The rise of traumatic events amongst many populations has led to greater exposure to traumatic events (TE) worldwide, including terror attacks, conflicts, interpersonal violence, severe car accidents and natural disasters. Internationally, the impact of trauma-related disorders is becoming increasingly concerning. Research and experience indicates that for every patient who is physically traumatised, there are a further 15 - 25 people who are psychologically injured. The World Health Organisation (WHO) has recently conducted extensive mental health surveys  encompassing 29 countries across six continents and producing extensive, cross-nation community epidemiologic data. The results indicate that overall exposure to a traumatic event ranges between 28.6% and 84.6% within a lifetime. 1
The five most commonly reported traumatic events, accounting for over half of all exposures, include witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, experiencing a life-threatening illness or injury 1.

Exposure to traumatic life experiences is a precondition to develop trauma and stress-related disorders including Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD). However, the relative risk for developing ASD or PTSD depends on personal risk factors including occupation such as emergency first respondents, veterans, policeman, cultural factors, country, including issues such as low income or post-conflict region, and the nature and severity of the event amongst others(2-11). The level of PTSD identified within the general population varies according to the year of the study, country, diagnostic criteria (DSM or ICD), methodology employed and population studied. However, data from the recent WHO Mental Health Surveys give an overall cross-national, lifetime prevalence for PTSD of 3.9% in the total sample and 5.6% amongst those recently exposed to trauma (12).

Stress disorders and particularly PTSD have a significant impact on the lives of individuals, their families, health services and society in general (13, 14). PTSD has been associated has been associated with increase comorbidity of depressive disorders, anxiety disorders and substance abuse (13, 15); medical illness (13, 16-18); work role disability and functional impairment (19, 20) and; suicidal behaviors and suicidality (21-24). The costs of PTSD to society are both direct and indirect. Firstly, via utilisation of health and related support services (25-28) and secondly, due to loss of years of productivity, premature retirement, job loss and unemployment (15, 26, 29, 30).

Update on findings/work of Heads Up CIO

Since 22nd May 2017, Heads Up CIO has been active in providing Cognitive Psychological First Aid. To this end, we have trained nearly 100 volunteer mental health therapists who have actioned their training to support those effected by the terrorist attacks at Manchester Arena and London Bridge as well as the tragic fire at Grenfell Towers. This body of therapists now exists to form a reserve corps of emergency psychological first respondents in the case of further terrorist attacks or major disasters. Our service was not only sought out by the general public but also by first responders and professionals who were vicariously traumatised by their experiences. It has become clear that staff including NHS emergency staff, ambulance and A+E staff, police, fire Services, EMS services, transport workers are particularly vulnerable to both trauma and vicarious trauma. The need for immediate need for training in Cognitive Psychological First Aid and Personal Resilience Training for those groups is therefore two-fold and particularly pressing. 

Heads Up action following the Manchester Arena bombing (MA 17) including intervening with over a hundred victims during the first three weeks of the aftermath has proven the acute need and the efficacy of our service.


Heads Up was born to fill a gap and to take bold action.

The Gap: Dedicated emergency response to casualties of psychological injury immediately following terrorist and mass casualty events.

Bold Action: Creating a National Programme that will reach out with speed, compassion and professionalism in the service of preventing and treating costly psychological and behavioural problems due to stress and trauma caused by terrorist action and mass casualty events.

Our aim:

1) To educate, prepare and train the general population for future mass casualty disasters to reduce risk of trauma and further complications, build capacity to deal with major events, improve resilience and mental health whilst simultaneously lowering risk for anxiety, stress and depression.

2) To provide Cognitive Psychological First Aid and Resilience training to mental health professionals, first-responders and emergency staff.

3) To provide a free-at-point-of-service emergency response service for the psychologically injured at mass casualty events due to terrorist action, natural disaster, criminal behaviour or accidents, caring for those affected while the other emergency services get on with the job.

4) To develop and build strong, resilient, caring and nurturing individuals within the different communities of the UK by encouraging and training more citizens to be proactive in responding and working together.

How is this done?:

1) Providing a free at-point-of-service emergency response team to reach the scene of traumatic events with speed, compassion and professionalism. (This will reduce the need to evacuate to expensive A&E units and improve the efficiency of the mass-casualties disaster management by allowing self-evacuation and lowering risks of mass hysteria, community trauma and chaos).

2) Establishing a site-specific, follow-up clinic immediately following such    events that will provide professional support to reduce the psychological impact of trauma. 

3) Implementing a national prevention training programme to create a state of preparedness for the general population, professional and emergency staff on how to cope with the stress and trauma following terrorism and other mass casualty events.

The evidence is clear; immediate support is essential to stem the flow of mental health issues and mental illness resulting from these horrific events. Complications such as PTSD are expected to affect many of the population directly as well as the impact on services and wider society.

In the aftermath of the tragic event in Manchester alone and based on expert experience, numbers reaching as high as 1600 people required psychological support following this traumatic event. The number increased dramatically after recent terrorist attacks in London and the Grenfell Tower fire further compounding the sense of community trauma which exacerbates individual suffering. It is likely that a fair number of those will need follow up treatment in the weeks and months and maybe years to come. Suffering on this scale has a ripple effect across communities and throughout the lives of those directly affected. For some, their need for support will be long-term. It is our hope to bring the lives of as many as possible back into balance as quickly as possible. We aim to do this by providing direct support and equipping society with the means to prevent and respond in the best way possible to protect our mental wellbeing on a national scale.


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3. Liu H, Petukhova MV, Sampson NA, et al: Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys. JAMA psychiatry 2017; 74:270-281
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16. Frayne SM, Chiu VY, Iqbal S, et al: Medical care needs of returning veterans with PTSD: their other burden. J Gen Intern Med 2011; 26:33-39

17. Alonso J, de Jonge P, Lim CC, et al: Association between mental disorders and subsequent adult onset asthma. J Psychiatr Res 2014; 59:179-188

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21. Ramsawh HJ, Fullerton CS, Mash HB, et al: Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army. J Affect Disord 2014; 161:116-122

22. Bernal M, Haro JM, Bernert S, et al: Risk factors for suicidality in Europe: results from the ESEMED study. J Affect Disord 2007; 101:27-34

23. Ursano RJ, Kessler RC, Stein MB, et al: Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers. JAMA psychiatry 2016; 73:741-749

24. Stein DJ, Chiu WT, Hwang I, et al: Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PloS one 2010; 5:e10574

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26. Ferry FR, Brady SE, Bunting BP, et al: The Economic Burden of PTSD in Northern Ireland. Journal of traumatic stress 2015; 28:191-197

27. Chikovani I, Makhashvili N, Gotsadze G, et al: Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study. PloS one 2015; 10:e0122673

28. Eekhout I, Geuze E,Vermetten E: The long-term burden of military deployment on the health care system. J Psychiatr Res 2016; 79:78-85

29. Yu S, Brackbill RM, Locke S, et al: Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers. American journal of industrial medicine 2016; 59:731-741

30. Sripada RK, Henry J, Yosef M, et al: Occupational Functioning and Employment Services Use Among VA Primary Care Patients With Posttraumatic Stress Disorder. Psychological trauma : theory, research, practice and policy 2016;












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