I have made the following notes based on my understanding of the Agreement document, and the concerns it raises in relation to victims. It has been read avidly by those we work with, and generally the response has been favourable. Therefore I think it is important, given that the Victims commission is mentioned in the Agreement, that any undertakings in the Agreement are seen to be delivered on.

The second stimulus to the following remarks is a consciousness that we as an organisation have been performing some of the functions outlined below, particularly those in relation to providing information and non-financial resources to local groups, and those of providing information on international approaches. We, however, will go out of business at the end of thjs year, when the funding for this project finishes. In my view, this work is valuable, particularly in supporting and bringing together those working in this field, and in encouraging local communities to begin to audit the effect of the Troubles on them, as a precursor to developing local initiatives. It is important that this work should be continued by someone.

1. Crucial role of Victims Commission: Whilst the inclusion of victims in the agreement document of 17 April, 1998 is welcome, it refers and relies on the work of the Victims Commission to provide the substance of the response to the situation of victims. This means that any findings or measures recommended by the Victims Commission will be linked to the agreement, and the ethos of the agreement.
2. International expertise: The agreement makes particular mention of areas worst affected by the troubles, and the need to support community based initiatives in such areas, which should not only be financially supported, but should also be resourced with expertise based on "international best practice" established in other societies coming out of violence. This will involve locating such international expertise, and making it accessible to local communities, in accordance with community development practice.
3. Deconstructing silence and denial: Many of the established voluntary and statutory organisations operating in this field have not addressed the issue of victims of the Troubles, and may have some difficulty in doing so, due to the long-standing culture of silence and denial that has surrounded these issues. Such organisations should be supported, through training, organisational development and other initiatives, to begin to formulate organisational policies and goals around meeting the needs of those who have suffered in the Troubles.
4. Allocation of resources: The agreement also makes mention of "services that are supportive and sensitive to the needs of victims... channelled through both statutory and community based voluntary organisations facilitating locally based self-help and support networks. This will require the allocation of sufficient resources, including statutory funding as necessary, to meet the needs of victims and to provide for community based support programmes." It will be important that those responsible for resource allocation have a sound understanding of the field and are able to evaluate proposals from a broad perspective. It is to be recommended that those with personal experience of bereavement or injury are involved in these processes. It is also crucial that some objective method of evaluating need is adopted, so that resources can be directed at the communities and groups that have suffered most, not merely at those who are good at obtaining resources. Support should also be provided to communities in order to assist them to access resources where the level of need is high, but where the community infrastructure does not exist to obtain resources.
5. The need for a dedicated Trauma Centre: As we mentioned in our earlier meeting, the needs of victims are diverse, with a small number requiring skilled psychotherapeutic treatment of conditions such as Post Traumatic Stress Disorder and the aftermath of torture. We have found that even though the numbers requiring scale of this need are limited, the situation of people is often totally disabling, and the need is not likely to disappear for at least a generation. Visitors to Northern Ireland are shocked that there is not a professional Trauma Centre already established, and in our experience, there is a skills deficit in the professions in recognising and treating such Troubles related conditions. Furthermore, some professionals appear to think that no special skills or knowledge is required for treating, for example, victims of torture. Local practice has been to rely heavily on medication, which is not in accordance with the state of knowledge in the field. Given that there are, in our estimation, several hundred people at least who suffer severe symptoms as a result of failed assassination attempts, witnessing brutality and so on, we would argue in favour of establishing a specialist service. This should be located outside of the normal mental health services perhaps housed within an independent body, in order to avoid stigmatisation and local professional politics. In such an initiative, local professional people coming fresh to the problem can be trained according to international best practice, and sent if necessary to Helsinki or Cape Town to gain the requisite skills and expertise. In my view, such an initiative should glean what it can from international experience in the field, and the appointment of advisors from international sites of excellence, who can act as sources of advice and support would be an invaluable resource.
6. Services for young people: Furthermore, there is a shortage of NHS facilities in mental health in general, with a doubling since 1992 of children and young people held in adult psychiatric wards in Northern Ireland. There are a total of 6 residential psychiatric beds for young people in Northern Ireland.

 

 
 



Children and Adolescents in Adult In-Patient Psychiatric Facilities in Northern Ireland

Year	Number	% increase over previous year	% increase  over 1991/92
1991/92	112	base	base
1992/93	125	11.6%	11.6%
1993/94	137	9.6%	22.32%
1994/95	179	30.7%	59.82%
1995/96	232	29.6%	107.1%

Source of baseline data for each year: Mental Health Inpatient System: Department of Health: increases calculated by author.

Young people, particularly young males as a priority: Given that the agreement document specifically prioritises young people, and given that our research shows that young people, particularly young (Catholic) males are at the highest risk from death in the Troubles, it is important that the support services and provision to young people are urgently reviewed. The major children's charities should be galvanised in this work, to lend it credibility and independence in the communities worst affected. In such communities, both Catholic and Protestant there is widespread disaffection from government agencies, and I fear for the effectiveness of any new initiative from that source. Services to children and young people are currently woefully inadequate, and require urgent review.

