This course is aimed at anyone who has been affected by a major incident or knows someone who has, either personally or professionally. It considers the personal impact of a major incident and explores what can help.
This course will take approximately 3 to 4 hours to complete. This timing will depend on how fast you read and how long you spend on the activities and reflective questions. You do not need to complete the whole course in one go. If you leave and come back to the course you can pick up where you left off.
If you would like to get a certificate for this course, you must mark each page complete. You can do this by pressing the ‘mark complete’ button at the bottom of each page.
This course is for educational and informational purposes only. It does not provide therapy, medical advice, or professional support. If you need crisis help please contact local mental health services, your GP or telephone 111 or the emergency services.
Course Updated: May 2025 (Further updates planned.)
Disaster Action (opens in new tab) provides support and guidance for those affected by disasters.
Mind (opens in new tab) provide information on all aspects of mental health.
MindEd (opens in new tab) is a free educational resource on children, young people, adults and older people's mental health.
You may find the NHS Coping with Stress Following a Major Incident Guide (opens in a new tab) helpful
Access the NHS overview of post-traumatic stress disorder (opens in a new tab) for more information on PTSD
National Institute for Clinical Excellence Resources:
Recovery College Online courses. You can access the courses listed below by going to the courses page of this website.
Access guidance following the tragic events in Manchester - Trauma Response, South East Clinical Network (opens in new tab)
Trauma Response Network (opens in new tab) is a free and anonymous trauma support by qualified EMDR therapists.
Trauma Informed Care:
See below to find out more about key topics.
Tees, Esk and Wear Valleys NHS Foundation Trust
Hope is an essential dimension of life (Masera, 2010); it comes alive when confronting life’s trials: darkness, illness and separation (Masera, 2010). Inspiring hope is an integral part of clinical practice and fundamental to recovery (Koehn & Cutcliffe, 2007) (Masera, 2010). Hope is a valuable tool in developing independence, achieving goals, enhancing wellbeing and resilience.
Hope is ‘A person or thing that may help or save someone’ (Oxford University Press, 2017).
Developing a therapeutic relationship is essential in the fostering and maintaining of hope in others; relationships can be a catalyst allowing hope to develop exponentially (Byrne, et al., 1994). A belief of another’s abilities can be a powerful motivator for change (Byrne, et al., 1994). Such psychiatric conditions such as depression and suicidality have been linked with the absence of hope (Cutcliffe & Herth, 2002), at times of crisis hope is sought externally as opposed to internally. Strategies to decrease hopelessness include altering negative thoughts, communicating hopefulness, emphasizing strengths as opposed to weaknesses and respectful practice (Farran, et al., 1995). Through a holistic, patient centred approach a partnership can be created, and such interventions can provide a therapeutic effect.
Although time can be limited our interactions with others hold a lot of meaning, we cannot underestimate the power of hope and the power it has to change (Byrne, et al., 1994). We have become a nation of ‘fast healthcare’ (Crawford & Brown, 2010) where our processes are focused and ends driven due to the current demands put upon our contemporary healthcare system; this has led to a reduction of time spent with patients (Crawford & Brown, 2010) and an increase in work pressure/stress and burnout. Regardless of the pressures put upon healthcare services it is obvious that the concept of hope and the philosophy behind our clinical roles is not lost; human beings have an endless possibility of improving their own being (Masera, 2010) and inspiring others. Regardless of the availability of time, values need to be upheld (NMC, 2015).
The loss of hope and courage can have deadly effect (Cutcliffe, 2009), as a holocaust survivor Frankl stated that it was hope that sustained him, and that without hope prisoners would have inevitably died. Although an extreme example, the people we work with may suffer with suicidal ideation that could potentially lead to the loss of a life. As clinicians’ we cannot underestimate the power of hope and the meaning it can hold.
Medicine is ever increasing and advancing, new therapies, new medication however what hasn’t changed is the fundamental values held by the healthcare community; the concept of hope. Providing family led education interventions equips families with the skills needed to better cope in their loved one’s journey of hope (Pickett-Schenk, et al., 2008). Respect is needed for the support they provide as well as education to gain a better understanding regarding their loved one’s mental health. Empowering choice, responsibility and independence are essential in relation to recovery; through the inspiration of hope, faith and education surrounding mental health. Patience and perseverance are also essential skills in providing effective care. Providing education and sharing success stories can promote change and choice, this can lead to greater independence, resilience and recovery; motivation been a major factor. The NMC code states that we must provide the fundamentals of care effectively (NMC, 2015); hope appears fundamental to recovery, in the empowerment of others and in the development of resilience.
