Violence Reduction Programme, NHS England
• Cherry Langford, Network Administrator

People react differently to traumatic events, and their personal and past experiences can contribute to how they react. These are some common reactions that you may notice in yourself and in those around you. 

• Feeling more alert and tense
• Feeling anxious, stressed or overwhelmed
• Feeling confused, numb or disoriented
• Struggling to relax and/or having difficulty concentrating
• Experiencing physical sensations – these could be palpitations, trembling, abdominal, sweating and others
• Feelings of fear, confusion, anger and irritability
• Constantly thinking about what happened
• Flashbacks or recurrent memories
• Mood swings
• Feelings of guilt and sometimes shame
• Struggling to sleep, having disturbed sleep and frequent waking
• Feelings of helplessness and hopelessness
• Worrying and feeling like you cannot stop worrying

These responses are a normal part of recovery and are part of the mind’s working of trying to make sense and come to terms with what has happened. They commonly subside over time. 

During and after a major traumatic event, once you've made sure you and your loved ones are as safe as possible from physical danger, you should then take steps to look after your mental wellbeing.

As well as the points below, it is important to note that everyday aspects of our lives such as nature, faith, art, sports and community, as tools for coping with trauma.

• An effective way to cope with an event like this is to be with people you feel close to and normally spend time with.
• It can help to talk to someone you feel comfortable with (friends, family, co-workers) about how you are feeling.
• Talk at your own pace and as much as you feel is useful.
• Whilst you may need to be updated on information that can help you ensure yours and your family safety, consider limiting time spent online/following the news as it can make you feel worst.
• Even during times of unrest it is helpful to try and to do something that feels soothing and that you enjoy.
• It can be helpful to notice things in our surrounding for example acts of human kindness, colours and nature or things that are stored in our heads such as fond images, tunes that we like, comforting prayers, sayings or ideas, all of these could be soothing and help regulate our feelings.   
• Try to be kind to yourself.
• Taking care of your physical health will impact positively on your emotional wellbeing. Do appropriate exercise when you can, even a short walk can help to alleviate physical symptoms.
• If you can try and eat healthy, and regular balanced meals 
• Try to return to everyday routines and habits. They can be comforting, when things feel overwhelming. Look after yourself: eat well, exercise, rest and relax.
• Your body and mind will need rest. Try where possible to make time for routine sleep 
• Remember you are experiencing normal reactions. They might be temporary notice how they change.
• It can be tempting to use alcohol or drugs to manage feelings of agitations, pain and sleep difficulties. These will interfere with your brain’s natural processing of what has happened and will slow your adjustment.  
• Reach out and talk to someone 
• If you can try to help others and be involved as much as possible by checking how they are, showing kindness to others also help us
• Spend time with others, you are likely to find it comforting even if you choose not to talk about your feelings.
• Give yourself permission to feel unsettled and low for a period of time
• If possible try to delay making  big life changes or choices
• Help others and be involved as much as possible by checking how they are.

Self-soothing in 8 Steps

1. First, check that you are in a safe place
2. Now stop and allow yourself to take a break to help sooth yourself
3. Start by clenching your hand into a tight fist, hold it… and then let go. Repeat several times
4. Look around you, what can you see.  Can you count 5 round shapes? Name them in your mind.
5. Breathe out with a long slow exhalation until your lungs are empty. Breathe in through the nose. Repeat slowly several times.
6. Smile at those next to you, even if this is a forced smile, or take a smiling selfie and send it to someone else.
7. Remember that any reaction is normal to this abnormal situation.
8. If you feel a bit calmer, look for someone who might need help.

4 Principles to Help Ease Stress

1. Relaxation

During an emergency, our emotional stress levels are high, we can reduce them by trying to relax in the following ways:

• Maintaining a routine and normal daily activities when possible, even when things are not normal.
• Reduce exposure to overwhelming news by taking breaks between checking on news and reducing exposure to upsetting images.
• Engaging in physical activity to release tension and improve our mood.

2. Understanding that our reactions are normal 

There can be many reactions to the situation: fear, frustration, crying, anger, headaches, fatigue, insomnia, difficulty concentrating, and feelings of guilt, shame or having negative thoughts. These are normal reactions!

