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The Grenfell tragedy and its mental health outcomes.

A critical evaluation of the work of psychological services, practitioners, and

academics in addressing the mental health outcomes of the Grenfell Tower tragedy.

 

On the night of the 14th of June 2017, many lives were lost, and even more were forever changed. A history of negligence, exclusion, austerity, and inequality (Welsh and Abbott, 2017) left not only the Grenfell survivors and bereaved of the Grenfell Tower fire with mental scars, but it affected the wider community and even beyond.

The causes and consequences of an event like this is what Pemberton defines as social harm, an endangerment of ‘human flourishing’ (Canning and Tombs, 2021). The different dimensions of harm Pemberton (2016) talks about are physical as well as mental and inflict damage to people’s autonomy and relations. Physically, the Grenfell fire brought 72 deaths (Rice-Oxley, 2018), and many injuries. Mentally it has caused trauma, grief, anxiety, and a range of emotional issues to thousands of adults and children often coming from families with a pre-existing history of PTSD after fleeing wars or persecution in their home countries (Adams, 2019). These people’s autonomy to make choices and act on them, and be a productive member of society, has been compromised. Pemberton (2016) describes this as the possibilities for self-actualisation, which have been reduced for a whole community because of the tragedy. Relationships are also affected with people being displaced, communities ruptured, and feelings of mistrust and neglect are created.

Maslow also talks about self-actualisation as being at the top of the hierarchy of human needs (Pichere, 2016). A person should satisfy all levels below - physiological, security, belonging and esteem - first to be able to reach that state of personal accomplishment. A tragedy like the Grenfell fire wreaks havoc on every level of these human needs and as such the mental health consequences are severe and wide-reaching.

This article attempts to shed light on what kind of mental health support was set up straight after the tragic night and what has been offered long term. It also looks at several investigations that have tried to demonstrate what the emotional outcomes look like for the directly and indirectly affected, how that research was done and to what standards, and whether ethical practice was maintained.

Although official support and services were launched with some delays, community effort shot out of the blocks straight away. The huge need for mental health assistance after the incident has prompted the research community into action to investigate what was done and why, and what can be learned for the future.

 

In the immediate aftermath of the Grenfell incident, the Grenfell Recovery Scrutiny Committee (2017) argues that the Royal Borough of Kensington and Chelsea had good intentions and several mental health responses in place to assist survivors, bereaved and otherwise affected people in the community but admits that execution was not always swift and efficient. It is important to note that this Committee was set up by the RBKC so questions can be asked as to how critical they have assessed the situation. Prominent Grenfell survivors like Eddie Daffarn (Channel 4 News, 2018) have explained how they were left to their own devices with only support from neighbours and the community for several days after the tragic night, until Monday the 19th of June when representatives of the RBKC opened a shelter for survivors in Westway Sports Centre. However, Alison Norman, contract manager for Everyone Active at Westway Sports Centre, contradicts this and describes how the centre stopped trading and opened its doors to the survivors the morning after the fire (Eaves, 2017).

On the other hand, voluntary community effort seems to have been the biggest and most important initial support system for the survivors and affected. This is clear from the big role faith groups played in providing shelter and emotional support in churches and mosques (Plender, 2018) as well as setting up continued faith and trauma-informed counselling services for e.g. Muslim communities (Hammad et al., 2020). Other immediate community initiatives were set up by e.g. The ClementJames Centre where, besides shelter and food, specialist counselling and bereavement support was offered (The ClementJames Centre, 2020).