7. Family support and therapy: Specialist family therapy services will also be important in providing support for families who have not been able to cope with, for example, the impact of bereavement. We have evidence of parents being unable to fulfil their parental responsibilities because of the impact of a death or trauma on them.
8. Rebuilding the social fabric of communities: Much of the thinking about victims of the Troubles has focussed on individuals and families. However, whole communities and communities of interest have been damaged, the culture of violence has been established in such communities and the social fabric seriously damaged. If there is to be a lasting peace, the work of rebuilding that social fabric in such communities is of crucial importance. This has been a challenge faced by many societies coming out of violence, and again, we should learn from the experience elsewhere.
9. Training for mental health and general practitioners: Some of the resources allocated should, in my view, be used to provide better and further training for mental health and general practitioners in recognising, referring on and treating the mental health sequelae to the Troubles. What is urgently required is a competent service to which they can refer on, and this point was dealt with above in relation to the establishment of a Trauma centre.
10. Training for new and existing professionals: In other professions, such as social work, teaching and nursing, professional bodies should be provided with effective incentives to initiate the inclusion of new training at basic, post-qualifying and in-service levels. This new training would ensure that people practising in these professionals are equipped to recognise and deal appropriately with the effect of the Troubles on people they come into contact with.
11. Resources to support self-help and social support initiatives: Many of those who have suffered require social support and self-help opportunities. Contrary to what might be supposed, the establishment of social support networks and facilitation of self-help initiatives is skilful and work, which requires a sound knowledge base in human services. Specifically, workers in this field must be able to build the capacity in local communities and support local initiatives with expertise, information and access to a wider network. People who have been victims of the Troubles, in our experience, often do not have the personal resources to manage and operate organisations without the support of paid workers who can carry the day to day responsibilities on their behalf.
12. Democratising services & accountability: It is crucial that such initiatives remain genuinely in the control of users, since the "professionalising" of services may well provide cuedos for professionals, but it further stigmatises and disempowers people. What is called for is a new professionalism that makes itself genuinely accountable to its patients and clients in a way many of the professional services in Northern Ireland have not done until now.
13. Employment of former victims: Where possible local people and those who have personal experience of surviving loss in the Troubles are employed in such schemes, and in any new initiatives for those affected by the Troubles.
14. Establishment of an independent body of "experts" with personal experience of loss/injury: Consideration should be given to a permanent independent body or commission that would advise, support and promote work with victims of the Troubles. Such a body should be multi-disciplinary and accountable to (or composed of) a Board of people who have personal experience of loss and injury in the Troubles. Its remit could be to influence existing services to gear themselves towards Troubles-related needs, and to advise and provide resources for local communities who wish to establish local self-help and other services.
15. Trust and acceptablity of new services: In the light of recent developments and the response to the Victims Commission, thought must be given to the participation and accessibility of any new arrangements to both of the main traditions in Northern Ireland. It should be remembered that those bereaved and injured by security forces are often understandably mistrustful of state provision, and often reluctant to participate in, for example the consultative exercise on the Victims Commission, or to use state services. It is part of the healing process that provision should take these fears into account and provide services that are acceptable to the people who need them.
16. Public awareness: In the course of our research, we have concluded that there are two worlds in Northern Ireland. The first world is the mainstream one, where the impact of the Troubles is limited to news broadcasts and occasional fear, inconvenience or upset. The other world is that inhabited by those who have been severely affected by the Troubles, where everything is significant in relation to the Troubles, every street has memories or dangers, anniversaries bring it all back. Most people do not know about this second world. Yet an appreciation of how much people have suffered is an important motivator for people in the task of building a peaceful society. Educational programmes, that are not sensationalist, or focussed on one incident or group of people should be established so that public understanding of victims' medium and long term experience is increased.
17. Truth and justice: For some people who have lost family members, there are strong feelings of injustice in cases where there are unresolved justice issues, missing bodies, unanswered questions. For these people, resolution or healing is often impossible in the absence of knowing more about the circumstances of what happened to their loved ones. The Victims Commission must address the situation of these people, by some formal public means, so that their quest for more information and public acknowledgement of what happened is satisfied as best it can be. We recognise that this is a difficult area in the context of a wider agreement involving prisoners and parties with links to paramilitaries. However, the situation of these people could be put to those parties, with a view to coming up with an agreed mechanism by which the situation of victims' families could be realistically addressed.

Marie Smyth
Project Director
The Cost of The Troubles Study
INCORE
The United Nations University /University of Ulster

22 April, 1998

Marie Smyth © INCORE 1998

Last Modified 22 January 1999
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