3. Social connection

• It is important to stay connected, even if it is long-distance.
• Make sure to be with your loved ones.
• Talk, hug and connect with your community.

4. Hope

Hope is a powerful way to combat distress.  Here are some ways to help strengthen our sense of hope.

1. Looking ahead
2. Connecting to personal and external strengths and resources
3. Supporting others even with small acts of kindness
4. Taking actions that can help ease our current distress

How to calm children during times of stress

First, try to help your child calm physically

1. Breathe – Hold your breath in, and then exhale very slowly through your lips.

• Pay attention to how the air makes its way into the lungs and out; is it warm? Cold?
• Imagine the shape, colour, and movement of the air.
• Introduce change to the rhythm - we release the air that comes out with a very slow exhalation through the lips. You can make the sound "shhhhhhh".
• Add a counting to the breathing - inhale 1,2,3,4; Stop 1,2; Long and slow exhalation 1,2,3…6.
• Repeat this exercise several times.

1. Jump in one place – shake your body, dance to music
2. Cuddle your child

Then try to help sooth their thoughts.

1. You can do it by talking about what is happening – explain in simple terms what is happening and end with a hopeful message, for example, we are together.

Normal responses to an abnormal situation

1. Explain that fear, crying, worries, and any other reactions are natural to children and adults.
2. We can manage these response by trying to calm ourselves (previous section)

Connect with others

1. Connect by meeting others even if this is on the telephone or online
2. Do an activity together – play a game, cook a meal, sport

Hope

1. Provide children a sense of control over the situation
2. Give them responsibilities and chores at home.
3. Encourage them to be active and to help others be active as well.
4. Remind the children that this is a temporary situation.
5. Encouraged them to think about the future return to routine - what fun things would we like to do?
6. Increase playing, smiling, and using humour at every opportunity.

Implementing a Sense of Calmness into your Daily Routine

Creating and maintaining an emergency daily routine - decide on set hours for: waking up and going to sleep, social gatherings, sports, playing, family activities, and relaxation.

Parents

Don't forget to take care of yourself – looking after your diet, sleep, and getting emotional support - so that you can provide your children the sense of security and peace of mind they need.

How to calm adolescents during times of stress

Stress accumulates in the body. In order to calm the body, encourage adolescents to:

1. Exercise - explain that physical activity helps in releasing hormones, which help to regulate stress. When going outside is not an option, suggest using YouTube videos etc. in doors.
2. Dancing to music - suggest they invite friends or join in
3. Try breathing together slowly.
4. Regulate your breathing by:

• Paying attention to how the air makes its way into the lungs and out; Is it warm? Cold?
• Imagine the shape, colour, and movement of the air.
• Introduce change to the rhythm - we release the air that comes out with a very slow exhalation through the lips. You can make the sound "shhhhhhh".
• Add a counting to the breathing - inhale 1,2,3,4; Stop 1,2; Long and slow exhalation 1,2,3…6.
• Repeat this exercise several times.

To calm disturbing thoughts during times of stress:

1. Encourage conversations - mediate events with reliable information. Listen to dilemmas, without panic or judgement, and without rushing to give advice.
2. Help them pay attention to generalizations & extreme thinking or closed mindedness – help to broaden their perspective and explore other options.
3. Be aware of information that reaches them - explain and mediate information that comes from groups and social networks. Harsh images can trigger fears and bad feelings, so reduce and even avoid exposure.

Normalising

1. It is important for adolescents to know that their feelings and reactions are acceptable to others.
2. Explain that the current situation can stress anyone out.
3. There is no need to worry about reactions such as fear, trembling, and depression or hide these feelings. We can help ourselves regulate them (see the previous section)

Connect

1. Encourage seeing friends even if this is online.
2. Offer to help others. 
3. Encourage family involvement - help with chores, look after younger siblings

Hope

1. Provide a sense of control over the situation - trust them & their abilities involve them in decision-making, give them significant responsibilities at home.
2. Remind them that this is a temporary situation - think together about the future and return to routine.
3. Increase playing, smiling, & using humour at every opportunity – be patient to cynicism and dark humour, as long as it is not offensive.

Maintain a daily routine as much as possible or create an emergency routine.