Although perhaps slightly delayed, the NHS West London CCG increased their primary care offer after the fire with extended GP availability, appointments, and screening for PTSD with 1739 Grenfell related consultations for 925 patients documented between June and December 2017 (Grenfell Recovery Scrutiny Committee, 2017). In the year after the fire, a further 2674 adults and 463 children received PTDS screening (Adams, 2019). Additionally, ongoing specialist psychological services for adults and children were created (Adhyaru, 2018), as well as non-specialist outreach teams that are still in place to facilitate the connection between NHS services and those in need (NHS Grenfell Health and Wellbeing Service, 2022). The latter has proven to be a crucial tool, especially for affected people that culturally would not call on traditional psychological services (BBC Newsnight, 2017). Additionally, extra funding, more than £3000000, was released after the incident for targeted voluntary community support (Grenfell Recovery Scrutiny Committee, 2017).

The London Fire Brigade also increased screening for PTSD and identified the need for self-help tools and targeted therapies like CBT and EMDR to assist their employees after the Grenfell Tower fire, and these methods are now staples within their in-house counselling service (Steel et al., 2021).

The combination of community involvement and specialist support has shaped the response to the mental health consequences for victims of the tragedy and beyond, but this has not been without criticism.

 

The ongoing suffering and criticism from those directly and indirectly involved, has warranted the need for investigations and independent research.

Although the RBKC has admitted that there were several issues with the quality of their response in terms of delays, the inability to reach everyone in need, and the lack of support for community feedback and volunteers, they committed in December 2017 to a continuous effort to improve their shortcomings (Grenfell Recovery Scrutiny Committee, 2017). However, the Independent Grenfell Recovery Taskforce argued in 2020 that although the RBKC had made progress on their initial recommendations for improvement, their concerns about the quality of the recovery efforts, the tempo of implemented change and the continued difficult relationship between them and the survivors, bereaved and wider affected community, remained (Chughtai et al., 2020).

Linked to this, Ohana (2021) researched how the knowledge about the incident coming from the traumatised community has not been considered in Phase 1 of the Grenfell Tower Inquiry and concludes that this is related to institutional discrimination and oppression. Looking at the Phase 1 Report of the Grenfell Tower Inquiry (2019), it does set out intentions to investigate the local community’s concerns about the existing problems with the building prior to the fire and the lack of support in the days after, in Phase 2 of the Inquiry, of which the report is currently being prepared (Grenfell Tower Inquiry, 2023).

The school-based mental health response immediately after the tragedy has been investigated by University College London and researchers have made recommendations to improve this kind of response for future major incidents (Dunsmuir et al., 2018). These recommendations are valuable in addition to the specialist emotional support for children and young people, who often deal with issues like relationship building difficulties, trouble sleeping, bed wetting, brain and body dysregulation, and disassociation after a traumatic event (NCTSN, 2023).

Additional research on how the wider community has been affected from a mental health point of view has provided interesting insights as well. Rubin and Greenberg (2021) have attempted to investigate what impact living in the surroundings of a disaster site has on the mental health of people. Although they were not able to conclusively determine any degree of impact through their method of literature review, they have confirmed that actual research with the Grenfell community would be valuable. A little further removed, Preece (2021) reports on the harm to the mental wellbeing of leaseholders all over the UK that live in buildings with comparable fire safety issues to the Grenfell Tower, which ranges from build-up of fear, anxiety, and even suicidal thoughts to financial stress about the removal or replacement of materials and the inability to sell their properties. The report has helped to shape recommendations to building owners and managers, and local and national government through the Building Safety Programme, to be able to efficiently assist leaseholders in improving safety (Local Government Association, 2023).

The research papers mentioned here all have valuable insights and recommendations to offer for a better understanding of the mental health outcomes of the Grenfell tragedy and hopefully contribute to future change in attitude and practice.

 

An analysis of how these papers are composed, shows the different methods the researchers have used to design the research question, develop the process, analyse and interpret the data, and present the outcomes (Matthews and Ross, 2010).

Matthews and Ross (2010) describe the elements of quality research and looking at the aforementioned papers, some assumptions can be made on their reliability, validity, credibility, generalisability and transferability. Apart from Rubin and Greenberg’s (2021) literature review, the other research papers have used the qualitative methods of interviews or secondary data analysis of conversations.

