Mental recovery will be a long haul

The trauma: The children who survived the Beslan siege will be given group therapy and one-on-one counselling sessions in the…

The trauma: The children who survived the Beslan siege will be given group therapy and one-on-one counselling sessions in the coming weeks and months to help them in their struggle to come to terms with the ordeal.

A team of child counsellors was flown into Beslan at the start of the crisis and has been on standby, ready to help the survivors deal with their horrific experience. Psychiatrists trained in stress counselling will meet teachers, relatives and even the neighbours of those families affected.

Bereavement support and post-traumatic stress are relatively new concepts in Russia, but expertise in this field has developed radically in the years since the Soviet Union collapsed and scientists were able to share information with colleagues in the west.

Dr Boris Voskresensky, a psychiatrist and academic with the Russian State Medical University in Moscow, said the sphere had won respect among Russian psychiatrists over the past 15 years.

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"There wasn't much understanding of the concept of post-traumatic stress a decade ago. But since borders have opened allowing us the chance for greater co-operation with scientists in America and Europe, it's something that has really taken off," he said.

"It's no longer the case that people are expected to have Stalinist characteristics of strength and stoicism in the face of crisis. There's a much greater readiness among doctors now to help people deal psychologically with this kind of catastrophe."

The counsellors would be particularly focusing on helping the families of those affected, he said. "They need to be alerted to the possible secondary effects of the trauma, which may take months or even years to develop," he added.

"Parents and teachers need to be made aware that their children may develop psychosomatic illnesses, that their school work could suffer, that their behaviour may deteriorate.

"The role of the parents is absolutely vital. If they can provide support in helping children re-establish a normal existence, re-create a sense of stability, then the effects of the tragedy need not be permanent."

"Everything depends on the strength of the child's relations with his family. If they can help the children build a peaceful, quiet and stable life in the next few years, then this event shouldn't blight their lives for ever," Dr Voskresensky said.

Dr Irina Angel, a child psychiatrist who was born in Grozny, but is now practising in Boston, said she believed doctors in the Caucasus were not as advanced as those in the capital in this sphere.

"In my experience there will be a much greater emphasis on coming to terms with tragedy through family support, that of the community and through religion. There may still be a reluctance to talk about this with psychiatrists," she said.

Dr Morris Zwi, a consultant child and adolescent psychiatrist at South-West London and St George's Mental Health Trust, said the children caught up in the Russian school had suffered such profound trauma that they may well have flashbacks and nightmares for years, if not the rest of their lives.

"They were exposed to overwhelming stress and fear, where events were not only beyond their control, but beyond that of the adults caring for them," he said.

"Adults often think very young children will not be as traumatised because they do not understand what is going on. But even pre-verbal children have a level of understanding and will play out or draw terrible scenes, such as murders or violence, over and over again, which sometimes helps them make sense of it.

"Individual children will react differently, depending on their personalities and stage of development. Some will express themselves, others will close down and shouldn't be forced to talk until they are ready, it's all a matter of trust and timing.

"But many will experience extreme anxiety, hyper-vigilance and wariness, nightmares and sleeplessness, and in some cases, any reminder will trigger graphic flashbacks, as it did for Vietnam vets hearing a helicopter overhead and suddenly believing they were back in Vietnam," Dr Zwi said.

He agreed that parents were the best people to comfort their children, in conjunction with organised professional psychiatric support. The fact that the the children had been through the ordeal together meant there would be value in sharing experiences as a group.

He said the children needed total honesty about those who had been killed.

"Children of school age understand the concept of death, though perhaps differently to adults, but they know when adults are trying to pull the wool over their eyes, so it pays to tell the truth," he said.

the children would benefit from return to normal routines as soon as possible. If given proper support through the initial shock and grieving process, they should be able to return to school, although it may prove too traumatic for them to return to the actual building where the siege took place.

"The most important thing now is to give these children love, support and reassurance," he said.