Years ago when I started in occupational health, it was common practice to de-brief workers who had experienced a traumatic incident immediately. However, this advice was changed years ago. So what should you do to protect workers against PTSD?
Neil Greenberg (Professor of Defence Mental Health at King’s College London,) in a recent article says:
Phoning your employee assistance programme provider (EAP) and asking it to bring in counselling for everybody is not just a waste of money, it actually has the potential to make things worse. Instead of doing that, the role of the psychological health expert from your EAP or elsewhere is in helping your management team and supervisors create an atmosphere where everyone is going to support each other and to get people talking and keep an eye on how people are doing.
What is PTSD?
PTSD is a health problem that occurs after actual or threatened death, serious injury or sexual violence in any of the following ways:
- Directly experiencing the traumatic event or witnessing an event as it occurs to someone else
- Learning of a violent or accidental event occurring to a loved one
- Experiencing repeatedly or being exposed to traumatic events, for instance for members of the police forces, social services, and firefighters
Not everyone gets PTSD; everyone is different after all. It can depend on:
- If you have suffered traumatic events already
- Abuse or severe neglect in childhood
- A lack of social support, as in the case of migrants or isolated members of society
- It is more common in women than men
Typical symptoms of PTSD:
- Re-experiencing symptoms: flashbacks, nightmares, intrusive distressing images, thoughts or sensory impressions of the event. Physical symptoms associated with remembering the event are common such as nausea, heart pounding, trembling or irregular breathing.
- Avoiding people, situations or circumstances resembling or associated with the event. The sufferer feels detached from other people or numb (inability to feel any emotions or sensing parts of the body). Amnesia is common for parts of the traumatic event.
- The sufferer is on high alert and easy to startle. There may be sleep problems as well as irritability, paranoia1 and poor concentration.
Symptoms vary depending on whether the person has had the condition for a short or long time (chronic PTSD)
- Depression is common
- Alcohol and drug misuse
- Unexplained physical symptoms.
Which is why PTSD is often missed. Sufferers may not link their health issues with the traumatic event; or, want to forget a shaming or violent incident.
Treatment for PTSD
GP’s (your doctor) should use a questionnaire to assess the level of seriousness of PTSD and then decide if a psychiatrist is required to confirm the diagnosis.
- NICE guidelines recommend trauma-focussed cognitive behavioural therapy (t-CBT) or eye movement desensitisation reprocessing (EMDR) as the main options for treatment. The number of sessions required in acute cases (less than three months after the traumatic event) is 12 sessions or less of weekly trauma focus therapy.
- Commonly more sessions are needed or if patients do not respond to t-CBT or EMDR.
- Address alcohol or drug misuse from the start, otherwise, therapy will often fail.
- If you have PTSD for more than three months with serious effects therapy is a minimum of 24 sessions.
- Social factors such as homelessness or domestic violence need to be dealt with prior to trauma therapy. Medication may be required.
The choice of treatment depends on the type of trauma experienced and how serious the resulting problems are. For instance, in cases where the memory is patchy, then EMDR may be the treatment of choice as language is not so relevant to the treatment.
Other treatments are also available too such as narrative exposure therapy.
Although tablets are not recommended; they may be needed when there is a depressive illness, or with anxiety and sleeplessness.
Other screening questionnaires medical professionals and therapists use include:
- Impact of Events Scale (IES-R)
- Post-traumatic stress disorder checklist
- The post-traumatic diagnostic scale (PDS)
- Trauma screening questionnaire (TSQ)
Can I Screen People for PTSD before I Employ Them?
There is no recognised way of assessing someone’s response to an upsetting incident; something which the military have looked at in some detail. The reason is that many do not answer mental health questions honestly, although this attitude is gradually changing in the workplace.
Proactive Ways of Protecting Workers
Greenberg suggests the best way to avoid PTSD is:
The biggest factor, by a long way, are the things that happen after the event and the support that someone gets in the immediate aftermath and how much stress or pressure they’re put through as they’re trying to recover .
The best way of protecting workers is to:
- Promote resilience
- Detect emerging problems
- Have policy/clear procedures for those likely to be exposed to traumatic incidents (e.g., firefighters, ambulance workers)
- Train managers and supervisors
- Good communication and decision-making
- Have the proper treatment for those affected.
- Patient leaflet on trauma-focused CBT
- National Institute for Health and Care Excellence (NICE): Management of PTSD UK guidance document
- Trauma risk management (TRiM) used in the UK Royal Marines and other high-risk employment e.g., Police, BBC, Fire and Ambulance services
- Paranoia – Irrational distrust or suspicion of others, especially as occurring in people with psychiatric disorders such as paranoid personality disorder and schizophrenia: paranoia about neighbours stealing from his vegetable garden