A literature review can be reliable if the literature used is wide ranging, peer-reviewed and critically evaluated (Matthews and Ross, 2010). Rubin and Greenberg (2021) started by setting out certain criteria for what to include in their review. They argued they found 4 peer-reviewed, relevant papers that fit these criteria out of 3500 possibilities. On the other hand, they did not research grey literature and did not do a full quality assessment of the included documentation. Based on that information, it can be assumed that their literature review was reliable, valid, and credible. However, as for generalisability and transferability, the evidence used might be too scarce to incontestably answer their research question and link this to the specifics of the affected Grenfell community, where there was a lot of pre-existing PTSD (Adams, 2019) and people suffered under the effects of discrimination and austerity (Welsh and Abbott, 2017). The question can be asked whether a rapid literature review was the most efficient method to use by itself to collect data and formulate a well-rounded answer to this specific research question. Research conducted by Lunt et al. (2014) on the implications of medical tourism on the NHS started with a literature review but then added a mixed-method approach of quantitative and qualitative data collection which included in-depth interviews. This allowed them to gain a greater amount of useful information needed to work out their analysis and conclusions related to their research question. Rubin and Greenberg could have taken a similar approach to conduct their investigation more thoroughly, which could have provided more conclusive evidence.

Although still secondary in its nature, Ohana (2021) chose to study a more first-hand perspective through the analysis of data from conversations with victims to investigate their research question. This is a good method to create a picture of the community’s experiences, feelings, and opinions on the given subject (Matthews and Ross, 2010). The research question sprung from the initial hypothesis that knowledge known from people that have undergone the trauma of an event is often excluded from official inquiries because of social oppression, and the paper evaluates the validity of this statement (Ohana, 2021). To create a good understanding of the subject and refine their research (Matthews and Ross, 2010), Ohana (2021) additionally reviewed literature on 2 other traumatic events in the UK where there were attempts to exclude the knowledge of the affected from the inquiries: the Hillsborough tragedy and the Stephen Lawrence murder. These events have run into their own issues with institutional power, respectively on a social and racial level, but their proceedings eventually evolved to be based on the knowledge of the affected families (Ohana, 2021). In doing so, Ohana obtained comparable background knowledge that created the base for their analysis.

When data is collected through the analysis of conversations, validity and dependability questions can be asked on the ability to replicate the results, and the inclusion of all relevant data (Matthews and Ross, 2010). Ohana (2021) extracted data from conversations conducted with 18 bereaved and community members through art workshops, where trauma specialists and translators were present to ensure emotional and cultural interpretation of people’s stories were as accurate as possible. An environment like this seems to provide a professionally supported and ethically sound setting for people to feel safe to share their experiences and ensure cultural understanding. However, replication of the results is questionable as a workshop with an alternative activity, different people, or another environment might have evoked different emotions for the participants and produced different results. Equally, different translators might have interpreted the conversations in another way as well. Ultimately, it can be assumed that the intention and design were set up to provide quality research.

 

Data collection is paramount for any form of research and without it, any statement made would just be a guess and results might be misrepresented. To uphold the integrity of this process and the study as a whole, and to minimise the risk of retraumatising the participants, ethical practice must always be observed (Matthews and Ross, 2010; SAMHSA, 2014).

The primary research done by Dunsmuir et al. (2018) and Preece (2021) has relied on interviews to collect data. Dunsmuir et al. (2018) set up semi-structured telephone interviews with 19 headteachers and educational psychologists. Preece (2021) conducted in-depth interviews with 32 leaseholders affected by the building safety crisis.

Semi-structured interviews are effective to gather information on specific topics from participants while leaving enough room for them to add personal ideas and experiences (Matthews and Ross, 2010). This is why it was a good choice for the exploratory research that Dunsmuir et al. (2018) supervised. It gave the participants the opportunity to describe how they structured support to their affected students and to express their views on what would be the best school-based mental response immediately after a disaster and long term. The data was then analysed with a thematic approach to be able to formulate the findings into recommendations for the future, which was the main goal of their project.

