Are you an employer who wants to make a lasting impact on mental health? Here are five expert-backed tips from Action Mental Health’s Workplace Wellbeing specialists to help cultivate positive change in your workplace.
1. Focus on Prevention, Not Just Reaction
Prevention is key when it comes to workplace mental health. Research shows that early intervention can significantly reduce the risk of long-term mental health conditions. In Northern Ireland, around one in five [1] adults experience a mental health issue at any given time, yet many do not seek support early enough.
Embedding mental health training, workshops, and awareness initiatives can equip staff with the tools they need to manage their own wellbeing. Proactive support can lead to lower absenteeism, reduced presenteeism, and improved overall staff morale.
2. Invest in Management Training
Managers are often the first point of contact for employees experiencing mental health challenges. However, a recent UK survey found that only 24% of managers feel confident supporting a team member experiencing poor mental health [2]. Without the right training, managers may struggle to have compassionate conversations or provide appropriate signposting.
Providing managers with mental health training empowers them to support their teams effectively, fostering a more open and understanding workplace culture.
3. Provide Accessible Support
Workplace mental health support should be easy to access and clearly communicated. Whether you implement Mental Health First Aiders, Wellbeing Champions, or an Employee Assistance Programme (EAP), it’s vital that staff know where to turn when they need help.
A UK study found that for every £1 invested in workplace mental health interventions, businesses see an average return of £5 due to reduced absenteeism and increased productivity [3]. Investing in accessible mental health support is not just beneficial for employees but also makes good business sense.
4. Adopt a Whole-Organisation Approach
Creating meaningful change requires more than one-off initiatives. To truly embed mental health as a priority, businesses should take a whole-organisation approach. This means ensuring that workplace policies, procedures, and leadership strategies reflect a commitment to employee wellbeing.
In Northern Ireland, mental health-related sickness absence costs employers hundreds of millions of pounds [1] each year. Companies that embed wellbeing into their culture experience higher retention rates and improved workplace satisfaction.
5. Don’t Do It Alone!
Supporting mental health in the workplace can feel overwhelming, but you don’t have to do it alone. At Action Mental Health, we specialise in equipping employers with the tools and expertise needed to support employee wellbeing.
Whether you’re looking for early intervention training, consultancy on mental health policies, or a comprehensive strategy to embed wellbeing into your organisation, our Workplace Wellbeing team is here to help.
Let’s work together to create healthier, more resilient workplaces across Northern Ireland!
References:
Mental Health Foundation (2023). “Mental Health Statistics – Northern Ireland.” Available at: [https://www.mentalhealth.org.uk]
Chartered Institute of Personnel and Development (CIPD) (2023). “Health and Wellbeing at Work Report.” Available at: [https://www.cipd.co.uk]
Deloitte (2022). “Mental Health and Employers: The Case for Investment.” Available at: [https://www2.deloitte.com]
We all enjoy a good joke and can attest to feeling better after a bout of laughing with friends or family, so it’s good to know that the science agrees. Indeed, from research carried out to date on laughter, it appears that sharing a giggle with people can do wonders for our mental health and helps us feel safer and more connected. Plus, it’s fun, so what’s not to like?
According to psychologist, Dr Robert Provine – the world’s leading scientific expert on laughter – the positive emotions we share when we laugh with people is critically important for social cohesion. Basically, when we laugh with those around us, we bond with them and make connections, which reduce feelings of isolation and help boost our mental wellbeing. In short, we form a community and/or a network in which we feel safe and at ease.
Describing laughter as “a social vocalization that binds people together,” [1] interestingly, Dr Provine found that the key stimulus for laughter was usually another person. I.e. we spontaneously laugh more in relation to the person, than what it is they’re actually saying. Laughter is also much more common in social situations than in solitary ones, so we tend to laugh more often when we’re with others than when we’re alone.
Physiological benefits of laughter
Further research shows that, while it “is commonly accepted that laughter produces psychological benefits, such as improving affect, depression, anxiety, and stress,” [2] there are also physiological benefits to laughing.
Indeed, recent studies have indicated that laughter can improve heart health, with the effects of a good chuckle expanding our arteries and increasing the flow of oxygen around the body. [3]. Other physiological benefits of laughter include stimulating the muscles and lungs as well as triggering the release of feel-good endorphins from our brain.
