Rafael Sarabia holds an American flag in tribute to those killed during the Route 91 Harvest Festival mass shooting on

October 1, 2018 in Las Vegas. Ethan Miller/Getty Images hide caption

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Rafael Sarabia holds an American flag in tribute to those killed during the Route 91 Harvest Festival mass shooting on October 1, 2018 in Las Vegas.

Ethan Miller/Getty Images

About an hour outside of Nashville, in the hills of Middle Tennessee, you'll find a sprawling compound of cabins and farmhouses with red roofs; a place where horses run the pastures and mist tends to settle in the valleys between the hills. If it weren't for the work that happens here, this could be a vacation retreat for Nashville's entertainment industry – a getaway from the trappings of daily life, to disconnect and forget the world outside. But here, at OnSite Workshops, the idea isn't to leave your life behind, but to process everything that's happened in it.

Two years ago this month, after the massacre at Route 91 Harvest Festival in Las Vegas that killed 58, OnSite's campus became one of Nashville's most crucial destinations. Along with organizations like Porter's Call, MusiCares, Music Health Alliance (all which often work in close collaboration with each other) as well as other groups focused on mental health and trauma therapy, OnSite helped musicians and their crews heal in the wake of the unfathomable. In the time since, those artists have had to balance this healing process with the constant pressure to stay on the road, make new music and deliver for their fans — to be "ok" when their circumstances are anything but.

"I worked with some artists who were terrified to go on stage again," says Miles Adcox, owner and CEO of OnSite. "Really scared of meet-and-greets. Asking, 'How do we amp up security?' That's a normal response, because this was historically a safe environment that now feels like what we can't deny is an unsafe one." Since Route 91 there have been (at least) dozens more mass shootings — a term which lacks a definition, making it impossible for tallies to be definitive, though the FBI offers its own — including several at music festivals and music events such as the Gilroy Garlic Festival this past July, where three were killed.

The healing process began not on the tranquil campus of OnSite, however, but in the lobby of a Nashville office building. Adcox remembers the immobilization happening almost immediately after the Route 91 tragedy, with the organization of a town hall at BMI in Nashville alongside MusiCares, Porter's Call and Music Health alliance. "We started getting calls right away from people who were out there, and people who were here and terrified," Adcox says, "not knowing what was going on and experiencing their own version of trauma. Stress was at an all-time high."

The grounds of OnSite Workshops in Tennessee. Courtesy of OnSite Workshops hide caption

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Courtesy of OnSite Workshops

Adcox remembers several hundred people in attendance at the BMI event. Dr. Lee Norton, a trauma therapist involved in the town hall who has treated multiple survivors of Route 91, including some of Aldean's crew, recalls that a flight had to be chartered to bring people home from Vegas, because when the shooting began, many of those working amongst sound and other equipment left their wallets, and with them IDs required for flying, right where they were.

One of those recruited to help speak to survivors at the town hall was Julian Dorio, who had been on stage drumming for Eagles of Death Metal when the attacks at the Bataclan in Paris took place. He speaks freely about the therapy he underwent with Dr. Norton, with the hope that his story will make other members of the creative community aware of the resources available to them.

"We woke up to Vegas, and Dr. Norton and I got on the phone," Dorio says. "She knew an event like that could trigger me." Instead, he asked: "What can we do?"

At the forum, Dorio encouraged those in attendance to remember that, despite the instinct and social pressure to return to work," it's necessary to make sure their mental health is a priority. "I thought about giving it up," Dorio says. "I asked, 'Am I ever going to play again? Meanwhile, it's all I know how to do. I'm a drummer. If a fan doesn't want to go to a concert, that might be an option. But for those of us who were there working, we can't not go to shows. So it's how do you get back up on the horse, but in a way that was healthy?"

"I think everyone got on their horse too fast," says Dr. Norton. Allsep wonders if part of this reaction could be attributed to country music's general reluctance to speak openly about mental health and to portray a certain brand of machismo. "In country music, we have a real tough-guy syndrome," she says. "That idea of, 'I don't do counseling, I'm good.' "

If normal folks were at the scene of a mass shooting, they likely wouldn't be expected to go back to work right away — and probably not in (essentially) the exact setting where the incident took place."I don't think we'd be expected to go to work for weeks," says Al Andrews, who runs the non-profit organization Porter's Call, which counsels artists and their spouses in Nashville at no cost. "I do think our expectations are high, and their own expectations are a little too high. The show must go on, but they don't get a pass or give themselves a pass. Realistically you are in shock for quite a while."

