Early phase child and adolescent psychiatry response after mass trauma: Lessons learned from the Easter Sunday attack in Sri Lanka

Sri Lanka is a South-Asian nation with a multi-ethnic population. A 26-year-old armed conflict ended in 2009 and the relative stability over the last decade was unexpectedly disrupted by the Easter Sunday Bombings of Catholic Churches and luxury hotels in 2019. More than 250 were killed and most of the deaths were reported from the St. Sebastian's Church in Negombo in the District of Gampaha. This article describes how mental health services of the District of Gampaha, with a population of 2.3 million and only one child and adolescent psychiatrist responded to the psychological trauma in children.

The child and adolescent psychiatry response to the mass trauma was a collaboration between health, educational and voluntary organisations. The psychological support was provided at affected villages, schools and hospital settings. Medical and non-medical personnel were able to refer affected children directly to the child and adolescent psychiatrist. Children who had developed psychological consequences of trauma were provided with evidence-based psychotherapies and psychopharmacology where necessary. In addition, health staff members and teachers were trained to provide psychological support and a booklet was prepared in the local language based on trauma-focused cognitive behaviour therapy. Psychoeducation about the psychological response to trauma was provided through electronic, printed and social media. The limited number of trained psychotherapists and experts in child mental health were a major barrier to implement effective management strategies.

Due to the severe shortage of child mental health experts, practical low-cost methodologies were employed to provide an early response to trauma. Traditional ways of mental health service provision were modified to be implemented via non-experts.