Long-term, laughter can also improve our immune system: “Negative thoughts manifest into chemical reactions that can affect your body by bringing more stress into your system and decreasing your immunity. By contrast, positive thoughts can actually release neuropeptides that help fight stress and potentially more-serious illnesses.” [4]. It can even help to relieve pain, as laughter can assist the body in producing natural painkillers.
Reducing social isolation
Counselling Coordinator – Casual Team at Action Mental Health, Lauren Darragh, said laughter was a great way of connecting people and reducing isolation – which is a key part of the work carried out by her team.
“Studies have shown that laughing also reduces a lot of stress hormones,” she said. “It can impact the dopamine and serotonin levels in the brain. Low levels of these are often associated with depression and low mood, so boosting these through laughter can have a positive effect on our mood.”
She added that laughter could also help to increase people’s resilience and tenacity. Indeed, by reducing stress and boosting the immune system, laughter allows us to refocus – all of which, with our enhanced mood, ultimately builds a more resilient character.
“I think life is about fun as well as overcoming the hardships,” said Lauren. “It’s about laughter and lightness and joy. As a therapist, you hold that hope that there are the positives. With laughter, the huge thing for me is the bond that you find with other people through laughing together. It can show that the person is safe and it encourages connection and communication and reduces isolation.
Lauren Darragh from Action Mental Health.
“At Action Mental Health the majority of our work is based on removing isolation. It’s about encouraging connectedness and counselling is part of that.”
With Action Mental Health’s ‘Stand-up for Someone’ comedy nights planned for April, these offer a great opportunity to enjoy a laugh with friends and family while raising funds for vital mental health services.
“I think, particularly in Northern Ireland, we have a very good sense of humour,” said Lauren. “It’s a part of our culture. Sharing a laugh with someone bonds you. It’s how people make connections and what we know about mental health is that people’s mental health deteriorates without connection. Anything that encourages connection is part of that and something to celebrate.”
A range of acrylic artwork produced by Action Mental Health service-users from our Belfast, Lisburn, Newtownards and Downpatrick locations recently exhibited at 2 Royal Avenue, Belfast.
The paintings, created as part of a series of workshops facilitated by local artist, Robert Peters, were on display in the city centre until January 29. They subsequently took inspiration from our “I AM SOMEONE” campaign, which aims to raise awareness of mental health issues in Northern Ireland and the fact that, behind every statistic, is a real person.
To produce their work, the Lisburn and Belfast service-users participated in a skills-based painting programme supported by the National Lottery through the Arts Council of Northern Ireland*.
“They created paintings which expressed each individual’s view of what recovery might look like, or their experiences of Action Mental Health’s services,” said Robert.
Meanwhile, those in Newtownards and Downpatrick took part in an acrylic painting programme funded by the Public Health Agency’s (PHA) CLEAR Project, which explored the ‘Five Ways to Wellbeing’. The programme subsequently encouraged participants to keep learning by developing skills in colour theory, connect with others through the weekly workshops and take notice of their subject matter, said Robert. He added that all of this then led to the creation of images which depicted how they kept active, while the exhibition then gave the public an opportunity “to see the outcomes and learn more about mental health recovery.”
“The classes were great,” said Robert. “They were very positive and I think all the groups enjoyed the process.
“With the Arts Council workshops we focused on colour theory. We did some work around colour mixing and the differences between colours. Once everyone had learned some basic skills they then came up with an image to represent their experiences with Action Mental Health. From their ideas, they generated prompts using AI and then selected the one they thought fitted that best, before painting these images. The PHA workshops then focused on the Five Ways to Wellbeing, so everyone selected something which represented one of those five things.”
A reflection of hope and support
Participants said they found the classes very enjoyable and that they had had a positive impact upon their mental health.
One client said: “Action Mental Health and in particular this painting class have been a port in the storm, a beacon in the fog of my week. I’ve really enjoyed learning about colour theory and mixing the paint to match different tonal valves.”
Others who took part in the workshops said they had provided “a safe environment to learn” and were “extremely helpful” in supporting their mental health.