Hope is a valuable tool in developing independence, achieving goals and enhancing wellbeing.
Byrne, C. M. et al., 1994. The importance of relationships in fostering hope.. Journal of psychosocial nursing mental health services, 32(9), pp. 31-45.
Crawford, P. & Brown, B., 2010. Fast healthcare: Brief communication, traps and opportunities. Patient Education and Counselling, 13 02, pp. 1-8.
Cutcliffe, J. & Herth, K., 2002. The concept of hope in nursing 2: hope and mental health nursing. British journal of nursing, 11(13), pp. 885-889.
Cutcliffe, J. R., 2009. Hope: the eternal paradigm for psychiatric/mental health nursing. Journal of Psychiatric and Mental Health Nursing, 16(9), pp. 843-847.
Farran, C. J., Herth, K. A. & Popovich, J. M., 1995. Hope and Hopelessness: Critical Clinical Constructs. London: Sage.
Kelly, M. & Gamble, C., 2005. Exploring the concept of recovery in schizophrenia. Journal of Psychiatric and Mental Health Nursing, 12(2), pp. 245-251.
Koehn, C. V. & Cutcliffe, J. R., 2007. Hope and interpersonal psychiatric/mental health nursing: a systematic review of the literature – part one. Journal of Psychiatric and Mental Health Nursing, 14(2), pp. 134-140.
Masera, G., 2010. Hope versus nursing. Journal of Medicine and the Person, 8(2), pp. 65-69.
NMC, 2015. The Code. [Online]
Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
[Accessed 10 08 2018].
Oxford University Press, 2017. Oxford Dictionary. [Online]
Available at: https://en.oxforddictionaries.com/definition/hope
[Accessed 22 08 2018].
Pickett-Schenk, S. A., Lippincott, R. C., Bennett, C. & Steigman, P. J., 2008. Improving knowledge about mental illness through family-led education: the journey of hope. Psychiatric services, 59(1), pp. 49-56.
Tees, Esk and Wear Valleys NHS Foundation Trust
Resilience is the ability to adapt to adversity despite conditions, it plays a large role in a toxic stress response. Primary prevention and early intervention is needed to strengthen resilience factors to help minimize a toxic stress response (Franke, 2014). Providing educational support to the family is needed to mitigate a toxic stress response in children and young people; targeting care givers stressors and improving the care givers capacity to provide safe, stable and nurturing relationships (Franke, 2014).
‘Doing well’ should be defined by the individual.
There are several opportunities across the life course to help promote positive mental health and wellbeing and to build resilience in children and young people. Resilience can arise from ordinary but powerful processes; self-regulation skills, effective schooling and good parenting (Lopez & Snyder, 2009). Restoring positive human development is key.
Emphasising strengths is essential when supporting the ‘whole child’. The goal is to minimise vulnerability and strengthen resilience to promote happiness and good health in the individuals we see and their families. Human beings have an endless possibility of improving their own being (Masera, 2010).
Hope is a basic human response that is essential for life.
Empowerment of the survivor and the creation of new connections are core to recovery. The survivor must be the author of their own recovery. Jacqui Dillon advised that trust, autonomy, competence, identity, and intimacy are important factors in building resilience and doing more than just surviving. Intimacy is about building trusting relationships, so a sense of universality can be discovered. Ultimately the development of trust is key in the promotion of wellbeing. Creating a safe space is essential for change.
The basics are key, having a good routine, getting enough sleep, having a good diet and quality of occupation of time.
Individuals with better mental wellbeing are likely to recover more quickly, deal better with stress and are less likely to engage in risk taking behaviour.
Franke, H. A., 2014. Toxic Stress: Effects, Prevention and Treatment. Children (Basel), 1(3), pp. 390-402.
Lopez, S. J. & Snyder, C. R., 2009. Oxford Handbook of Positive Psychology. 2nd ed. New York: Oxford University.
Masera, G., 2010. Hope versus nursing. Journal of Medicine and the Person, 8(2), pp. 65-69.
Oxford University Press, 2017. Oxford Dictionary. [Online]
Available at: https://en.oxforddictionaries.com/definition/hope
[Accessed 22 03 2017].