"I think people pull the human-ness out of the artist, which is why we see so many crash-and-burns," says Adcox. "I can't tell you the [amount of] times when an artist really needed to pull out, just to recharge. But didn't."

Most of the artists who performed at Route 91 did not cut their scheduled tours short. Jason Aldean, who was performing as a headliner when the attack occurred, appeared barely a week later on Saturday Night Live, playing Tom Petty's "I Won't Back Down." He will return to Las Vegas this year for a three-day residency in December. "Like everyone, I'm struggling to understand what happened that night and how to pick up the pieces and start to heal," Aldean said at the top of SNL. Even the festival itself was rumored to be preparing a return.

"I don't know if any of these artists or their crew will ever walk into an event or festival the same way, ever," says Tatum Allsep, founder of Music Health Alliance which serves to provide care to the often uninsured or underinsured musical community. "Though not all of it is negative. We are seeing everything through gratitude and hope. Music heals, and there is a lot of science behind that."

Many artists found their healing within song after Route 91. Maren Morris and Vince Gill recorded "Dear Hate," a track she actually wrote in response to a different shooting which took place four years ago at Emanuel African Methodist Episcopal Church in Charleston, South Carolina. Eric Church composed and sang "Why Not Me," which he debuted with an emotional performance on October 4th at the Grand Ole Opry while the family of Sonny Melton, a fan of Church's who was scheduled to be at the Opry that same night, sat in the audience. Church's signature sunglasses could not hide his tears as he sang "I'll never know why the wicked / Gets to prey on the best of us."

"It got dark for me for a while," Church told Rolling Stone. "I went through a period, a funk, for six months at least. I had anger. I've still got anger. Something broke in me that night, and it still hasn't healed. There's a part of me that hopes it haunts me forever."

There's an Emmylou Harris song called "Beneath Still Waters" that Andrews thinks about a lot: "Beneath still waters there is a strong undertow," he says, quoting the lyrics, "What the surface won't tell you, [what the] deep water knows." It reminds him of the artists he works with, getting on stage night after night knowing that their experience at Route 91 will never leave their minds entirely.

Part of what Music Health Alliance and other organizations advocate for is the destigmatization of mental health care and treatment. While artists in other genres, like pop, often openly speak about therapy, it's never been at the forefront when it comes to country music. That tide looks to be changing, though – Morris, Church, Wade Bowen, Kip Moore, Jimmie Allen and David Nail are just some of the artists who have publicly discussed their own struggles and/or treatment, and mental health is undergoing public perception transformation in the west. Even so, musicians are often required to put their own wellbeing on the back burner for the sake of staying on the road, especially in a climate eager to turn a respite for self-care into fodder for gossip — when Demi Lovato, for example, checked into residential treatment, the scrutiny was incessant.

A tribute to the victims of the Route 91 Harvest Festival shooting, hung on a fence outside the Las Vegas Village on September 30, 2019. Ethan Miller/Getty Images hide caption

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Ethan Miller/Getty Images

A tribute to the victims of the Route 91 Harvest Festival shooting, hung on a fence outside the Las Vegas Village on September 30, 2019.

Ethan Miller/Getty Images

"The abuse of an artist and their mental health, that's always been sacrificed at the cost of their art," says says Brad Parker, who handles Strategic & Government Partnerships for AC Entertainment and works on large festivals such as Bonnaroo. According to Dr. Susan Raeburn, certain particular barriers can keep even more "elite" musicians from seeking treatment. "While finances may not be the primary barrier to care for wealthy, elite musicians, other aspects often become problematic," she wrote in a presentation this summer called "Popular Musicians: A High Risk Subculture Worth Protecting." "Shame and stigma around addiction and/or mental health problems, significant financial consequences for career/tour disruption denial and enabling behaviors amongst family, managers, staff who are 'on the payroll,' " Dr. Raeburn continued. In the context of extraordinary trauma, it's easy to see where things could go swiftly wrong.

Adcox remembers a time, shortly after Route 91, when he was on the road with an artist and a fire alarm was pulled. "I felt it, everybody felt it," he says of the panic that ensued. "I went straight to 'active shooter.' You go right to the worst case scenario now." For Dr. Norton, working with artists and crew to tackle that "startle effect" has been part of the challenge in treatment.

"You need to go back to Vegas and you need to put your boots on again," says Dr. Shiva Ghaed, a clinical psychologist who happened to be on site at Route 91 as a fan, eventually going on to work closely with survivors and release an e-book on healing from mass violence specific to the country festival. "But I can't do tailgates anymore. Whether you are an artist or a fan or part of a security team, we now know that there is a potential of mass violence anywhere."