1. Keep clear boundaries - agree about the appropriate boundaries in the current situation. When restrictions are required, explain the dangers and ensure that they know that these are temporary requests.
2. Agree on fixed times for sleeping and waking up, taking into consideration the difficult nights.
3. Set time for sports, games, relaxation, and meals - make sure to have a balanced diet.
4. Encourage adolescents to take part in family gatherings at least once a day.

Parents

Adolescents challenge us on a daily basis. During a stressful situation, the challenge is even greater and patience and sensitivity are required. Don't forget to take care of yourself - nutrition, sleep, and emotional support.

Call 999 if you are in immediate danger 

Contact your GP or call NHS 111

Samaritans
Call 116 123 Any time, day or night
Email them on jo@samaritans.org 

Mind (Open 9am to 6pm, Monday to Friday)
Call 0300 123 3393
Email: info@mind.org.uk 

If you prefer to text instead of call and you’re experiencing a personal crisis, are unable to cope and need support, text Shout to 85258 or text YM if you're under 19 (available 24/7)

Kooth (online counselling for children and young people Visit the Kooth website.

Saneline

0300 304 7000
4.30pm – 10.30pm daily
Saneline is an out-of-hours telephone helpline offering practical information, crisis care and emotional support to anybody affected by mental health problems.

Rethink

Rethink is the largest severe mental illness charity in the UK and their information and advice service can be contacted on 0845 456 0455. The advice team are available to provide specialist advice on a wide range of mental health issues. They can be contacted from 10am – 2pm Monday to Friday.

FRANK helpline

0800 77 6600
Available 24 hours a day
The FRANK campaign helpline provides information and advice about drugs and information on local services. The service can take calls in over 120 languages via a three-way call with a translator.

Veterans

• Combat Stress: Call their free 24/7 helpline: 0800 138 1619 or visit their website.
• Veterans’ Gateway: Call them Monday to Sunday between 8am to 8pm: 08‍08 80‍2 12‍12

Recognising stress in others

Typical, normal signs of stress Up to 72 hours after a major incident

1. Crying and being visibly upset
2. Moving into action - searching for first responders, calling for help
3. Connecting & sharing the tragic news with loved ones

Possible signs of Acute Stress Response

1. Hyperventilation, rapid heart rate, or nausea
2. Extreme trembling, disorientation, dizziness, feeling faint or fainting
3. Intense crying that makes it difficult to understand or silence and appearing "frozen"

Red flags to out for – 72 + hours after the incidents

1. Unable to sleep well, disturbances from nightmares and flashbacks of incident.
2. Afraid to go back to site of incident; feels unsafe in safe places
3. Unable to return to normal routine and daily living; avoids all reminders of the event

If someone, you know presents with one or more of these signs 72 hours or more after the incident it is recommended to seek help from your GP or a mental health professional.

The following things can help to support someone who has been through a traumatic event:

• Be there - Offer to spend time with them, either in person, over the phone or messages.  If they don’t want to talk, it can still help to let them know that you will be there if they change their mind.
• Listen – Try not to pressure them into sharing if they don’t want to. If they do want to talk, try to listen and not interrupt or share your own experiences.
• Ask general questions – If you do ask questions, try to make them general and non-judgemental. For example, you might want to ask ‘have you spoken to anyone else about this?’ or ‘can I help you to find some extra support?’
• Offer practical help – such as making phone calls for them, or feeding their pets whilst they’re in hospital. 

You should try to avoid:

• Telling them you know how they feel – Even if you have experienced something similar, people experience situations very differently. It can be unhelpful to make comparisons.
• Telling them they are lucky to be alive – People who have experienced traumatic events may not feel that way and in some cases may even feel guilt over their surviving.
• Minimising their experience – Avoid suggesting it could have been worse, even if you are trying to make them feel better. This can make people feel as though their experiences aren’t justified.
• Making suggestions – Avoid making suggestions, even if you have found that these have worked for you in the past. People are very different and often they may have already tried what you are suggesting.

Each child will react differently, but these are some common reactions you may notice in children:

• They may appear to be reverting to younger behaviour like bed wetting or thumb sucking
• Feeling very sad or withdrawn
• Having nightmares and disturbed sleep
• Fearfulness
• Feeling angry or easily upset
• Becoming more clingy with parents and carers
• Physical complaints like headaches or tummy upsets
• Trouble in school
• Disruptive behaviour
• Having lots of worrying thoughts and feeling like they cannot stop thinking about worries
• Difficulty concentrating
• Drug, tobacco and alcohol use in older children

Many of these symptoms will lessen over time. Please contact your GP or health professional if they continue after xxxx or you become concerned.

