Guidance on the Management of Post Traumatic Stress

Transcription

1 Guidance on the Management of Post Traumatic Stress Health and Safety Services 1

2 Contents Page No. 1. Introduction 3 2. What is Post Traumatic Stress and Post Traumatic Stress Disorder 3 3. Symptoms 3 4. Diagnosis and Treatment of Post Traumatic Stress Disorder 3 5. The Role of the Employer 4 6. Trauma Experienced at work 4 7. Post Incident 4 8. Early Intervention Protocol 4 9. Protocol within the University Students Experiencing Trauma Role of Individuals References 5 Appendix 1 Possible Symptoms of PTSD 6 Appendix 2 Protocol Flow Chart 7 2

3 1. Introduction This guidance is aimed at the Management of Post Traumatic Stress (PTS) which may arise in the professional lives of staff, with a view to minimizing the likelihood of an individual developing Post Traumatic Stress Disorder (PTSD). However, elements of the guidance can also be used more broadly in the interests of supporting staff who may suffer from the effects of PTS after an incident which has occurred in their private lives. 2. What is Post Traumatic Stress and Post Traumatic Stress Disorder? PTS is a psychological and physical condition that can be caused by extremely frightening or distressing events. PTS can be caused by witnessing or experiencing traumatic events including: Military combat Natural disasters Terrorist attacks Violent deaths Personal assaults such as rape, or other situations in which the person felt extreme fear, horror or helplessness It is normally associated with events which are out of the ordinary, beyond normal coping mechanisms. It is a common condition. There are also known to be cases where people experience PTS where they have not been actually present at an incident but are connected with the situation in some other way. Some individuals will go on to develop PTSD following such events. Symptoms usually develop immediately or within three months of a traumatic event, although occasionally they do not develop until years later. 3. Symptoms Most people who are exposed to a traumatic event are likely to experience some symptoms of PTS. In most cases the symptoms subside and/or disappear in the days and weeks following exposure. A list of possible symptoms and associated indicators can be found at Appendix 1. When the symptoms do not subside then it may be the case that a person is suffering from PTSD. PTSD often involves a period of symptom remission followed by an increase in symptoms. Some people may experience severe and unremitting symptoms, which can also be triggered by exposure to an external stimulus, even some time after the event/s. A GP or other health professional can diagnose PTSD by discussing all the symptoms with the person affected. However, this can only be done if the individual recognises that they are experiencing a problem themselves or if someone around them encourages them to seek help. It is not unusual for an individual to fail to recognise that they have developed PTSD. 4. Diagnosis and Treatment of PTSD Treatment of PTSD usually begins with a detailed evaluation, which would be carried out by a medical professional, using a set of clear diagnostic criteria. A treatment plan can then be 3

4 tailored to the individual s needs. A number of psychotherapeutic models can be used in the treatment of PTSD. 5. The Role of the Employer It may be that an individual begins work with the University having already developed PTSD. If this has an impact on the individual s work, relationships at work or results in sickness absence it should be dealt with by a line management referral to Occupational Health. The line manager would not be expected to pick this situation up independently. The symptoms may, however, become apparent in discussions with the member of staff or through referral within the sickness absence procedures. 6. Trauma experienced at work If a traumatic incident is experienced whilst a person is at work, then the employer should support the individual in order to minimise the impact upon the well-being of the person affected. 7. Post Incident The role of the line manager is pivotal in this process. The person involved with an incident is very likely to want to talk about the events which have taken place and the line manager should then be able to make a judgement on the potential seriousness of the situation. Often, following a serious incident a person will deal with the immediate aftermath in a way that they are familiar with, e.g. they may wish to have some time away from work, they may wish to stay at work, they may wish to talk or they may wish to get on with routine duties. Once the line manager has been informed that an incident has occurred they should discuss with the member of staff how they feel about the incident and give them the space to decide how to deal with it themselves in a supportive manner. This may involve practical social or emotional support. It is often very useful to provide the opportunity for some initial discussions as a group if more than one person has been involved with an incident. Such discussions will often develop naturally; as people come to terms with a situation they have had to deal with. When very distressing events have been experienced it may be that an Early Intervention protocol will reduce the potential for the individual to develop PTSD. This needs to be initiated by the line manager after the event. 8. Early Intervention Protocol Following research and analysis of effective interventions, the National Institute for Health and Clinical Excellence (NICE) have published guidance on the treatment of PTSD. NICE s Clinical Guideline 026 refers, and chapter 7 in particular deals with appropriate early intervention strategies. It is no longer thought to be good practice to carry out critical incident de-briefing (single sessions focussing on the traumatic incident) following an incident. 9. Protocol within the University A protocol has been established within the University for dealing with staff who have experienced traumatic events at work. The process for referral is included as Appendix 2. The trigger for operating the Early Intervention Protocol rests with the line manager of the person who may be affected following an incident. 4

5 The first step involves a telephone call or to Occupational Health from the manager. Occupational Health will need a summary of the incident, the numbers of employees affected and their contact details. The manager should inform the members of staff involved that this action has been taken. Occupational Health will then make contact with FOCUS the independent counselling service contracted to the University. Occupational Health will speak to the staff affected and facilitate contact with FOCUS and their own GP. A watchful waiting technique is then adopted in the immediate period following the incident. This then may or may not be followed up with further interventions depending upon the circumstances. If a person is absent from work following an incident then normal sickness absence procedures will also apply. 10. Students experiencing trauma If students are involved in a traumatic incident, the Head of Security and /or the Head of Student Support Services will ensure that other relevant people in the University are aware of what has happened, and obtain the contact details of students likely to have been affected. Students known to have been affected will be made aware of Student Counselling. If relevant, pro-active engagement will be made with the affected student or group of students. (e.g. course group, house group, Halls residents etc) Having been alerted to the incident, Student Counselling staff will make every effort to ensure timely and appropriate support is available to the students. It is also likely that in the event of a major incident Student Counselling would have been alerted to an incident as part of the Crisis Response, Disaster Recovery plan ( 11. Role of individuals Although it is hoped that individuals will take up offers of assistance from Occupational Health, engagement in the early intervention offered is entirely voluntary. FOCUS counselling is an independent provider and medical confidentiality will not be breached. Owing to the subjective nature of this illness there will be some onus on the individual to communicate to their line manager if they have experienced something which would prompt action under this procedure. 12. References 5

6 Appendix One Possible Symptoms of PTSD Flashbacks, nightmares or frightening thoughts, especially when exposed to anything reminiscent of the traumatic event Sweating and shaking Avoidance of reminders of the event and refusal to discuss the experience Numbness and feelings of estrangement or detachment from others Inability to remember aspects of the traumatic event Decreased interest in life Increased consciousness of one s own mortality Flight /fight syndrome Problems with concentration Problems with sleeping Irritability or outbursts of anger Hyper-vigilance and alertness to possible danger Re-experiencing the traumatic event Feelings of guilt Possible associated indicators Long term behavioural effects Alcohol abuse Drug dependency Failed relationships/divorce Severe depression, anxiety disorders or phobias Chronic illness headaches, stomach upsets, dizziness, chest pain, and general aches and pains, together with a weakened immune system and Employment problems 6

7 Appendix Two POST TRAUMATIC STRESS (STAFF) PROTOCOL Line Manager Advises Employee the situation has been referred to Occupational Health Contact Occupational Health Feedback to Manager as required (no disclosure of confidential information) Occupational Health Make contact with Employee and explain that Focus will contact them Contact Focus Counselling Focus Counselling Make appointment with Employee Feedback to Occupational Health on acceptance/refusal and further action which may be required 7