Many have made fundamental changes to how they tour to address those preliminary levels of concern: establishing active shooter plans, opting out of meet-and-greets, rethinking show specifics like the use of pyrotechnic effects, or anything that the artist and their team is afraid might instill a sense of panic or unrest in the audience. "It used to be tornado drills. Now it's active shooter drills," says Allsep. Just this past weekend, San Francisco's Hardly Strictly Bluegrass Festival implemented new security measures as a direct response to the rapid increase in mass shootings.

"We see riders [a list of requests submitted by artists to a venue where they are scheduled to perform] come through, that say, 'Hey we are not allowing these types of pyros or blasts because, regardless of what it is, we don't want to have the chance of causing any sort of panic in our audience,' " Parker says.

"People know what to do if there is a shooting, now," says Andrews. That level of preparedness doesn't just provide physical security. "It brings a whole new level of anxiety," he says. "People are just more aware, and therefore more anxious."

OnSite, at that beautifully rustic campus, offers residential programs and workshops to process and heal from trauma, and Adcox also individually advises members of the entertainment industry on mental health. He's not the only one to work one-on-one with artists in the wake of the festival.

"Therapists went on the buses and were just available to people during the day for the next few weeks," says Andrews of the time immediately after Route 91. Last week, around the two-year anniversary, Dr. Norton went on the road again, doing a "housekeeping" kind of therapy to address any triggering effects that might occur around notable dates. It's this kind of catered care that gives artists a better chance of healing in the midst of an atypical and erratic lifestyle where they are often forced to put their needs last — as Dr. Raeburn wrote, artists might opt out of therapy, particularly at a residential facility like OnSite, for fear of letting down the huge machine they've built around them.

But after Route 91, teams in Nashville assembled with speed and precision to make sure that this care was instantly available to anyone who was at the festival and to their circle of loved ones experiencing secondary trauma ("it's quite amazing, the tentacles it has," Andrews says). A large part of this process was making sure the artists and their crews had the ability to properly digest what they just went through.

"We spent hours doing critical stress debriefing, helping people understand what they went through," says Adcox. "The, 'Here's what you may feel in the wake of this, and here's what we'd like to offer.' " Part of this healing process, for artists in particular, has been to address the particular cocktail at play within the creative field: musicians, Dr. Norton says, can be "predisposed" to certain personality traits, intensifying their reactions to trauma.

"A situation like this only heightens what is already there," says Andrews. "Usually when a trauma like this happens, we often deal with prior traumas that this has just triggered." Allsep not only experienced trauma care through Music Health Alliance, but within her office itself. "One of our staff members' husband is Jason Aldean's lighting director, so we had an unfortunate front-row seat through him," she says. "We learned very quickly that not all mental health is the same, and trauma is a subspecialty where biography becomes biology."

What Allsep is speaking to is that tertiary response to trauma – the childhood events or other life circumstances that change and influence how one responds to distressing events. That's the specialty of Dr. Norton: to help patients not only understand how to make sense of what they have experienced, but to recognize that not everyone will respond to trauma the same way. Sometimes, in country music, that upbringing can even encourage an artist to just ignore that trauma, and keep on singing – the "tough guy" syndrome that Allsep mentioned.

Dorio chooses to speak out because he wants to remind other struggling artists that it's never too late to begin therapy, even two years later. "If you don't go on day one, it doesn't mean it's too late," he says. "Go now. For me this is a lifelong thing, like a tattoo. I don't know if I will ever be like, 'Well, that's done.' These organizations are offering help, but I have to show up. Of course the world is going to move on, but I have to get out of bed and tackle this. Even if it's showing up somewhere and just saying, 'I don't know.' "

"I think it's the most important part for everyone ... to have that support," Route 91 survivor Chris Madsen told NPR's Bridget Bennett. "It's really hard for people that weren't there to understand."

For others, like Andrews, it's just about making sure mental health gets a seat at the table, particularly given the shadow that Route 91 has cast over Nashville's creative community. "That's the overall most-important issue," he says. "Usually the table is filled with management, label, lawyers, hair and makeup. When we are talking about their life, an artist's mental health must come up in the conversation. Addressing their anxieties, opening the door to say that if you are struggling, there is help available in this crazy vocation you are in. And if artists stay healthy, we all win."

"It just helps to feel less alone," says Dorio. "That there is a way through, and there is life after this."

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