“It relaxes me; makes me think about shades and colours,” said one person. “We have a good time.”
Reflecting on what the paintings represented, feedback included “community and friendship” and a “feeling of support,” along with “friendship, trust and acceptance… things that everybody wants in their lives.”
One client said their painting “represents routine, which I need in my life,” while another said theirs was to show “that there’s beauty in the simple things in life and to appreciate even the smallest things i.e. nature.”
“It’s hard not to see Action Mental Health as a flaming beacon of hope and a comforting place of warmth in an otherwise dark landscape of my mental health,” said another participant. “The storm clouds represent stressors, the sunrise, the prospect of a new start and the other beacons in the middle distance, the other Action Mental Health sites in Lisburn and Newtownards.”
Reflecting on the benefits of the sessions, Robert said that any opportunity people had to can together and be sociable while taking part in an activity was positive.
“With art, I think the interesting aspect of that is that you can learn new skills and it bolsters your confidence when you achieve something,” he added. “Also, you get to express something of yourself and spend a bit of time contemplating that – what you enjoy. There’s an idea that we become what we contemplate – so the more opportunities there are to contemplate positive things, the better for our wellbeing.
“Other benefits are to do with how our brains perceive different things. When you’re drawing you’re using the visuospatial area of your brain. While you’re using that you can’t really talk because you’re not using a verbal reasoning part of your brain. So, it gives people a break from the constant ‘brain chatter’ which goes on all the time. Verbal reasoning is over-developed in our society, so to get an opportunity to just concentrate on spatial relationships is great. It lets you switch off that part of your brain and takes you into a different zone. Anything that makes you conscious of yourself in space is a good thing.”
* Thanks to National Lottery players and money raised for good causes.
With Time to Talk Day taking place on Thursday, February 6, this is a great opportunity to raise awareness about the importance of talking about our mental health – and how this can help to improve our wellbeing.
Whether it’s talking to a friend or family member, a work colleague or having a chat with someone in the street, talking can help to ground us and make us feel more at ease. It brings our attention back to the present moment, so if you’re worrying about something or are feeling stressed or anxious, then it’s a great way to stop this in its tracks. Meanwhile, speaking to your GP – or to a professional counsellor or therapist – can offer vital support and help you find the most effective tools and techniques for improving your mental health.
This was the case for Kapeela, who sought out counselling after experiencing a period of stress-related issues during the pandemic – initially through a private psychologist and then via referral to Action Mental Health’s free counselling service. Having felt herself reach breaking point, Kapeela realised that she really needed to talk to someone and counselling gave her the space she needed to address the issues affecting her mental health.
Explaining that it was difficult being away from family during the pandemic, Kapeela said that this sparked her first instance of mental ill-health. Having accessed private therapy and then managed a visit home, her life returned to normal for a while. However, in 2023, a subsequent relationship breakdown followed by a new job and a new house created a lot of fresh stress and Kapeela found her mental health deteriorating once again.
“It was a very stressful time in my life but also, financially, it was quite difficult for me to access private therapy,” she said. “It was quite an isolating time and I didn’t feel I had the right support in place to keep me going. That’s why I got in touch with my GP. They referred me to Action Mental Health and I then had therapy for six weeks through Action Mental Health.
“I was able to have talking therapy consistently every week with my counsellor. We went through lots of helpful tools – working on guilt, shame, self-esteem. I had that nine months ago and am still able to apply most of those tools to my day-to-day life. It made a huge impact and I really needed it, so I was grateful that the service was there and accessible and free. I definitely benefitted from it.”
Carving out a safe space to talk
Describing her talking therapy experience at Action Mental Health as a “very cathartic” experience, Kapeela said her initial nervousness soon gave way to relief at having a safe space to talk.
“It was online and I definitely felt that I was in good hands,” she said. “My therapist was very experienced and knew how to work with me. I think during those six weeks it was a very helpful experience.”
During the sessions with her Action Mental Health counsellor, Kapeela explored various tools and techniques, which she then used to support her mental health going forward. As part of her therapy, she also discussed her core beliefs, as well as topics such as guilt, shame and self-esteem.
