Responding to Nationwide Psychological Trauma

1. Prof Philip MorrisMB BS BSc Med PhD FRANZCP FAChAM (FRACP) AmBPNAmBIMEBond University PresidentAustralian and New Zealand Mental Health Association www.drphilipmorris.com Responding to Nationwide Psychological Trauma

2. Norway’s Trauma Anders Behring Breivik

3. Anders Behring Breivik Norway’s mass killer July 2011 69 people murdered at gunpoint on the island and 8 people murdered in a city bombing in Oslo Trial just started He has confessed tothe killings Not guilty plea as “acting is self defence” He defends his actions as “cruel but necessary” against “state traitors” for opening up Norway to a “Muslim invasion” and multiculturalism Saluted in a raised arm and clenched fist Said he does not recognise the court’s legitimacy

4. Court Decision As there is little doubt he carried out the carnage, the court’s decision is about whether he is sane and accountable for his actions Psychiatric spectrum Psychotic – drug intoxication – unusual personality (paranoid/schizoid/schizotypal/eccentric) – antisocial/narcissistic psychopath – or just plain ‘evil’

5. Most psychiatric patients are anxious, withdrawn, shy and avoidant Hardly likely to engage in threatening behavior But, the combination of psychosis, substance abuse and antisocial personality make-up can be associated with violent actions Psychiatric opinion in Norway is divided For the record my opinion about Breivik is that he has schizotypal/paranoid personality traits embedded in an antisocial psychopathic personality The court will have to make up its mind

6. 77 deaths and a large number of other ‘survivors’ in population of five million Many adolescents and young adults All have families, school and college friends, and associates A significant proportion of the entire population likely to be affected either directly, indirectly or vicariously

7. The nation and individuals feel – fear, anger, sadness, survivor guilt And will ask “why?” – a question not easily answered Followed by realization of loss with associated feelings of posttraumatic stress and intense grief

8. National trauma response Reassurance and comfort from authority figures Initial help to provide ‘basics’ – safety, water, food, shelter, medical care Connect affected individuals to ‘natural’ supports – family, friends, church, community services Make a register of identity and contact details of all survivors and bereaved families so all can be monitored over time

9. Provide information to affected individuals on what to expect, what are ‘normal’ and other reactions to the devastating circumstances, and when and how to get help Provide information to the public on what to expect about individual and community responses to the disaster, and how to be of assistance to people more directly affected Arrange national observance services and ceremonies to recognize the losses and the survivors experiences and needs

10. For all individuals and the nation life will never be the same For most affected the intense distress will fade and recovery will gradually build – the value of resilience Unfortunately a small proportion of survivors and bereaved will remain emotionally unwell A regular follow-up program for those registered initially is essential to identify and provide early medical and psychological assistance – that may need to be ongoing

11. Suicide - The ‘silent’ nationwide psychological trauma In Australia more suicides than road deaths annually – 2400 deaths from suicide Yet no national ‘suicide toll’ Journalist reporting guidelines have muzzled public debate about suicide Suicide is not a personal event – there are many survivors and others affected and bereaved by suicide

12. Suicide is a multi-determined behavior But psychiatric illness and the quality of psychiatric services must play a part In Queensland (2007) more than half (86) of 140 unexpected deaths in Q Health patients were psychiatric cases – nearly all from suicide within a week of not being admitted or within a week of being discharged from hospital In Victoria (2005) 42 deaths by suicide in young adults were linked to inadequate psychiatric treatment

13. Publish mortality data from individuals under care of public and private mental health services Suicide deaths Fatal single driver road death ‘accidents’ Unexpected deaths Homicides Police shootings

14. A standing audit or commission of inquiry into all suicide deaths Independent of health department and executive government Review hospital or community deaths ‘Pathway to death’ explored Nature of contact with mental health services in three month period prior to suicide Monitor accessibility and quality of services Comment on application of mental health acts Make recommendations to parliament

15. Where is our nationwide response to the psychological trauma of suicide? A challenge for the future!

16. Thank You! www.drphilipmorris.com