Including personal stories, experiences and views brings along the need for informed consent and ethical practice to protect participants and the quality of the research (Matthews and Ross, 2010). An example of unethical practice in research was the Tea Room Sex Study by Humphreys (1970). Although many stereotypes about the participating men were overthrown and police stopped pursuing their arrests because of the study, most data were collected unethically, without the men’s knowledge or consent (Sieber, 1978). When participants don’t know that the person they are talking to is a researcher, that the information they share will be used, analysed and shared, what the purpose of the conversation is, or that they can withdraw their statements at any time, the results become essentially unusable (Matthews and Ross, 2010).

Dunsmuir et al. (2018) seem to have followed a good procedure, as they gained verbal consent for participation first, followed up with written information about the study and the individual’s rights, and continued to ensure confidentiality throughout the process. As such, integrity and quality were ensured and the value of the outcomes of the study is preserved.

Preece (2021) deployed a similar procedure where consent for participation was obtained before – through surveys - and during the in-depth interviews. The purpose of the study and the participant’s rights were also clearly communicated, and confidentiality was maintained throughout the data analysis. The data collection and analysis were simultaneously approached through grounded theory (Preece, 2021), which allows for the formulation of social processes (Noble and Mitchell, 2016). In this study this meant defining mental wellbeing and its dimensions in relation to people living with the worries of the building safety crisis. A subjective concept like mental wellbeing calls for an interpretivist perspective because Preece made conclusions based on the participants’ understanding of what good support for children and young people looks like, and their interpretations of an adequate response after a disaster like the Grenfell fire (Matthews and Ross, 2010). Those conclusions were then the basis for the recommendations Preece made to owners, managers, and government agencies. If Preece would not have handled the stories, experiences, and feelings of the leaseholders - the data - with care and consent, those recommendations would hold much less weight and, to a certain extent, solutions for the building safety crisis might have been stirred.

A psychologist who’s results from studies about human behaviour have not been able to hold their value is John Watson. He was known to conduct studies lacking in care and consent because he would often use orphans in his experiments (Beck and Irons, 2011). An example is the Little Albert experiment, in which he used a 9-month-old orphan to produce proof for his hypothesis that fear could be conditioned, and eventually never de-conditioned this child from the fear of white, fluffy animals the researchers instilled in him (DeAngelis, 2010). Clearly, an infant cannot provide consent for participation, and the parent that was later discovered to be paid 1 USD did not or was not capable to protect the child (DeAngelis, 2010). As such, Watson handled the whole experiment with a complete disregard of care and ethical practice.

Sensitive research dealing with mental health support and wellbeing outcomes must keep individuality and personability in mind, and therefore treat every bit of data collected with the upmost respect, honesty, and confidentiality.

 

This evaluation has shown that in the immediate hours after the start of the fire, community support became the shoulder for victims to lean on. Even in the days following, this voluntary help from the neighbourhood seemed to be the biggest effort made to provide immediate shelter and other necessities, as well as emotional and mental support.

In contrast, the RBKC had to admit that the official response was not set up quickly nor efficiently and lacked quality, which has led to much criticism from the Grenfell survivors and the public. The Grenfell Independent Recovery Taskforce as well as the Grenfell Tower Inquiry have been investigating these response efforts to be able to make both recommendations for a continuous improvement of the response (Chughtai et al., 2020) and conclusions on the circumstances leading up to and surrounding the fire (Grenfell Tower Inquiry, 2023).

In terms of official ongoing mental health support, the NHS has created specialist psychological services and outreach teams to follow up the survivors and bereaved, and the London Fire Brigade has expanded their in-house counselling service because of the disaster.

A tragedy with such wide reaching mental health consequences has called for wide ranging but distinct research due to the cultural and religious specifics of the Grenfell community. Analysing the methods used in the papers discussed, it can be concluded that although the overall quality of the research can be good, a stand-alone literature review might be too narrow to get conclusive results, and a secondary conversations analysis might lack in dependability.

