Eleanor Keegan was just 16 years old when she went to see Ariana Grande at the Manchester Arena with her friend Tom. She should have joyful memories of the concert, but it’s now seared in her memory for all the wrong reasons, and keeps her up at night.
“I saw children wearing Ariana’s white merchandise covered in blood,” she remembers. She now suffers from “nightmares about other traumatic things, like school shootings and knife attacks”.
Like hundreds of others who witnessed the bomb explode, the trauma of the night of the 22 May 2017 has left a long shadow on Keegan’s life. But because she wasn’t directly affected by the explosion – like hundreds of others, she witnessed the immediate aftermath – she says she has struggled to get the help she needs.
It’s something local mental health services have tried to address. Soon after the attack, a support centre was set up to help children, young people and adults who were struggling to cope with what they had seen. Called the Manchester Resilience Hub, it was billed as a place where “everyone who was affected, wherever you may live”, could seek help.
The Hub sent an online assessment to everyone who had bought concert tickets, and respondents were categorised as red, amber or green priority. Red individuals were highly symptomatic and potentially suicidal, while amber individuals presented several symptoms and green individuals fell into the sub-clinical range.
Six months after the anniversary, the Hub was supporting 2,500 individuals. Today, exactly a year after the attack, and the number has risen to 3,100, with everyone being re-screened at three-month intervals. Twenty percent of people they treat are children. While they have secured funding until 2020, the team is made up of less than 20, mostly part-time, staff.
Dr Alan Barrett, the lead clinician for adults at The Hub, says it was set up because “after this kind of attack, everyone understandably focuses on life and limb saving practices and community safety. This can mean that mental health is viewed as a lower priority.
“It is just as valid and distressing, but it’s harder to get treatment for because many professionals don’t know about it.”
Dr Mike Drayton, consultant clinical psychologist and associate of the Cabinet Office Emergency Planning College agrees, and says even people who aren’t physically injured in a terror attack “are going to be really shaken up and distressed” afterwards.
“Further down the line they may develop symptoms like severe anxiety, insomnia, flashbacks, nightmares and survivor’s guilt” – symptoms which are similar to those of post-traumatic stress disorder, and can be triggered “not from witnessing anything particularly gruesome or horrible”.
Janet Sherret, 55, travelled from her home in Fife with daughter Kaela, 12, who had counted down the days to the Grande concert, planning her outfit well in advance and making a poster especially.
“I still feel guilty. Kaela had been mesmerised and glowing with happiness, but after the attack she had lost her usual sparkle. She made up illnesses to stay off school and didn’t want to be away from me,” Sherret says.
“I consider us lucky to have escaped uninjured, but the mental scars - that we had been in the same building as a suicide bomber - will remain,” she says.
As an outpouring of support focuses on the injured and bereaved, and huge efforts are made to properly celebrate the lives of those who died with memorials, funds and charities, some psychologists say thousands of people who escape physical harm in terror attacks – like Keegan and Sherrett – may have been left unsupported in dealing with secondary trauma.
Sherret says her daughter is still struggling with symptoms of secondary trauma. “Kaela’s school mentioned referring her to CAHMS (the NHS’s Child and Adolescent Mental Health Service) but nothing seemed to happen. Perhaps I should have persisted,” she says.
“Six months later my anxiety got much worse. I thought several times about ending it all”
Madeleine Bird, 22, from Cardiff, fled the arena after having attended the concert alone. In the immediate aftermath, she says she stood unable to move, expecting gunmen to storm the arena.
“My dad is a professional musician so I immediately knew it wasn’t a speaker blowing, like many initially suggested. I didn’t see any bodies, but running through the streets alone with no phone signal is terrifying when there are sirens blaring and thousands of people around you.”
“Six months later my anxiety got much worse. I thought several times about ending it all.”
With such severe symptoms, it might seem like a given that there is comprehensive support for those suffering from secondary trauma. Yet this is often not the case.
The professional advice suggests you should seek help from your GP within four to six weeks after witnessing a traumatic event. However, as NHS GP Toni Hazel says: “Mental health services have been underfunded for years and GP funding has fallen in real terms for at least a decade. We’re understaffed, struggling to recruit and waiting lists for anything but the most basic psychological therapy are routinely 6 to 12 months.”
“Patients who have suffered trauma need long appointments and continuity of care but this isn’t always possible because we are snowed under.”
For some people, the Hub has been a lifeline. Rachel Crowcroft, 42, from Otley, says she had felt exhausted trying to find support for her and 11-year-old daughter Ellie, yet “after the Hub was set up I found them a massive support. They did the door knocking for me.”
Keegan, now 17, disagrees. “I felt the Hub was just there to make the services look good. They did not offer any helpful support. I had to wait until the start of 2018, when I began Eye Movement Desensitisation and Reprocessing (EMDR) therapy with the NHS,” she says.
Many people we interviewed say they have turned instead to Facebook support groups. “I found a group that has been more of a support system than anything we have been offered from the Hub or the government. It’s disgusting how many children are still on waiting lists to this day,” says Keegan.
Psychologist Dr Mike Drayton advises those with family or friends suffering from secondary trauma to keep a watching brief. “Don’t fuss around them, or give advice, just check in and ask them how they are. The most important thing is to listen.
“If someone has been traumatised, don’t think for a minute that they’re not thinking about it just because they’re not talking about it.”
As the anniversary memorials kick off today to mark the year since the attack, Crowcroft says she feels let down in many ways. “I’m angry that NHS cuts mean that it took nine months for my daughter to access help and 10 months for me.
“Being left to our own devices encouraged our fears to develop and for us to become isolated.
“We’ve just had to muddle through.”