“My counsellor was able to provide me with tried and tested methods of training to cope with my core beliefs,” she said. “She was able to answer my questions and was available through email as well. She told me to contact her any time during those six weeks. She also encouraged me to journal and to bring (what I wrote) along to the therapy sessions so we could discuss them. It felt like a very involved experience – like we were in it together trying to cope with the issues. I was then able to lean on others a lot more, too.
“After the therapy sessions ended I realised what my coping mechanisms might be. They highlighted my strengths – that were really inside of me the whole time – and I was able to rely on myself a bit more and have more confidence in myself to use those tools and get back to my day-to-day life.”
Ultimately, Kapeela said that her therapy experience with Action Mental Health had helped her to share her problems and to feel less alone when, at the time, she had felt the opposite. She added that being able to lean on other people had also removed that feeling of having the “entire weight of the world on your shoulders.”
“It can feel very isolating when you think that your problems are not relatable to somebody else, but speaking to a talking therapist… they’re able to get to the crux of the situation and to draw things out of you and work through it with you,” she said. “That’s something my therapist at Action Mental Health was able to do.”
Counselling services at Action Mental Health
At Action Mental Health we provide a wide range of counselling services to both children and adults.
Indeed, during 2023 – 2024 Action Mental Health’s counselling team delivered 16,825 counselling sessions to 2,956 individuals and families across Northern Ireland. Participants described how the sessions provided them with a safe space in which to talk to someone who understood and listened to them, with feedback also stating how therapy helped them feel calmer and more open to talk.
Of the total counselling sessions delivered by Action Mental Health during 2023 – 2024, 12,662 of these were with 2,200 adults. Meanwhile, 28 families benefitted from 133 counselling sessions across the year, with 4,030 sessions delivered to children and young people.
Our counselling services include:
Counselling for adults: Service-users can choose from a variety of therapy options, including Person-centred therapy, Cognitive Behavioural Therapy (CBT), Psychodynamic, Somatic/Body-focused therapy and Art Therapy.
HOPE schools counselling: Our HOPE counselling programme, delivered in partnership with the Education Authority, provides counselling in post-primary schools across Northern Ireland.
Postvention (supporting those impacted by suicide): Available in the South Eastern and Belfast Trust areas, this service is delivered to families and communities which have been impacted by suicide.
Counselling for children and young people: Our counsellors work with primary school children (5-11 years) as well as with young people (12-17 years), providing mental health support in schools and at our various premises. We also work together with social services to support children and young people.
If you or someone you know needs counselling, then you can contact our team here.
While January may not be everyone’s favourite month, in recent years it has become synonymous with ‘Blue Monday,’ thanks to a marketing stunt from a travel company back in 2005. Despite the fact there is no scientific evidence to support the concept of Blue Monday, however (and that it was fabricated to sell holidays…), it has nevertheless lodged itself as a concept in our collective psyche.
Supposedly taking place on the third Monday of January, making it January 20 this year, Blue Monday is alleged to be the most depressing day of the year. The original reasoning given for this was that factors such as debt after Christmas, low motivation and bad weather all worked together to make this third Monday ‘the worst one’. Indeed, the company that coined the term claimed to have come up with a formula as to why this date was so depressing (the equation was later discovered to have been fabricated).
However, attaching the word ‘depression’ to a particular day and suggesting that it is something you can experience for 24 hours and then move on from, risks undermining what depression actually is. As a diagnosed condition, clinical depression is a serious mental illness and it is, of course, impossible for the entire nation to succumb to collective depression on a single day. It is more than a passing ‘low mood’ and can significantly impact upon people’s day-to-day lives in a variety of ways.
In the darker days of winter, some people may suffer from Seasonal Affective Disorder (SAD), where low mood can result from reduced sunlight. Again, this is different from depression and usually only lasts until the days begin to lighten once more – and it isn’t restricted to January or a single day.
Ultimately, while January can be a challenging month due to reduced finances after Christmas, bad weather, less sunlight and various other things, there is no proof to suggest that people actually feel significantly worse at this time of year. Different seasons and periods of our lives may cause more difficulty than others and, although these can coincide with January, it doesn’t mean that this month is any better or worse than the rest. It’s important to be aware of our mental health all-year round and, if you’re struggling, then there are things you can do to help this.
