Caring through troubles

The North and West Belfast Health and Social
Services Trust straddles two areas riven with sectarian strife.
Researchers Jennifer Hamilton, Marie Smyth and Mike Morrissey look
at how the Troubles are a barrier to social work and damaging to
people who live in these areas.

Northern Ireland is like no other region in
the UK in that it has endured 30 years of political violence, which
may be a factor in the health status of the population and
ultimately the delivery of health and social care. As a result,
mechanisms need to be developed to understand this relationship and
to factor it into the allocation of health resources. Certain areas
of Northern Ireland have suffered more in terms of the violence.
North Belfast (predominantly Protestant) and West Belfast
(predominantly Catholic) are two such areas.

A previous study, The Cost of the Troubles
,1 indicated that more respondents from North
and West Belfast (11.2 per cent) classify their health as being
poor compared with the rest of Northern Ireland (6.3 per cent). It
was evident from survey findings that residents of North and West
Belfast have witnessed more events related to the Troubles than
residents of other areas. Of the respondents surveyed, 20.9 per
cent, compared with 10 per cent in the rest of Northern Ireland,
indicated that they had a lot of experience of the Troubles, while
a further 26.8 per cent had quite a lot of experience compared with
13.7 per cent elsewhere.

The Troubles also affected the psychological
and emotional lives of the residents in North and West Belfast to a
greater extent. Seven per cent of those living in North and West
Belfast found that they frequently lost interest in activities that
had meant a lot to them before, compared with only 3.5 per cent
living in the rest of Northern Ireland. A further 22.6 per cent of
people in North and West Belfast saw themselves as more easily
startled, compared with 8.5 per cent in other areas of Northern
Ireland. Respondents from North and West Belfast were more likely
to strongly agree with the statements listed in the table (facing
page) about the psychological effects of the Troubles.

All of these factors have increased the
pressure on health and social services staff working in North and
West Belfast. Following discussions with management at North and
West Belfast Health and Social Services Trust, a research project
was initiated to evaluate the impact of the Troubles on staff
within the Trust.2 A series of focus groups and
individual interviews were conducted with social work, nursing and
management staff to elicit their experiences and ascertain the
impact of the Troubles on them.

Staff confirmed the prevalence and incidence
of Troubles-related difficulties in North and West Belfast and how
this added pressure to their daily work. One worker told us: “I
don’t think that there is anybody in North and West who has not
been touched and their lives affected by the Troubles in one way or
another… therefore that, in itself, can make our life more
stressful. And it takes more time to deal with the clients, the
issues and the problems.”

According to the respondents the Troubles
were, “creating complications for clients and workers in dealing
with the more ordinary difficulties”. In the lives of their clients
and patients the Troubles also created, “specific problems that are
particular to Northern Ireland in general, and are concentrated in
North and West Belfast”.

Some of these additional problems focused
around the sectarian division in Northern Ireland. This division is
manifested in widespread residential segregation and issues about
the identity of workers and their relationship to the communities
they work in. These issues raised concern about staff safety and
effectiveness. One worker says: “It’s made our work more difficult.
There are times when you can’t send a worker in, and you’ve got to
think, unfortunately, of the religion of your worker…”

Some staff had used pseudonyms in certain
circumstances since names can reveal religion in Northern Ireland.
Working across the sectarian divide, as many staff do, aroused
feelings of vulnerability, particularly for male staff. According
to one worker: “But, when you’re a male… and your name is [common
Catholic male name] and you’re sitting in the Shankill and a known
Loyalist paramilitary is out the back, it does impact on

These challenges, coupled with the coping
mechanisms of clients to deal with their difficulties, have made
the working lives of health and social services staff in North and
West Belfast very difficult. Interviewees reported noticing that
people in the communities they serve have been increasingly turning
to alcohol and drugs in order to deal with the effects of the

Alcohol abuse is perceived to be a problem in
the younger age groups, yet our informants told a different story.
“Even elderly people now are taking more alcohol, whether it’s just
to numb the senses… you know nursing people, and you can smell
alcohol off their breath at 10am.”

Dangerously high levels of alcohol consumption
have been normalised in communities particularly affected by the
Troubles and quite heavy consumption is commonplace and often not
regarded as problematic.

The use and abuse of prescribed medication was
another major concern for workers compounded by children’s access,
both legitimate and illegitimate, to prescribed medication. “A
majority of them are on medication as well, and then you have the
children sitting in the house, take a couple of mummy’s
anti-depressants and what not…” and a housing estate in West
Belfast “was known as Valium City because children from the age of
six were on Valium”.

Staff also described how illegal drug
trafficking presented problems of a different order in the
communities in North and West Belfast because of the role of
paramilitaries. “Because of paramilitaries and their funding and so
on, drugs are readily available. And it seems the police are
powerless to do anything about it.”

The research concluded that the Troubles
complicate and compound other social problems as well as being a
problem in their own right. If left untreated workers noted that
other difficulties are inclined to emerge. Together these
difficulties make the working lives of health and social services
staff more stressful and increase their already heavy

The full report of this research makes a
series of recommendations on how North and West Belfast Health and
Social Services Trust and others can begin to address the specific
problems highlighted in the report.

Jennifer Hamilton is research officer
with the Institute for Conflict Research. Marie Smyth is chief
executive officer at the ICR and a member of staff with the school
of policy studies, University of Ulster. Mike Morrissey is member
of staff with the school of policy studies, University of Ulster.
More information on ICR at


1 M T Fay, M Morrissey, M
Smyth and T Wong, The Cost of the Troubles Study. Report on the
Northern Ireland Survey: The Experience and Impact of the
, Incore, 1999

2 M Smyth, M Morrissey, and
J Hamilton, Caring Through the Troubles: Health and Social
Services in North and West Belfast
, North and West Belfast
Health and Social Services Trust, 2001

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