Supporting children and young people

• Let them know that you understand their feelings
• Give them the opportunity to talk, if and when they want to
• Respect their pace. Help them understand what happened by explaining the main details  truthfully, if they ask
• Reassure them that they are safe
• Keep to usual routines
• Keep them from seeing too many frightening pictures

Losing someone important to you is one of the hardest things to experience in life. If you’re young, bereavement can be even more difficult. But support and advice are available to help you get through it.

Emotions after bereavement

Grieving is a natural part of recovering from a bereavement, and everyone’s experience of grief is different. There are no rules about what we should feel and for how long.

But many people find they feel a mixture of the following

• sadness
• shock, particularly if the death was unexpected
• relief, if the death followed a long period of illness
• guilt and regret
• anger
• anxiety
• despair and helplessness
• depression

These feelings may be very intense, particularly in the early days and weeks. Time eventually helps these intense emotions subside, and there’s no need to feel guilty about starting to feel better. It doesn’t mean we’re not respecting the person’s memory or forgetting about them.

There are several things that can help people to start to feel better. Looking after your health and talking to someone will help you get through this difficult time.

Finding support for bereavement

Talking about grief is an important part of getting through a bereavement. Choosing who to talk to about our feelings is a very personal decision. Sometimes the most unlikely person can actually offer the most support.

If you’ve lost a family member, someone else in your family may also be good to open up to because they’re likely to understand how you’re feeling.

A close friend can be a good listener and a source of comfort and support, even if they haven’t gone through this themselves.

Other advice and available support include:

Websites and blogs 
Hope Again youth bereavement website
Child Bereavement website

Helplines
Cruse Bereavement young people’s helpline: 0844 477 9400.

Your GP: Especially if you’re concerned you’re not coping, might be depressed, have trouble eating or sleeping, are thinking about hurting yourself, or you’re not starting to feel better after a few months: they may suggest you have counselling.

Winston’s Wish charity: a national charity supporting children and their families after the death of a parent or sibling.
Phone: 08088 020 021
Email: ask@winstonswish.org 

Experiencing trauma can often impact our sleep. If you experience sleep problems, here are some ideas you can try.

Remember that different things work at different times. So only try what you feel comfortable with, and don't put too much pressure on yourself. 

Try to establish a routine

It could help to establish a regular sleeping routine and good sleeping habits. You might need to try different things to find what works for you. 

You could try going to bed and waking up at around the same time every day. Or it might help to go to bed only once you feel ready to sleep, but still get up around the same time.

It may also help to do something relaxing just before you go to bed. For example, you could listen to relaxing music. 

You might hear some people use the term 'sleep hygiene'. This may include some doctors. This term means having a good routine around your sleep.

Don't force yourself to sleep

If you're struggling to get to sleep, try not to force yourself.  Instead, try doing something relaxing in bed. Or get up and do something calming, until you feel tired. 

Find ways to relax

If you experience lots of stress, this could affect how well you sleep. Finding ways to relax could help with this. Mind has some helpful information on relaxation that includes lots of tips and exercises you could try, such as, breathing exercises and meditation. 

I don’t know why it’s difficult for me to sleep

You may find it difficult to work out what's affecting your sleep. In this case you might find keeping a sleep diary helpful to understand your sleep problem and what's affecting it. This involves recording information about your sleep habits.

If you want to, you can show your sleep diary to healthcare professionals. It could help explain what problems you're having. For example, you could take it with you to a doctor's appointment.

A sleep diary could include information about:

• What time you went to bed and what time you got up
• How long you slept for
• How well you slept, which you could rank on a scale or use pictures or words to describe
• How many times you woke up in the night, how long you were awake and what you did while you were awake
• Whether you had nightmares, night terrors or sleep paralysis, or sleepwalked during the night
• Whether you slept during the day and for how long
• Any medication you're taking, including the dose and what time you take it
• The amount of caffeine, alcohol or nicotine you have, and at what time of day
• The amount of physical activity you do, and at what time of day
• Your general feelings and moods, including any anxious or repetitive thoughts

You should keep your sleep diary for at least two weeks. It's ok if you don't know the answers to everything. You can make a guess, or leave sections blank. 

