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A Qualitative Evaluation of Southwark Council's Public Health Response To Jumbe et al. BMC Public Health (2021) 21:1427 https://doi.org/10.1186/s12889-021-11447-8 RESEARCH ARTICLE Open Access A qualitative evaluation of Southwark Council’s public health response to mitigating the mental health impact of the 2017 London bridge and borough market terror attack Sandra Jumbe1* , Adrienne Milner2, Megan Clinch1, Jonathan Kennedy1, Richard J. Pinder3,4, Carolyn A. Sharpe3,4 and Kevin Fenton4,5 Abstract Background: Over recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council’s pioneering public mental health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore perceptions of the mental health impact of the incident by those living and working in the borough. Methods: A rapid qualitative evaluation informed by the logic underpinning Southwark Council’s response was conducted. Seven formative interviews were undertaken with individuals involved in the response planning and/or delivery, enabling the evaluation team to establish the response’s theoretical basis. Subsequently, nineteen semi- structured interviews with consenting Council employees, residents, business owners, and workers from the Borough were conducted to understand perceived mental health impacts of the attack and the success of the Council response. Thematic analysis of transcribed interviews was undertaken to evaluate the extent to which the response was implemented successfully. * Correspondence: [email protected] 1Institute of Population Health Sciences, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Jumbe et al. BMC Public Health (2021) 21:1427 Page 2 of 12 Results: Participants reported feeling the attack had a wide-reaching negative impact on the mental health of residents, those working in the borough and visitors who witnessed the attack. Delivering the response was a challenge and response visibility within the community was limited. Participants suggested a comprehensive systematic approach to health needs assessment informed by knowledge and relationships of key Council workers and community stakeholders is imperative when responding to terrorist incidents. Improved communication and working relationships between statutory organisations and community stakeholders would ensure community groups are better supported. Prioritising mental health needs of terror attack responders to mitigate persisting negative impacts was highlighted. Conclusions: This article highlights a potential public health approach and need for developing robust practical guidance in the aftermath of terror attacks. This approach has already influenced the response to the Christchurch mosque shooting in 2019. Keywords: Terror attack, Mental health, Qualitative research, Public health Background dead by London’s Metropolitan Police. A further forty- Over recent years there have been a number of violent eight people received hospital treatment for physical in- attacks that have targeted civilians in major cities in Eur- juries, twenty-one of these in critical condition [5]. ope and elsewhere. The most notable of these include In addition to the fatalities and direct physical injuries, the November 2015 Paris (France) attacks (including the there were approximately 850 witnesses and between Bataclan Theatre) that resulted in 130 deaths, the truck 1000 and 3000 people were evacuated from the area. attack in Nice (France) in July 2016 which left 87 people Following the attack, police cordoned off Borough Mar- dead, the Manchester Arena (United Kingdom) bombing ket and the surrounding streets. Two hundred and that killed 23 in May 2017, and the Christchurch (New twenty-eight businesses were in the initial wider police Zealand) shootings that led to 51 fatalities [1–3, 14]. The cordon and 50 in the inner cordon. Much of the cordon immediate physical harm caused by terror attacks are was lifted on Wednesday 7 June but the Borough Market managed by emergency blue-light services using well- area (home to many market stalls, eateries and drinking established protocols. However, such incidents also have venues) did not re-open until Wednesday 14 June – 11 longer term impacts on the mental health and wellbeing days after the attack. Beyond these tangible conse- of a much larger population [1]. Indeed, it is through quences, it is clear that the attacks caused considerable this sense of long-term anxiety that terror targets under- distress, characterised by psychopathology symptoms mine the mental health and wellbeing of the target and unpleasant emotions (but not classified as a psychi- population. Despite being widespread and long lasting, atric disorder) to the population in Southwark and be- these effects are less tangible and protocols to deal with yond [1, 3]. The leader of Southwark Council wrote that them are less well-established since they have attracted this was “an attack on the diversity we celebrate - the comparatively little academic research [2]. It is crucial mix of nationalities drawn to our borough – and the that learning is derived from responding to terrorist at- great pleasure we take in our restaurants, bars and mar- tacks and other major incidents to improve future man- kets” [6]. agement of such events [2, 3]. This article examines the innovative approach pioneered by Southwark Council’s Evidence base Public Health team who sought to characterise and miti- Research into the mental health impacts of terror attacks gate the mental health and wellbeing effects of the shows they are difficult to quantify [3]. Factors including London Bridge and Borough Market terror attack that proximity to the attack, previous mental health issues, occurred on 3 June 2017 [4]. heightened media use, and previous exposure may cause The incident took place at ten o’clock on a Saturday more adverse outcomes related to post-traumatic stress evening amid the busy bars, restaurants and nightlife disorder (PTSD), post-traumatic stress symptoms found adjacent to the River Thames in the centre of (PTSS), prolonged grief disorder (PGD), and insomnia London, United Kingdom. The attackers drove their van [7–12]. Those trained to respond to a terror attack, as into pedestrians on London Bridge before the three at- well as those with certain personality dispositions, are tackers proceeded to the Borough Market area on foot, less likely to experience mental health consequences fol- where they attacked people with knives. Eight members lowing an incident. Those who have previously experi- of the public were killed, and the three attackers shot enced a terror attack, been highly exposed to subsequent Jumbe et al. BMC Public Health (2021) 21:1427 Page 3 of 12 media coverage, and volunteers with no professional res- development of best practice guidance for local govern- cue training or experience are more likely to suffer nega- ment organisations who might face similar situations. tive mental health consequences such as PTSD and PTSS [13, 14]. Empirically confirmed successful mental Methods health interventions include preparedness programmes, Design cognitive behaviour therapy, exposure narratives, and We conducted a qualitative evaluation of Southwark eye movement desensitization and reprocessing [15–17]. Council’s public health response to the London Bridge The evidence base for the effectiveness of psychological terror attack, within the London Borough of Southwark. first aid as a post-disaster intervention remains inconclu- This evaluation, commissioned over a 3-month period, sive [15]. involved two phases. Firstly, formative semi-structured Research into psychosocial outcomes indicates that the interviews with key informants who were Southwark clinical presentations of PTSD following terror attacks Council employees or statutory service employees in- are often complex [1, 4]. There may be long-term nega- volved in the response to gain an in-depth understand- tive impacts on survivors,
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