Dr Fred Bemak

Professor and Program Co-ordinator

Counseling and Development Program

Graduate School of Education

George Mason University

MSN 4B3, 4400 University Drive

Fairfax, Virginia

USA 22030


Dear   Dr. Bemak,


I wish to thank Bob and yourself for the helpful and interesting report which you forwarded following your visit last month. Your visit was much appreciated by both Trust staff and the community agencies with whom you met in the course of your brief  but packed trip.


Many of your observations struck chords with ourselves so we have taken a little time to consider them internally and to share your findings with our community partners.


The emphasis which you have placed on prevention programmes is entirely in accord with our own thinking. You will recall the presentation of our ‘Heads Away, Just Say’ initiative which included a television and radio campaign and an accompanying website. In one week following the television campaign the website recorded over 40,000 hits which is good evidence of the impact of the campaign.


We have also been working with the education service and youth from our communities in developing a prevention programme ‘Turn It Round’ for use in schools and youth clubs. This initiative which includes a DVD and workbook will be launched to coincide with World Mental Health Day in October 2004. The programme will be made available initially to all the schools within North and West Belfast and we are in discussions to secure its more general distribution.


In this way your report is already influencing our strategy for promoting the emotional and psychological wellbeing of our young people. It might be useful for you to contextualise this report by visiting the Eastern Health and Social Services website and looking at our recently published strategy on Mental Health Services particularly the section on the needs of people affected by the conflict



Another key strategic document which you may wish to refer to when reading this report is the Investing for Health Strategy  which can be found by visiting





Since your visit, there have been a number of  other significant developments about which I would like to update you :


PIPS ( Public Initiative to Prevent Suicide)  - You may recall that we discussed this suicide prevention programme with you and our plans to roll it out throughout the communities of North and West Belfast. This work has already commenced and we have also been able to secure some places for community workers to train as ASIST trainers. The North Belfast Partnership Board, (the local community regeneration agency) is sponsoring a proposal by PIPS to secure a franchise for the delivery of the ASIST programme in Ireland. This would significantly increase access to this internationally benchmarked training.


Community Counselling Project – The Trust has secured recurrent funding for  this community provided project. Evaluation of this project identified that it was supporting significant numbers of young adults who had experienced trauma through the conflict and/or had been victims of physical and sexual abuse. This service was much valued by our family doctors and I am delighted  to have secured its future.


Health Action Zone  -  An important initiative has been taken through the Health Action Zone(HAZ). The Health Action Zone is a government sponsored, multi-sectoral, interagency partnership which unites senior representatives from health, education, housing, social security, employment and training agencies with community based regeneration bodies. The Trust is the lead agency within the HAZ and I chair the Zone Council which directs the work of HAZ. Building on the success of initiatives such as our  Communities in Schools Project the HAZ is now exploring the creation of integrated development pathways for young people and for mental health and wellbeing.

This work will seek to secure integrated service delivery for vulnerable young people and ensure co-ordinated efforts to promote their emotional and psychological wellbeing.   


This should also see a strengthening of our existing programmes of youth mentoring and peer education. The Trust has been committed to these approaches for many years now and sponsored development of services such as Opportunity Youth which works with vunerable young people across the whole range of youth issues, promoting their personal development and capacity to contribute to society.


Child and Adolescent Mental Health Services   -  The Trust working in partnership with our commissioning authority and colleagues in the other half of the city, have advanced plans for addressing some of the deficits in these services and for recruitment of staff. We are examining new models of service that are not so dependent on scarce disciplines.


Trauma Resource Centre – The Trust has secured funding for an initial period of 3 years to develop a Trauma Resource Centre in North Belfast.


The aim of this project is to improve the accessibility and quality of treatment for those individuals, children and families resident in North and West Belfast who have been affected by Troubles related trauma.


It is proposed that a multi-disciplinary team of professional staff will provide a holistic range of services for victims/survivors.


Central to the vision of the service is a community based approach that will ensure active collaboration with the voluntary/community sector to provide a co-ordinated, tiered and seamless service for victims/survivors in North and West Belfast.  This model has the potential to become a centre of excellence as a community based model of meeting needs.