The Sleep Charity has a sleep diary template that you could try. 

Make your sleeping area more comfortable

You might not have much control over where you sleep. For example, if you're staying in hospital or temporary accommodation. But there might still be small changes you can make, or ask someone to help you with. 

These are some ideas you could try:

• Try different temperature, light and noise levels to see what works for you. For example, you could try keeping a light on or using earplugs. 
• If silence makes it harder to sleep, listen to music, nature sounds, a podcast or the radio.
• You might find it helpful to try different bedding. For example, a warmer or cooler duvet, or a different pillow.

Think about screens and device settings

Using screens in the evening, including on tablets and mobile phones, can negatively affect your sleep.

It can help to think about when and how you use screens. For example, you could try to:

• Avoid or cut down on using screens shortly before sleep
• Reduce the brightness of any screen you use
• Avoid stimulating activities before going to sleep, such as playing games on a screen
• Reduce distractions by switching on silent, airplane or do not disturb mode, if you can

Look after yourself

Looking after your physical health can help improve your sleep. These are some tips that might help.

Think about your diet. Some types of foods can affect your sleep, including caffeine and sugar. It can also help to avoid eating large meals right before going to bed.

Try to do some physical activity.  Physical activity can help you sleep, including gentle physical activity. But try not to do this too close to when you want to sleep. Some people find this makes them feel more awake. 

If you feel scared to go to sleep and or are having nightmare, psychological therapy such as cognitive behaviour therapy can be helpful.

Pain is your body’s warning alarm system letting you know that something might be wrong, and that you should pay attention in case you need to do something to keep yourself safe or prevent some damage to your body. This is really useful if we break an arm or step on Lego! In those cases, we need to take action to take care of the problem.

But sometimes that warning system can send a signal when we don’t need it because:

1. Our body is already safe and okay

and/or

2. We’ve already done all the things we need to do

Once that pain signalling system is no longer telling us anything new or helpful, that signal becomes like someone ringing a doorbell over and over again: not helpful and really annoying.

This can happen with things like headaches, stomach pain, and pain in your body that sticks around much longer than it needs to.

When that happens, the challenge is what to do with that unhelpful signal. The great news is that there are alot of things we can do to turn down, turn off, or ignore those pain warning signals.

And here’s a secret: you most likely already know how to do some, if not all of them! To figure out what you like and could work best for you, let’s take a second to learn a little bit more about how pain works.

Pain is just a signal. It has three important parts: Physical, psychological and social. Understanding each of these three parts is really powerful because it opens up many possibilities for making things feel a lot better. You can use this information to help yourself with any pain...from a little stubbed toe to headaches and stomach aches to major injuries.

Physical

The physical part of pain is the one we are most used to thinking about. It means obvious things like how bad an injury was and what kind of damage was done to our body, but it also involves things like our physical stress level, how tired or hungry we are, how much sleep we got, eating healthy food, and whether or not we have some other kind of infection or illness. All of these things affect how pain feels to us.

Psychological 

Have you ever noticed that it hurts much worse when you stub your toe when you are in a bad mood than when you’re in a good mood? That isn’t a surprise…our mood and our thoughts impact how we feel pain. Stress, anxiety, and worry about what is happening around us can all make pain worse. Pain feels better when we feel more in control and have good coping skills. This doesn’t mean we’re weird or crazy, it’s just the way human bodies work.

Social

What is going on around us and how people act around us when we feel pain matters a lot. When there is a lot of stress around us, our pain can be much worse. When we feel supported, believed, and taken seriously, it feels better. When people help support good coping skills, it makes a big difference.

What helps?

The overall goal is calming down our central nervous system, and turning down the dial of our stress.

Higher stress = more pain

Lower stress = less pain

Here are some skills and strategies that you can do almost anywhere to help yourself feel more comfortable and in control. Doing them helps calm down that central nervous system and change your experience of pain.

