It was 6 o’clock in the morning on the 14 June when London community mental health nurse Ian Sorzano was woken up by his brother and first learnt of the fire at Grenfell Tower.
“We had patients in the building. I have also lived locally for a few years; Kensington is work and home to me. So, with Grenfell, it was very personal,” he said, noting some of his team’s patients were still unaccounted for.
“We needed to quickly establish a rapport and build trust with people”
The acting senior nurse for the North Kensington community mental health team went immediately to the site and began to try and locate his patients, as well as offering immediate assistance to residents.
Although his role at Central and North West London NHS Trust means he co-ordinates psychiatric support for patients, his training in physical health was also required. “Around a year ago, I completed an advanced assessment in physical health, so I was able to offer my help in this area,” he said.
He was due at work that day so, after an hour at the site, he headed to his office and began helping to co-ordinate the trust’s response to the fire by pinpointing where patients who lived nearby were, setting up a psychological triage system and ensuring the wider community could access support as well.
On top of that, Mr Sorzano and his team of eight nurses had to ensure mental health service users living in the borough could continue to receive their usual care and treatment. It was a long day, the first of many that stretched into weekends and weeks to come.
“It’s been all-hands-on-deck, pretty intense and is by no way complete”
His team worked from a relief centre in a nearby sports centre that was initially open 24 hours a day. They assessed adults and children who lived in the block, as well as those from the local community who knew the residents. Communication with other healthcare professionals, particularly about clinical advice, during shift changes was key during this time.
“We kept having to feedback the guidance from our trust’s head of psychology about not going too much into the details of the actual event of the fire, which could bring on post-traumatic stress disorder (PTSD) early.
“Rather it was about allowing it to take its natural progression and about reassuring people some of the things they were feeling were natural to be experiencing – such as uncertainty, fear, confusion, panic,” he told Nursing Times. “We were responding to that with treatment in some cases – with medication, for example for anxiety relief.”
They have also been taking part in outreach work by going to hotels and other centres where families have been moved to, as well as mosques and into schools. The magnitude of services involved reflected the huge variety of local people affected – and who were requiring care and treatment at different times.
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“People were coming up to us on the streets asking for help,” said Mr Sorzano, noting this had still happened weeks after the fire. “I had one gentleman come in and he lived nearby and he was quite traumatised by the fact he saw the fire, but couldn’t remember hearing the sounds – even though he knew he had – but he had blanked it out. That was creating a lot of panic and anxiety for him.
“Offering him the space to talk and counselling did make a big difference. Also talking about a crisis response in case things should escalate. Writing it down meant he was clear what to do,” said Mr Sorzano.
The community is “very close knit” and the impact from the loss of life has been far-reaching, he said, noting children in local schools had in some cases lost classmates. “Almost everyone knew somebody in that building and people went out to help and offer support,” said Mr Sorzano.
From his work over the past couple of months, the majority of people he has seen needed psychological assistance. He and his team have also been working with the emergency services who first responded to the fire, to ensure staff were able to access help if they needed it.
“We are dealing with a very traumatic experience, not only for the people who have experienced it, but the first responders,” he noted.
“Offering him the space to talk and counselling did make a big difference”
At the relief centre, a team of workers across all disciplines and groups – including child and adolescent mental health services, community services, nurses, social workers and psychology staff – were on hand.
“The mandate was to assess people at the point of need and see how we could help them – sometimes just by listening,” he said. “We had a lot of distrust initially from the residents and we needed to quickly establish a rapport and build trust with people.”
While some people were patients who were already known to staff, he said that the vast majority “we had no clue about” prior to the fire, which was more challenging.
Aside from the mental health impact from Grenfell, nurses and other staff in the community mental health team were also finding people’s physical health problems were worsening in some cases.
“Personally, I have been seeing to people’s high blood pressure, diabetes, chronic illnesses, heart conditions and mobility problems,” he said. “We are not following the traditional guidelines of ‘we are mental health’ – we are covering the need where it is.”
Coping mechanisms differed between people and this meant some had also turned to smoking, alcohol or illicit drug use.
“For me as a community psychiatric nurse, the skills I use with my usual patients you can use as well in this scenario,” said Mr Sorzano. “You don’t want to be hitting people with a big stick – you want to be compassionate, empathetic and at their side, rather than seemingly talking down or at them.”
Meanwhile, colleagues had seen admissions to mental health wards increase since the fire, and home treatment crisis resolution teams were taking on a lot more people, he said.
“You want to be compassionate, empathetic and at their side, rather than seemingly talking down or at them”
However, nurses and doctors in the community mental health team had also increased their contact with patients and were carrying out more reviews. This was all part of an approach to try and prevent health problems from getting worse if possible.
To help with ongoing support, extra nurses had been brought in from other parts of London and also Milton Keynes – where his trust also provides services.
He noted the community would likely continue needing additional help for several years. After the 2005 London bombings, there was evidence to show that “three/four years down the line people were still presenting with PTSD symptoms, so I think it would be remiss if we didn’t learn from that,” he said.
Reflecting on the immediate aftermath of the event, Mr Sorzano said very few healthcare staff could have been prepared for exactly how to respond – and that the most important thing for his team had been about being able to adapt to the situation. “You go back to your core nursing – which is about preserving life and ensuring people can use whatever skills they have to cope with a very difficult time,” he told Nursing Times.
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He said he believed that a joined-up approach across all services had been key because “no one service or profession has the answers”. But, at the same time, he underlined that nursing had been at the forefront of the support provided to those affected by the Grenfell fire.
“Nurse training allows you to draw people in and then to help them see things from a perspective that allows them to gain more control over their lives,” he said. “Mental health nursing, in particular, is one of the fields of professions that you are faced with ever-changing personalities or situations and you’ve got to respond. We have to deal with security issues, physical health issues, social dynamic issues, mental capacity, compliance and medication issues.”
He noted that the relief centre was now starting to reduce its opening hours, with the focus increasingly shifting to the wider community, but a broad range of nursing care was still required. “It’s been all-hands-on-deck, pretty intense and is by no way complete,” he said.