The Five Ways to Wellbeing are a great place to start and are focused on connecting with people, getting active, taking notice of things around you, learning a new skill and giving. Talking to someone you trust – or to a professional – is also important, if you have poor mental health.
If you need someone to talk to …
If you’re struggling with your mental health, then it’s important to speak with someone – and help is out there, should you need it. If you’re in crisis, then talk to your GP, as they can diagnose conditions and outline possible treatment options. You can also contact the organisations below at any time.
Minding Your Head: Access information about mental health and the issues that can affect it, along with tips on how to maintain good mental health. www.mindingyourhead.info/
Lifeline: A Free 24-hour crisis response helpline for people who are experiencing distress or despair, where trained counsellors will listen and help immediately on the phone and follow up with other support if necessary. Tel: 0808 808 8000 / www.lifelinehelpline.info
Samaritans: A registered charity aimed at providing emotional support to anyone in emotional distress, struggling to cope, or at risk of suicide throughout UK and Ireland, often through their telephone helpline or online chat. Freephone: 116 123 / www.samaritans.org/
(L-R) Joanne McClelland, Talent Acquisition Specialist at Henderson Group; Lauren Houston, Workplace Wellbeing Coordinator; David Babington, Action Mental Health CEO; Dr Ruth Fleck, Consultant Clinical Psychologist; Heather White, Head of HR at Lunn’s Jewellers.
A new online platform and membership scheme created by Action Mental Health to help HR professionals support their workforces more effectively with their mental health and wellbeing launched at The MAC, Belfast on Thursday, 23 January.
Created by our team of experienced professionals, the Workplace Wellbeing Hub offers bespoke solutions for organisations of all sizes. Those who sign up will subsequently benefit from a range of strategic mental health and wellbeing consultancy, training and support, along with a suite of professional online resources, webinars and more.
David Babington, Action Mental Health CEO.
Speaking at the launch, Action Mental Health CEO, David Babington, said the Workplace Wellbeing Hub was unique in that, it not only offered tailored support to employees but also specifically assisted HR and wellbeing professionals in supporting their workforce.
“There remains a significant unmet need for businesses in terms of supporting their staff and addressing their wellbeing needs,” he said. “Whilst workplace training has been part of Action Mental Health’s service offering for a number of years we have never had a membership offering or digital platform designed specifically for this purpose.
“The new Workplace Wellbeing Hub strengthens our existing services by combining digital innovation with expert, locally-delivered support – offering employers a comprehensive solution to workplace wellbeing.”
Also speaking at the launch were Joanne McClelland, Talent Acquisition Specialist at Henderson Group – one of Action Mental Health’s partners – and Heather White, Head of HR at Lunn’s Jewellers, which is one of the first employers to sign up to the Wellbeing Hub. Consultant Clinical Psychologist, Dr Ruth Fleck, also addressed attendees, along with Lauren Houston, Coordinator of Action Mental Health’s workplace wellbeing services.
“We’re incredibly fortunate to have worked alongside Action Mental Health and over the past year have witnessed their expertise and support,” said Heather. “The feedback from our managers and colleagues has been nothing short of exceptional. It’s given us the confidence to support each other in the workplace and at home. The support from Action Mental Health has been invaluable and being part of the Workplace Wellbeing Hub going forward is a key part of our business strategy for this year.”
Dr Fleck added that organisations had a duty of care to their staff to implement impactful mental health care within the workplace, something that required long-term investment rather than one-off training days or events. “It’s about having a range of strategies in place – a complete and whole-system change and approach.”
Workplace Wellbeing Coordinator, Lauren Houston with Action Mental Health CEO David Babington and Dr Ruth Fleck.
With many of us kick-starting the year with personal fitness goals and resolutions to prioritise our health and wellbeing in 2025, why not help both yourself and others in the process?
At Action Mental Health we have multiple opportunities throughout the year for runners to take part in a range of marathons and half-marathons, both locally and further afield. Indeed, if Belfast doesn’t appeal, then how about Vienna, Rome, Paris or Milan? The perfect opportunity to combine some sightseeing with your running, you could even make a holiday of it and book a few days away to really make the most of your trip.