• Distraction: Paying attention on purpose to things we like is a POWERFUL tool, and can totally change how we experience pain. When we focus on pain, it gets bigger. When we focus on something else, pain gets smaller. Distracting yourself by doing something like watching a video, playing a game, doing an art project, hanging with friends, or focusing on a book are all easy ways to tune out what is happening around you, turn down that stress dial, and turn down/turn off pain signals.
   
• Breathing: It’s the ultimate hack of your nervous system. Slow deep breaths trick your brain and body into calming down. When things feel out of control, it’s great to know you can always control the pace of your breathing…and it makes a BIG difference. Notice how it changes the way you feel.
   
• Imagination: Since pain happens in your brain, your imagination is one of the most powerful tools you have. Using your imagination and your focus of attention can totally transform how you experience pain and help you feel much more comfortable and in control. Some people call this self-hypnosis. To learn just how powerful this can be, we suggest checking out a website called ImaginAction. It was put together for Stanford Children’s Health by some of the top experts in the world. You’ll find a great video explaining how and why it works, and helpful audio recordings you use anytime you’d like. The overall goal is calming down our central nervous system, and turning down the dial of our stress.
   
• Connection: Being with people who make us feel safe and supported helps a lot. The touch of a trusted person can calm us and relax us. Hugs, back and head rubs, and holding hands can be really comforting. When friends and family members don’t focus on the pain (remember…what we focus on gets bigger!) but help us find other things to pay attention to and do, it makes a big difference. This can also include telling stories, talking about fun times, or playing games.
   
• Sleep: Lots of sleep on a regular schedule is one of the best things we can do to regulate our bodies. Going to sleep at the same time at night, and getting up at the same time in the morning helps. While it is good to rest, try not to take naps (especially in the afternoon) as it can mess up our sleep schedule and sometimes make pain worse.
   
• Eating: Eating good, healthy food on a regular schedule helps our body be less stressed.
   
• Medicine: If a doctor or medical provider has told you medicine could be helpful, be sure to take it as they recommend. Sometimes medications don’t work as well or as fast as we’d like them to, so use your other coping skills to help yourself too.
   
• Movement: When we are hurting, it’s usually a natural instinct to not want to do anything and be still, but it turns out that can be a bad idea. As weird as it sounds, that can actually make many kinds of pain worse. Doing things like taking walks, light exercises, and moving our bodies is really, really important to improving pain. Having other people do it with us can help! If it’s possible, working with a physical therapist who understands pain can be really useful for helping us out the best ways to get moving.
   
• Schedule: When things feel out of control in our bodies and/or around us, having more structure is really important. Creating a schedule to follow that guides things like sleeping, eating meals, and doing school and play around the same time makes a big difference. It helps us feel more regulated, decreases stress, and calms down those pain signals.
   
• Psychotherapy: As we’ve already covered, there is a BIG psychological part of the pain experience (and because it may need to be said again...this DOES NOT mean you are crazy or that your pain isn’t “real”…it is just how human beings work!). You also already probably know that dealing with pain can be very stressful and takes a very specific set of coping skills. Since the big goal is to turn DOWN the stress dial, working with a psychological therapist can be a huge help. They can help you learn the coping skills that work best for you, provide support, and help you figure out how to get your life back to the way you want it to be.

Each time you use one of these strategies, it’s going to help that much more. You will start noticing a big difference when you do them every day. Managing pain can take time, patience, and persistence, but it’s pretty incredible to discover how powerful you are and the many ways you can have control over your body and experience.

Tragic events make news headlines, so you may find yourself at the centre of media attention.

You might want to share your story with the media as part of your recovery process, to help law enforcers catch offenders, to raise awareness of crime or for fundraising purposes. But you might also find the attention intrusive and upsetting especially as you are trying to come to terms with what has happened.  

If you've been affected by an incident and getting calls or visits from the media as a result, you need to think about the pros and cons of speaking to the press before you talk to them. There are systems in place to help protect you and there are a number of people you can talk to about your options:

• Many UK newspapers are members of the Independent Press Standards Organisation (IPSO), which means they must not engage in intimidation, harassment or persistent pursuit. You can contact IPSO on 0300 123 22 20 for advice and support.
• If you have been allocated a police family liaison officer, they will be able to give you advice on how to deal with the media.
• If you have a Victim Support caseworker. 
• If you have a lawyer involved in your case they may also be able to give you advice on dealing with journalists.