Tees, Esk and Wear Valleys NHS Foundation Trust
Toxic Stress
Stress is a common response to demands encountered on a daily basis. Stressors can be emotional, physical, theoretical and environmental. Stimulation of the fight or flight response releases the hormone cortisol which can increase respirations, blood pressure and heart rate; not all stress is damaging and most changes are transient. However, in the absence of protective factors stress can become toxic and if stimulation is severe, repetitive or prolonged. Prolonged cortisol activation increases the risk of long-term adverse health effects (Franke, 2014). The body’s failure to fully recover from ‘toxicity’ can impact upon functioning.
Examples of toxic stress include abuse, neglect, extreme poverty and violence.
Traumatic experiences can become toxic and affect brain architecture in the absence of stable, caring relationships. The development of resilience is needed so a sense of wellbeing can be established. Developing coping strategies is an essential and important part of development, however, in the absence of hope, strategies developed to survive may increase risk to self, i.e. self-harm.
Imagine walking across a road and nearly getting knocked down, think about your feelings in that moment and the physical responses you might experience, for example, an increased heart-beat. Now imagine stepping into a road and having to constantly dodge oncoming traffic; this is toxic stress.
The constant activation of the body’s stress response systems increases the risk of long-term adverse health effects, physical and mental health. Duration, intensity, timing, and context may predict impact.
The ACE study highlights the health risks associated with adverse childhood experiences and the impact of toxic stress (Felitti, et al., 1998); the more adverse experiences in childhood, the greater likelihood of health problems; physical and mental (drugs, heart disease, diabetes, and depression). Toxic stress health outcomes include:
ACEs are common and may include domestic violence, abandonment including divorce, parental mental health ill health, abuse, parental incarceration and witnessing drug and alcohol abuse.
Early experiences influence the developing brain. Impact can be significant on cognitive, emotional, and social development. Includes pregnancy.
Damaging effects and exposure to toxic stress can be prevented and/or reversed.
Maslow states we all have basic needs; to feel safe and to feel loved. If these are not met vulnerability and susceptibility to toxic stress increases. Children need to feel safe and secure. The development of stable and supportive relationships can reduce the impact of adversity. What else can help reduce effects of adversity?
References
Felitti, V. J. et al., 1998. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), pp. 245-258.
Franke, H. A., 2014. Toxic Stress: Effects, Prevention and Treatment. Children (Basel), 1(3), pp. 390-402.
Dr Rob Gordon is a psychologist and disaster recovery expert. In this video he provides six tips to assist people living in Canterbury in New Zealand who may be affected by the earthquakes.
Beacon House Therapeutic Services and Trauma Team Resources. You can access this website via Beacon House Resources (opens in new tab)
British Red Cross Information Line: Support agency for family help. You can access this website via British Red Cross Information Line (redcross.org.uk)
Child Bereavement UK: Guidance, support and information for anyone caring for a bereaved child. You can access this website via Child Bereavement UK (opens in new tab)
Child Death Helpline: Helpline for anyone affected by the death of a child of any age. You can access this website via Child Death Helpline (childdeathhelpline.org.uk)
ChildLine: For children to talk about anything that worries them. You can access this website via ChildLine (opens in new tab)
Cruse Bereavement Care: Offers bereavement support. You can access this website via Cruse Bereavement Care (opens in new tab)
Home Office: Supporting victims of overseas terrorism. See Annex B for Third Sector Matrix. You can access this website via Third Sector Matrix, Home Office (avoidable-deaths.net)
National Child Traumatic Stress Network Resources: Resources page. You can access this website via National Child Traumatic Stress Network (opens in new tab)
Samaritans: Offers a 24 hour helpline for those in crisis. You can access this website via Samaritans (opens in new tab)
Support for Victims of Terrorism – Information on where to seek advice and assistance following a terrorist attack. You can access this website via Support for victims of terrorism (opens in new tab)
The Childhood Bereavement Network: This website has a directory of local open access services which support children and young people who have been bereaved. In addition, the following organisations have a national remit to support those helping children and young people affected by death and bereavement. You can access this website via The Childhood Bereavement Network (opens in new tab)
The Compassionate Friends: Support for bereaved parents who have experienced the death of a child of any age and from any cause. You can access this website via The Compassionate Friends (opens in new tab)
Victim Support: Offers free and confidential support to help you move beyond the impact of crime. You can access this website via Victim Support (opens in new tab)
Winston's Wish: Support children and young people after a death of a parent or sibling. You can access this website via Winston's Wish (opens in new tab)