Whether you’re new to running, are an occasional runner or a seasoned marathon-goer, our events are scattered across the year, so there’s plenty of time to train up for a good cause. By running on behalf of Action Mental Health you’ll subsequently help to raise awareness of our services for people in your local community as well as assisting with vital fundraising to help us continue delivering these. You’ll also have something to work towards, with a clear running goal, which will give that added sense of achievement when you complete your run.
So, this year, why not run for a reason and sign up to one of our marathons or half-marathons? Your support today will ultimately help to make someone’s tomorrow that bit brighter.
Embrace the mental and physical benefits of running
There are many benefits to running, both to our physical and mental health, so it’s a great way to keep fit and healthy, no matter what age you are. It’s also a flexible hobby as you can do it whenever suits your schedule and is relatively cheap, as the key essentials required are simply a good pair of running shoes and some appropriate running kit.
Advantages of running:
Boosts heart health: Research shows that running strengthens the heart and lowers your resting heartrate, making it more efficient. Running further reduces the risk of heart disease, as a healthier and more robust heart is less likely to succumb to illness.
Improves muscle and joint strength: Running makes your body more resilient so if you run regularly, your muscles will get stronger and this in turn will help to prevent injury. Your joints will also benefit, as research indicates that runners actually experience less wear and tear on their joints than those who don’t run.
Better mood: The so-called ‘runner’s high’ is true as it has been found that running boosts our mood and enhances mental wellbeing. It reduces feelings of stress and anxiety and makes us feel better and happier in ourselves.
Gets you out in nature: When we run outside it allows us a chance to get out and about in nature, which is also known to boost our mental wellbeing.
Improves sleep: Running, especially earlier in the day, gives us energy while ultimately tiring out our body in a good way. It means that, by the time we go to bed, our bodies are better prepared for sleeping, while the sleep we experience will be better quality as a result and we won’t find it as difficult to nod off.
Run for a reason in 2025
If you’re ready to give running a go this year then we’re currently accepting applications for our various Action Mental Health running challenges in 2025.
Having launched our “I AM SOMEONE” campaign on World Mental Health Day last October, we’re now encouraging our supporters to ‘run for someone’ by participating in one (or more!) of our marathons or half-marathons. Why not run for a reason this year and help to support people in your community who are struggling with their mental health?
With Northern Ireland experiencing some of the highest rates of poor mental health in the UK, transgenerational trauma is a term that has surfaced more frequently in recent years and been linked to various mental health issues here.
The term essentially refers to how the trauma of a previous generation impacts upon the next i.e. those who have experienced trauma may also pass this trauma on to their children. In 2022, OUR Generation, a collaborative PEACE IV programme between various organisations – of which Action Mental Health is lead partner – launched Transgenerational Trauma Awareness Day (TTAD).Essentially, this is a day to highlight what transgenerational trauma is and to generate discussion around it. As OUR Generation (OG) is a cross-border initiative with a specific focus on youth mental health and wellbeing, addressing the issue of transgenerational trauma is subsequently an important element of OG’s ongoing work.
Transgenerational Trauma Day was launched in 2021.
As part of the TTADs to date, events have included speakers such as Northern Ireland’s Mental Health Champion, Dr Siobhan O’Neill, along with experts from Ulster University, Queen’s University Belfast and the Northern Trust’s Regional Trauma Network.
While it’s important to highlight that transgenerational trauma is a very real issue, however, there should also be clarity around what exactly it is – which is another element of TTAD. Indeed, not everyone who experiences trauma will suffer from conditions like PTSD and the children of those who do will not necessarily always experience trauma themselves.
Dr Michael Duffy.
Dr Michael Duffy is a Consultant Cognitive Psychotherapist specialising in PTSD and complex grief. A Senior Lecturer and Director of the Specialist MSc (Trauma) in Cognitive Behavioural Therapy at Queen’s University Belfast, he leads the QUB Trauma Research Network and is a research/clinical advisor to the Northern Ireland Regional Trauma Network. He subsequently spoke with us about transgenerational trauma, including his ongoing research into Complex PTSD (CPTSD) and Prolonged Grief Disorder (PGD) – and how this will help to shape the future of mental health services.