Anniversary of a traumatic event

Traumatic events can change how we perceive and experience time. It is not unusual for people to experience the trauma as an incident that just happened or is still happening even when time has lapsed since the actual date of the event.  A first anniversary following a traumatic event is an unusual time, as it is a marker of time that had passed since the attacks as well as a reminder of it.

Anniversaries of traumatic events can lead to an increase in memories, dreams, and feelings about the event as well as thoughts about the impact that it had on your life and on the people close to you. These feelings may be more intense than usual.

It is important to be aware that these reactions are both normal and understandable and do not necessarily mean that you are getting worse.

The anniversary of a traumatic event can be a challenging time and it may therefore be helpful to think about the best way to look after yourself.

Marking the anniversary

All though what happened may have affected many people, different people will have different needs and preferences for coping, depending on their individual needs and stage of their journey that they are at. 

For some people, attending an organised event may feel like an important way to mark the day. For others, this may feel too difficult or it may not fit with their personal preference.

People may have their own ideas about how they would like to mark the anniversary. Some people may feel tempted to avoid anything to do with the anniversary. Although in the short term this may feel safer, it could become stressful trying to avoid and block it out when it is likely that thoughts and feelings will be present regardless. In fact this may use up more emotional energy than acknowledging the anniversary, on your own terms, and in a way that feels right for you.

What can I do to help me cope with the anniversary?

1. Be aware that this is likely to be a difficult time and you may experience a number of different feelings.

It is important not to compare your own reactions to those of others, including close family members. We are all unique in how we respond. Try not to over-analyse why you might be feeling a certain way, instead acknowledge that these feelings are present and look for a helpful way for to cope. Remember these feelings are normal, so be kind and compassionate towards yourself

    2. Identify helpful ways to manage distress.

What helps you to feel comforted and soothed?

• You may find that spending time with people you feel close to, such as family or friends, and sharing memories and feelings with them may be more helpful than trying to deal with them on your own.
• Engaging in relaxing activities such as going for a short walk, listening to music, or reading may help you to feel more calm and relaxed. Try not to plan too much for the day. You are likely to use up a lot of emotional energy which can be mentally and physically exhausting.
• If you want to have other people around you check if they are available. Be aware that you can change your plans throughout the day based on how you feel. Put your needs first. Do you need to take a moment away from people to reflect or recharge?  People will understand if you explain to them what you need.
• You may want to engage in an activity that helps you to remember loved ones that you may have lost, for example, looking at pictures, sharing happy memories about them with others, doing things that they might have enjoyed, or something in their memory. Remember this may feel too difficult for you right now, so remember to do only what feels right for you.
• Do not hesitate to contact professional help from your GP, A&E or the Samaritans if you feel that you are struggling to manage and are in need of urgent help 

Difficult emotions are not easy to manage and you may be tempted to block them out or use strategies, such as drinking too much. These strategies can offer some short term respite, but are likely to make it harder for you to cope in the long term. Remember, experiencing difficult, upsetting feelings is a normal part of the process of learning to cope with your experience.

After the anniversary

It might be helpful to reflect after the anniversary on how you felt and whether there were things that helped you, or made it harder for you to cope with your feelings.

Although over time your needs may change you are likely to encounter anniversaries and certain dates and events that will bring back memories of the incident and it could help to develop awareness of what helps you to cope with them.

What is an inquest?

An inquest is a public legal inquiry held by a coroner when the cause of death is uncertain, or the death is considered ‘violent’ or ‘unnatural’. It aims to determine the identity of a person who has died as well as how, when and where they have lost their lives. The inquest is not a trial. It has no defence or prosecution parties, and it does not aim to draw conclusions about responsibility.

An inquest takes place in a courtroom and is a formal proceeding. Not all the people who have witnessed the incident will be required to attend the inquest or give evidence. During an inquest new information about the incident could be presented, this may include photographs and video footage. Individuals attending an inquest can access practical and emotional support from the Coroners’ Courts Support Service (see Support available below).

How the inquest may affect you?

Following a traumatic incident, people often talk about having information or ‘pieces of the jigsaw’ missing, which makes it more difficult to come to terms with the trauma and its consequences. During the inquest, information might appear that improves understanding of what happened. This may help you with your personal recovery. With this additional information, you may also find yourself thinking about the ‘what ifs’, such as “What would have happened if I or they had …?” Although this is understandable, it may not be helpful.

