Sunday, April 7, 2019

The legacy of Northern Ireland’s past: Mental Health

Ulster University professors Siobhan O’Neill, left, and Brandon Hamber argue that understanding the effect of the Troubles related trauma, including transgenerational trauma, is vital for fostering peace building in Northern Ireland.

The conflict was a significant and distinctive stressor in the life of the community in Northern Ireland for over 40 years. The world mental health survey found that whilst around 71.5 percent of the population have minimal levels of mental illness, the mental health difficulties of at least half of the remaining 28.5 percent (approx. 213,000 adults) appear to be directly related to the Troubles (Bolton, 2017; McLafferty et al., 2016; O’Neill et al., 2015). The same study showed that 39 percent of the population experienced a traumatic event that was related to the Troubles. Such events included bombings, shootings, and witnessing killings and mutilations. The research demonstrated the depth and scale of the mental health needs of the Northern Ireland population, however progress on meeting those needs and providing the evidence-based treatments for complex trauma-related illnesses has been slow.

In the meantime, the consequences are manifest in the form of social unrest and high rates of suicide (O’Neill et al., 2014) and prescribed medication (Benson et al., 2018). Mental illness stifles healing and empathy. Psychological therapies can help individuals make meaning from their experiences, which not only reduces their suffering, but also allows them to place the experience in context, to foster recovery. Such processes at both a personal, and community level can promote peace-building, and potentially create the environment for peace.

For victims and survivors of trauma, the issues of truth, justice, accepting responsibility, compensation and official acknowledgement are also part of this “meaning making” and are interwoven with healing (Hamber, 2009). In fact, healing, often promoted by addressing wider victim issues such as truth and justice, in such circumstances may provide the conditions for post-traumatic growth (Joseph, 2015).The opposite is also true, that failing to address the wider needs of survivors (such as a desire for justice or truth) can have negative psychological consequences into the long term (Hamber, 2009).

We made these points in response to the consultation on the proposed legacy institutions (O’Neill and Hamber, 2018, see our full response), and also noted that the institutions will have a profound impact on the mental health of the individuals who engage with them, those who for whatever reason choose not to, and those with existing trauma-related conditions who either participate, or hear about them from the media and other sources. It is vital that the mental health of those affected is protected through this process.

The consultation – ‘Addressing the legacy of Northern Ireland’s past’ – includes proposals to implement the four new legacy institutions set out in the 2014 Stormont House Agreement (SHA) and the Government’s manifesto for Northern Ireland 2017. A key element of the Stormont House Agreement is that all of these bodies will be under statutory obligations to act in ways that are balanced, proportionate, transparent, fair and equitable.

Our six key recommendations in relation to the legacy institutions:
  1. The institutions should adopt a victim and survivor-centred perspective. The process should be scrutinised from the perspective of the victim, and their journey through engagement with one or more of the structures.
  2. Support for victims through the process should be standardised and offered on an equal basis to all survivors across the legacy institutions.
  3. A process of demand profiling and impact assessment should be undertaken prior to the commencement of the work of the institutions.
  4. The institutions should adopt a trauma-informed approach that: Realises the impact of trauma and understands potential paths for recovery; Recognises the signs and symptoms of trauma, responds by integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatisation. (SAMSHA, 2018). This particularly means that the legacy structures and processes should screen people for trauma-related conditions and facilitate them in receiving treatment.
  5. We recommend that a Mental Health Advisory Group with an expert chair, is convened to oversee and monitor the implementation of all four institutions.
  6. We need to protect the mental wellbeing of those who work within the institutions particularly those who witness the testimonies of the victims and survivors and those tasked with delivering justice and establishing a level of need.
Citing this Article

O’Neill, Siobhan and Hamber, Brandon (2019). Addressing the legacy of Northern Ireland’s past. The View Digital, Issue 51, pp.30-31.


This article was published by The View Digital (Issue 51, 2019), to download a Pdf of the article as it appeared, click here. To download the full edition of The View Digital which features "An in-depth look at victims, survivors and legacy issues from the Troubles", click here.

Learn more about The View Digital, click here.


Benson, T., Corry, C., O’Neill, S., Murphy, S., Bunting, B. (2018). Use of prescription medication by individuals who died by suicide in Northern Ireland. Arch Suicide Res, 22, 1, 139-152. Download. 

Bolton, D. (2017). Conflict, peace and mental health: Addressing the consequences of conflict and trauma in Northern Ireland. Manchester: Manchester University Press.

Hamber, B. (2009). Transforming Societies After Political Violence: Truth, Reconciliation and Mental Health. New York: Springer.

Joseph, S. (2015). A person-centred perspective on working with people who have experienced psychological trauma and helping them move forward toward post-traumatic growth. Person-Centered and Experiential Psychotherapies, 14(3), 178-190.

McLafferty, M., Armour, C., O'Neill, S., Murphy, S., Ferry, F., Bunting B. (2016). Suicidality and profiles of childhood adversities, conflict related trauma and psychopathology in the Northern Ireland population. J Affect Disord, 200, 97-102. Download.

O'Neill, S., Ferry, F., Murphy, S.D., et al. (2014). Patterns of suicidal ideation and behaviour in Northern Ireland and associations with conflict-related trauma. PLOSOne, download.

O’Neill, S., Armour, C., Bolton, B. et al., (2015). Towards a Better Future: The Transgenerational Impact of the Troubles on Mental Health. Belfast, CVSNI. Retrieved from here.

O’Neill, S. and Hamber, B. (2018). Consultation Response: Addressing the Legacy of Northern Ireland's Past. The need for a victim and survivor centred, trauma-informed approach. Retrieved from here, 25th Feb 2019.

SAMHSA (2018). Trauma-Informed Approach and Trauma-Specific Interventions. Download.


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