Why transgenerational trauma isn’t always the answer
When it comes to discussing transgenerational trauma, “we need to take care about what we mean,” said Dr Duffy, “because a lot of research is based on false assumptions.”
“It would be wrong to assume that just because your parents have been exposed to trauma that you’re going to suffer,” he said. “That’s not the case. The vast majority of people exposed to traumatic events don’t get PTSD. It’s a false assumption to say that they do.
“However, there are some studies internationally and here, in Northern Ireland, that very clearly indicate that the children of people who have suffered from prolonged and severe trauma are more at risk of developing mental health problems. One example of this is with survivors of the horror camps during World War Two. Follow-up research with the children of these survivors showed they had a high risk of PTSD, even the grandchildren. But what we don’t know is the detail – the mechanism that led to that.”
Discovering this detail – the exact cause of any subsequent mental health issues in the descendants of trauma survivors – will ultimately help to explain transgenerational trauma more precisely. Indeed, recent American research with Holocaust survivors has suggested that transgenerational trauma within that context could actually be biological and therefore physically inherited.
“Their hypothesis was that transgenerational trauma can be conveyed in a very physiological way,” said Dr Duffy. “But I think we have to be quite careful about that. There are various answers to this – and no simple answer.”
He added that, with a range of factors to consider when discussing transgenerational trauma, there were also different reasons as to why children could develop mental health issues. Particularly in Northern Ireland, where there was a legacy of the Troubles, it was important not to assume that childhood mental health issues, when they presented, were always due to trauma passed on by parents or carers.
“For example, we’ve always known that children raised by mothers that have depression are more at risk of developing depression,” he said. “The kids grow up vulnerable and have anxiety conditions. These children are at high risk of developing mental health problems.
“Some small studies have been done here with my colleagues where they have looked at children exposed to challenges from the Troubles. They used drawings [to gain insight into their mental health] and most of those kids drew normal pictures. Some drew pictures of soldiers etc. but where there were incidents that the children had difficulties, we traced it back again to the fact the parents had mental health problems.”
In short, conflict situations like the Troubles mean that more people are exposed to high-risk situations and those who then go on to become parents are subsequently more susceptible to having mental health problems. A direct result of this is that their children are also more likely to experience mental health issues – although not all of them necessarily will. Whether or not this can be referred to as transgenerational trauma, however, is less clear.
Researching new therapies for Complex PTSD
Regarding his own research, Dr Duffy recently studied children within the care system, assessing whether frontline services had a validated diagnostic tool to identify PTSD in children who had suffered maltreatment [1]. The results indicated that there were “very high amounts of PTSD and very few had been diagnosed.”
“Without the correct diagnosis you’re not going to get the correct therapy,” he said. “I shared that as a wake-up call.”
His current research, however, is predominantly focused on Complex PTSD (CPTSD) and Prolonged Grief Disorder (PGD) – two terms recently added to the International Classification of Diseases-11 (ICD-11) Diagnostic Manual (WHO, 2018).
According to a report on Conflict, Trauma and Mental Health published by QUB and the Commission for Victims and Survivors (CVS) in 2022 [2], which was led by Dr Duffy, “both of these conditions are pertinent to the psychological distress experienced by many victims of the Northern Ireland “Troubles”.”
“We have a large multi-sector trial taking place in England and Northern Ireland for CPTSD – PTSD that’s usually linked to childhood traumas, child abuse or prolonged and extensive trauma in adulthood, for example, rape or being held prisoner,” he said.
“Complex PTSD is a new condition. There have been no studies so far to test what works in terms of therapy for this, so we’re testing trauma-focused cognitive therapy that works for PTSD – does it also work for CPTSD? The argument ‘in field’ has always been that we shouldn’t start straight in with therapy for PTSD – proceed slowly. So, half of the patients will be randomised phased and the others will go straight into the 26 therapy sessions. Follow-up will then take place three and six months later to see where they are.”
Delivered as part of a £2m NIHR research grant, the project involves a wide range of people from across Northern Ireland and England, many of those from NI having had experiences of the Troubles.
“Mental health is noticeably different from all other forms of healthcare in that the concept of evidence isn’t held in the same regard,” said Dr Duffy. “But the wrong therapy can make people worse, so it’s really important that evidence-based treatment is embraced in the mental health sector. Clients who have a certain condition should only be offered the therapy that works for that condition. When clients are referred, they should then be offered a range of therapies – and those with the strongest evidence base.