Holding onto these thoughts and creating alternative scenarios in your mind is unlikely to provide you with the answers or solutions that you are seeking. Instead, it might make you feel more upset. Trying to process the ‘what ifs’ can also be emotionally draining and take your attention away from the ‘here and now’. If you can, try to remind yourself that these ‘what ifs’ did not happen. Instead, try to focus on processing what you did experience, and on what you are experiencing now. How the inquest may affect you.

For those who have lost loved ones, the inquest is likely to provoke feelings of sadness, grief and possibly anxiety. Information presented in the inquest is likely to play a part in the grieving process. However, it may take some time to make sense and process the new information. Sometime people find that their emotions make it difficult for them to give evidence or do so in the way that they would wish to in court. You may worry that you have let others down, especially loved ones you may have lost. Although this is understandable, try to remind yourself that this is an especially difficult situation and that you are doing your best to cope. If you are responsible for children who were affected by the loss of life, you may wish to ask for advice on how to support them during the inquest.

Common reactions:

Inquests can be difficult whether you plan to attend the inquest in person, access the hearing through remote court arrangements, follow it on the news, or read the transcript.

You might find it brings back memories and triggers difficult emotions related to the incident. Common reactions include:

1. worrying about the inquest before it happens
2. upsetting memories and dreams about the incident
3. distressing feelings of guilt, shame, anxiety or anger about what happened
4. feeling upset about any press and television reports and how they report information about the inquest
5. trying to avoid news and conversations about the inquest and the incident
6. dwelling on the details of the transcript or reports from the inquest
7. feeling upset about the details of how people died or were injured
8. realising the ‘scope’ of the inquest is unlikely to provide you or your family with all the answers
9. struggling to come to terms with what happened, with new information and/or with the outcome of the inquest
10. concerns about the impact the inquest it has on you, your family members and any children involved

Helpful strategies to manage feelings of distress

• Consider whether or not you would like to observe the inquest, remember that it is your choice.
• You are likely to use up a lot of emotional energy during this time, which can be mentally and physically exhausting. Engaging in some small self-care activities can provide you with some relief.
• Remind yourself of what usually helps you to feel comforted and soothed.
• It can be helpful to spend time with people you feel close to, such as family or friends.
• Make a point of ‘being kind to yourself’ and not expecting too much of yourself, your family members or friends.
• Take one day at a time and try to deal with what you need to at any one time
• Engage in relaxing activities that keep you focused on the present, such as going for a short walk, listening to music, or mindful breathing exercises.
• Since the incident, you may have got to know others who were involved in it or who were bereaved because of it. Talking with each other can sometimes bring a sense of support, although this will depend on your circumstances.
• Take breaks from news about the inquest. Try to limit the amount of time you focus on the news.
• Try to avoid using alcohol or drugs to soothe yourself.
• Do not hesitate to contact professional support if memories or feelings persist or affect your day to day life.
• The inquest may last for months. You are not expected to put yourself at increased risk, trauma or financial hardship in order to attend. You may wish to consider seeking help and advice from the support services below.

Managing the media

Journalists from the newspapers and television may contact you for interviews or comments. Remember:

• You do not have to speak to them. According to the Editors’ Code, the press should leave you alone if you say you do not wish to speak to them.
• Sometimes people choose to make a statement. If you wish to do this, you can ask the press to put any questions they have for you in writing. If you wish, someone else can also make the statement on your behalf.
• The media sometimes access or publish information from individual social media profiles. You may want to change your privacy settings on social media to prevent this and check Social media:
• social-media-public_v4.pdf
• The Independent Press Standards Organisation (IPSO) has a helpline for advice about press harassment 0300 123 2220 / 07799 903 929.
• For more information, please head to the Department of Media, Digital, Culture, Media and Sport website.

More support

• Individuals attending an inquest can access practical and emotional support from the Coroners’ Courts Support Service. This can include arranging for a volunteer to meet with you for a pre-inquest visit to orientate you to the court, familiarise you with the process and answer questions. You can call the helpline on 0300 111 2141 or e-mail: helpline@ccss.org.uk
• A Police Family Liaison Officer (FLO) can also offer information and support.