We are determined that this service will be informed by good practice internationally and to this end are exploring the creation of an international advisory Board to which progress and evaluation reports would be submitted for consideration and guidance.  The work of such a Board would lay a robust foundation for an international conference in perhaps 2/3 years time.  We would be delighted if  both yourself and Bob would be willing to be part of such a Board.


This international aspect of sharing good practice globally was the theme of our recent conference “Building Better Futures” which was hosted by North and West Belfast Trust. This conference attracted speakers from all over the world who were able to share experiences of delivering health and social services with and for communities experiencing conflict. Many of the people who participated in this conference have expressed a willingness to sit on this international advisory board


We intend to utilise the Clinical Outcomes in Routine Evaluation (CORE)  model developed by the University of Leeds which has been to the fore in researching the effectiveness of psychotherapeutic practice by auditing outcomes. This model is already being used by some of our partner organisations and will assist in comparative evaluation of the effectiveness of services. This is an area in which Bob and yourself may also be able to provide assistance.


The CORE model should allow us and partner organisations to develop the baseline data which you rightly emphasise as important  to a better understanding of what is effective in tackling the problems of suicide and other trauma.


Your comments on the preparedness of staff for work in the field following their basic professional training is apt. This is an issue which we are keenly conscious of and through the good existing links which we have with local universities and colleges a range of training programmes have been developed to better equip practitioners in working with the very complex needs with which patients and clients present. This includes post professional training in the management of trauma and the use of cognitive approaches.

In Northern Ireland we have also just completed a major review of social work training and seen the launch of a new policy to reform social work training. This will be effective from October 2004 and will include an assessed year in practice following the college based training. This should allow a much more focused approach to linking theory with practice. 


You have been forthright in addressing the issue of  intra-sectarian and inter-sectarian conflict and it is only right that I should be just as straightforward in responding. I have some difficulty with what you write. I am not convinced that we can assume only a causal relationship between the conflict and our suicide problem. The experience which we have over many years has helped us to identify the conflict as a very important part of the context for the suicide problem and many other mental health issues. However, our analysis of the suicides and suicidal behaviour suggests that this is a most complex issue and that there are often a whole range of factors involved including family relationships, unemployment, lack of hope and poor self esteem. In a recent focus group which we convened as part of the Heads Away campaign young people themselves identified a wide range of issues which were relevant to them which they believe may contribute to a young person seeking to take his or her own life.


Our primary responsibility is to deliver treatment, care and support to address health and wellbeing need within our catchment population. The conflict is an important part of the context in which we have to deliver services and we address those issues through a range of community development approaches in each community and across communities. This includes interagency initiatives to support displaced families, support for interface projects and involvement with the development of the Community Empowerment Partnerships in North Belfast which were recommended in the

Dunlop Report which followed the Holy Cross School dispute. The Trust is active in all these initiatives but it is not our remit to lead on the resolution of the conflict which as you appreciate is fundamentally located in the political



We as a Health and social services Trust look primarily to other Government supported agencies such as the Community Relations Council to take on some of the work you refer to.        


http://www.community-relations.org.uk/ Is their website with many interesting publications including work on the Belfast Interface project which you might find helpful. It would also refer you to an excellent publication “Delivering services in a divided society”


You have observed on some of the excellent work being done by our community partners and we would certainly appreciate any support which yourselves or the Children in Ireland Group could make available to these organisations to strengthen their efforts.


I have attempted in responding to your report to highlight those areas in which I think international collaboration can produce most dividends:  sharing of best practice; guidance on development of services;  support with evaluation of services;  support for our community partners. These  are the areas which we have agreed with our community partners would allow us to derive the most from your extensive experience and knowledge  and the goodwill of the Children in Ireland Group.


I trust that you will find these proposals of interest and I have asked Bernie Kelly who co-ordinates trauma services for the Trust to follow this letter up by making direct contact to discuss how they can be operationalised.


I would again wish to record my appreciation to Bob and yourself and to Terry Ryan for facilitating your visit. I am sure you will be happy that I copy this letter to both.


Yours sincerely



RG Black

Chief Executive


cc. Dr Robert Conyne

      Mr J.Terry Ryan