“The rates of poor mental health are on the increase and we can’t afford as a society to have people drifting through ineffective therapies. We’re getting better with this, though.”
Trauma-based therapy for Prolonged Grief Disorder
Another key piece of research Dr Duffy is currently running relates to Prolonged Grief Disorder (PGD) – also recently added to the International Classification of Diseases-11 (ICD-11) Diagnostic Manual (WHO, 2018).
“Like CPTSD this is a relatively new category developed in the last few years,” he said. “It’s to differentiate people who suffer from normal grief reactions and those who have prolonged grief. These people need an evidence-based response as studies show that traditional grief counselling doesn’t work with them. What we’re doing is looking at what does seem to work and developing a therapy model for PGD.”
Using current PTSD treatments as a baseline for PGD therapy, Dr Duffy said that PGD usually occurred after a traumatic or sudden loss and was characterised by social withdrawal. “There’s an element of trauma that we have to treat with PGD,” he added. “We have to try to find out about what’s going on in their minds and how their patterns of behavior change. We’re getting very encouraging results but we need good research to understand PGD better and develop more effective therapies. That’s our next big project.”
With a clear need for more evidence-based practice within the mental health sector and more specialised and consistent treatment for conditions such as CPTSD and PGD, there is still a way to go on this front. Indeed, the joint report commissioned by QUB and the CVS stated that a “substantial proportion of victims and survivors of the recent Northern Ireland conflict have enduring mental health needs that requires a comprehensive, joined-up, evidence-based service response.”
Research like Dr Duffy’s is, however, helping to address this, with all learning feeding back into training up the next generation of therapists and, ultimately, evolving mental healthcare delivery.
“It’s been a learning model over the years,” he said. “We research, bring that back into our courses at QUB and then update our teaching based on what we learn. And from there, we enable more effective treatment to be delivered to those who need it.”
About Dr Duffy
Dr Michael Duffy is a Consultant Cognitive Psychotherapist specialising in PTSD and complex grief. A Senior Lecturer and Director of the Specialist MSc (Trauma) in Cognitive Behavioural Therapy at Queen’s University Belfast, he leads the QUB Trauma Research Network and is a research/clinical advisor to the Northern Ireland Regional Trauma Network. Dr Duffy is also a Fellow of the Centre for Evidence and Social Innovation; Assoc. Fellow of the George J Mitchell Institute for Global Peace Security & Justice; Fellow of the British Association for Behavioural and Cognitive Psychotherapy and a member of the UK Trauma Council.
Dr Duffy led the work of the trauma team after the Omagh bombing in Northern Ireland in 1998 and published research on the psychological effects of this event on adults, children and adolescents. He was later team leader at the Northern Ireland Centre for Trauma (NICTT) and led two clinical trials on the application of TF-CT for conflict-related PTSD. In addition to this, Dr Duffy has provided many workshops on PTSD after large-scale traumas, including: 2004, New York the 9/11 Twin Towers attack; 2005, 7/11 London bombings; 2012 Oslo bombing and Utoya Island shootings; 2017, the Manchester Concert bomb.
Dr Duffy’s main research is focused on PTSD and evidence-based psychological interventions and he is currently researching PTSD with children who have been maltreated or abused. He is also looking into new cognitive approaches for complex grief and complex PTSD. Dr Duffy has provided many webinars and podcasts including a recent BBC documentary entitled ‘PTSD – Stress of the past’.
References
[1] Duffy, M. et al. (2021) Screening Children with a History of Maltreatment for PTSD in Frontline Social Care Organisations: An Explorative Study. Child Abuse Review, Vol 30 (6) pp. 594-611. https://doi.org/10.1002/car.2735
Yehuda, R.; Lehrner, A. (2018) Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry, 17 (3), pp. 243-257. DOI: 10.1002/wps.20568. PMID: 30192087; PMCID: PMC6127768.
Day, N.; Shloim, N. (2021) Therapists’ experiences of working with the intergenerational impact of troubles-related trauma. Available at:https://doi.org/10.1002/ppi.1585