A review of ethical practice shows that the research community has put a lot of effort in ensuring the understanding and consent of, and the care for their participants. In their dealings with such a sensitive topic and participants that have been under enormous mental strain, the researchers have kept their integrity, honesty, and respect, which brings more value to the outcomes of their reports.

Because of the duress the Grenfell victims have been under, it is important that researchers investigating a multitude of issues stemming from the incident continuously consider high standards in their work and ethical practice. The mental health outcomes for these people are dire, and they should be able to rely on the specialist, voluntary and research community to continue to receive the help and support that they are much in need of.



References

 

Adams, T., (2019). The hidden mental-health legacy of Grenfell Tower. The Guardian [online], 9 June 2019. Available from: https://www.theguardian.com/uk-news/2019/jun/09/hidden-mental-health-legacy-grenfell-disaster [Accessed 11 May 2023].

 

Adhyaru, J. S., (2018). Trauma Therapies for Grenfell Survivors [online]. London: NHS Grenfell Health and Wellbeing Service.

 

BBC Newsnight, (2017). Grenfell’s toll on mental health. YouTube [online]. 23 August 2017. Available from: https://www.youtube.com/watch?v=ictMsyd0KP8 [Accessed 10 May 2023].

 

Beck, H. P. and Irons, G., (2011). Looking Back: Finding Little Albert [online]. Leicester: The British Psychological Society. Available from: https://www.bps.org.uk/psychologist/looking-back-finding-little-albert [Accessed 2 June 2023].

 

Canning, V. and Tombs, S., (2021). From Social Harm to Zemiology: A Critical Introduction [online]. Oxfordshire: Routledge.

 

Channel 4 News, (2018). The man who predicted the Grenfell Tower fire: first in-depth interview. YouTube[online]. 21 May 2018. Available from: https://www.youtube.com/watch?v=UxMEAAOTt30 [Accessed 10 May 2023].

 

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DeAngelis, T., (2010). Little Albert. Monitor on Psychology [online], 41 (1), pp. 10.

 

Dunsmuir, S., Hayes, B. and Lang, J., (2018). Professional Narratives and Learning from Experience: Review of the Critical Incident Response to the Grenfell Tower Fire [online]. London: UCL Educational Psychology Group.

 

Eaves, S., (2017). Westway Sport Centre: Westway Sports Centre’s involvement in the Grenfell relief effort. Sports Management [online], November 2017. Available from: https://www.sportsmanagement.co.uk/Sports-features/sports-management-magazine/Westway-Sports-Centre-Westway-Sport-Centres-involvement-in-the-Grenfell-relief-effort/32351 [Accessed 10 May 2023].

 

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Hammad, J., El-Guenuni, A., Bouzir, I. and El-Guenuni, F., (2020). The Hand of Hope: A Co-produced Culturally Appropriate Therapeutic Intervention for Muslim Communities Affected by the Grenfell Tower Fire. Journal of Muslim Mental Health [online], 14 (2).

 

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Ohana, N., (2021). The politics of the production of knowledge on trauma: the Grenfell Tower Inquiry. Journal of Law and Society [online], 11, pp. 497–523.

 

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Pichere, P., (2016). Maslow’s Hierarchy of Needs [online]. Brussels: Lemaitre Publishing.

 

Plender, A., (2018). After Grenfell: the Faith Groups’ Response [online]. London: Theos.

 

Preece, J., (2021). Living through the building safety crisis: Impacts on the mental wellbeing of leaseholders [online]. Glasgow: UK Collaborative Centre for Housing Evidence.

 

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Steel, C., Travers, Z., Meredith, L., Lee, D., Conti, M. and Scoging, A., (2021). London Fire Brigade’s screen and treat approach to the Grenfell Tower incident. International Journal of Emergency Services[online], 11 (1).

 

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