More than 200,000 people are struggling daily to cope with Troubles trauma, says expert
NI author of new book on conflict and mental health urges politicians not to abandon the victims of our troubled past
A trauma expert who helped victims of the Omagh and Enniskillen massacres has claimed that over 200,000 people in Northern Ireland are living with mental problems caused by the Troubles.
And David Bolton has called on politicians to tackle the legacies of the past to stop them becoming major issues for future generations.
Sixty-one-year-old Mr Bolton, who is a former health care trust official, has outlined the extent of the mental health crisis created by the Troubles in a new book called Conflict, Peace and Mental Health.
The statistics from Mr Bolton, who was a pioneer in the setting up of the Northern Ireland Centre for Trauma and Transformation which operated for nine years between 2002 and 2011, are stark.
He says that as well as the 3,700 people who died in the conflict, it's estimated that another 50,000 were injured, though there are no definitive records on file.
He also says that research on behalf of the Commission for Victims and Survivors has shown that half a million of the province's 1.8m population had direct experiences of the Troubles.
He also quotes from a 2008 survey which found that 34,000 people are suffering from conflict related post-traumatic stress disorder (PTSD).
On top of all that, Mr Bolton says the Troubles have also had an impact on thousands of people who have developed depression, stress and anxiety issues as well as addictions to drugs or alcohol.
Thousands more still have to cope with the loss of their loved ones during the conflict, he says.
Mr Bolton says the impact from the Troubles was profound and he cites a personal experience from his own teenage years when one of his teachers became a victim.
She was Eva Martin (28) from Lisbellaw who was the first female soldier from the UDR to be murdered by the IRA. She died in a concerted rocket, mortar and gun attack on a UDR base in Clogher, Co Tyrone by an estimated 40-strong gang in 1974.Double agent Sean O'Callaghan later confessed to the murder.
Mr Bolton says that the killing was devastating not only for Eva Martin's family and colleagues in the UDR but also for the staff and pupils in Fivemiletown High School where she was head of the modern languages department.
Mr Bolton says the memory of the Greenfinch's death is still with him, 43 years on from her murder.
"It was like a thunderbolt which went right through the school community," he says. "It was a dreadful experience and it shows these events have devastating consequences way beyond the immediate families.
"I left school within a year of her death, but it remained like a pall of gloom and sadness."
In the aftermath of Omagh, Mr Bolton co-ordinated the health and social services' response to the attack in which 29 people were killed along with unborn twins.
For two years after the 1998 atrocity, Mr Bolton and his colleagues worked with over 600 people who had been impacted by their experiences of the bombing including men and women who had provided help on the ground.
In the book Mr Bolton draws on the work he undertook after Omagh to show what lessons were learnt in the provision of services, training and education to help communities affected by the tragedy and how the measures were rolled out to assist the wider population in Northern Ireland.
Mr Bolton says it was the war in Syria which inspired him to write his new book which he hopes will be of use to anyone dealing with the traumas of conflict anywhere in the world.
He says: "I had the idea for the book after I was in touch with a psychiatrist in the Jordanian desert who was dealing with refugees coming across the border from Syria.
"The book was an attempt to crystallise for the benefit of others what we learnt from Omagh and also to reflect on the wider Troubles here, not only from research that had been done but also from my own observations on the mental health burden left behind by the conflict."
Copies of Mr Bolton's book have already been sent to the authorities in England who are responding to recent terrorist attacks including the Manchester Arena suicide bombing and the outrages in London.
And it's been suggested that what Mr Bolton says could be of use to mental health professionals coping with trauma in the wake of the Grenfell fire disaster.
Nearer home, Mr Bolton's book also references reports which he helped to compile in partnership with the Ulster University which showed that Northern Ireland has the world's highest rates of post-traumatic stress disorder (PTSD) - ahead of war-torn regions like Israel, South Africa and Lebanon. One of the reports, which was part of a World Mental Health Survey initiative, said that the cost to the public purse in Northern Ireland ran into tens of millions of pounds every year.
Researchers, taking 2008 as a sample year, estimated the combined direct and indirect costs of PTSD here to be a staggering £172.8m.
The study also estimated that nearly four in 10 people here had had a conflict-related traumatic experience and it predicted that costs would soar over the years as people whose mental health was linked to traumatic incidents grew older.
Speaking on a visit to the Flemish parliament in Flanders, Belgium, Mr Bolton said that on average it took 22 years for some people with trauma disorders linked to the Troubles to come forward to seek help.
Mr Bolton says while that might come as a surprise to some people, it's a reality for many others like doctors and workers in the voluntary sector.
He adds: "Hardly a day goes past without someone turning up on a health professional's doorstep and saying that 20 or 30 years ago they were caught up in an incident but they hadn't looked for help until that visit. The impact of the Troubles has a long reach."
The author says he has tried but not always succeeded in staying detached in his work with and on behalf of victims.
He adds: "That was especially true in Enniskillen where I knew many of the people who were killed and injured. You need to be a wee bit detached, but at the same time I didn't want to be detached because these people meant a lot to me.
"I couldn't deny their significance in my own life, but nonetheless there are times when you have to steel yourself."
In his book Mr Bolton also deals with the way in which the emergency services, medical staff, undertakers and the media have had to cope with terrorist attacks during the Troubles.
He says: "Many of them, particularly the health staff, were front line witnesses to what happened and the Troubles had a very powerful impact on them."
And looking to the future, Mr Bolton says in his book that if politicians here or in Britain don't tackle mental health issues the implications of their inaction could be extremely serious.
"It's something that we should be able to do quickly and easily. I'm not saying that nothing has been done, but we need to bring forward more services to deal with the past and to help the victims who mustn't be abandoned."
Mr Bolton says that many controversial differences like the very definition of what is or isn't a victim must be resolved between politicians.
But in the meantime he says other countries around the world are also plagued by questions about how to emerge from a conflicted past.
Mr Bolton says: "I remember speaking to the national security adviser for Iraq, maybe 20 years ago.
"It was around the time the civil war was still raging and he asked me, knowing what I knew about Northern Ireland, if I could give him any advice.
"I told him he should start preparing for peace and the mental health impact that was going to come in the wake of the ending of conflict.
"And that is the message from the book - that our peacemakers and peacebuilders should be factoring mental health and well-being in at the start of any humanitarian, political, nation-building response to the impact of war or civil conflict."
David Bolton's book Conflict, Peace and Mental Health is published by Manchester University Press. Paperback copies will be available soon, priced £14.99