TRAUMA IN THE WORKPLACE

Transcription

1 TRAUMA IN THE WORKPLACE Dr Angela Busuttil Consultant Clinical Psychologist Lead for Clinical Health Psychology Sussex Partnership NHS Foundation Trust UK

2 Clinical Health Psychology Traumatic stress reactions feature significantly in all 14 services ITU and major trauma team Chronic Pain Cardiac services Neurological disorders Occupational health

3 Examples of Trauma at work Major untoward incidents : unpredictable rare incidents: school shootings/stabbings pupils or teachers, death of staff member at work, bank hold up, High Risk working environment Prisons, care of those with conditions such as dementia, ID, emergency services, personal attacks Bullying Large scale work place accidents e.g. Factory explosion, Fires Routine distressing events where effects are magnified by personal impact or scale of event incidents involving distressing injury or death of children, my patient, my colleague - in hospitals dealing with illness death of colleague. Death of patient, medical error. Grenfell tower

4 Structure of Presentation Why consider Trauma and wellbeing in the work place? Evidence base for the problem Looking after staff: Evidence base for interventions, individual, team and organisational Policies in the workplace First line interventions Psychological First Aid Therapeutic interventions in the workplace

5 1. Why consider Trauma and wellbeing in the workplace? Adults spend approx 1/3 of their lives at work; trauma can occur and needs to be manged in the workplace Some work settings deal with trauma on a regular basis and this can impact on those employed there Individuals will attend work having experienced personal trauma and this may impact their well being and performance Some evidence that policies, training and interventions can ameliorate the psychological impact of traumatic events supporting recovery and wellbeing

6 2. Evidence base for the Problem : Work related PTSD Literature search Emergency workers such as police firemen ambulance workers often experience incidents that meet stressor criteria for PTSD Also health care professionals, train drivers,divers, journalists, sailors,bank workers, stores may be exposed to work related traumatic events Work related PTSD usually diminishes over time Skogstadm. Skorstad A Lie H et al Occupational Medicine , 3,

7 Vulnerability factors and factors associated with prevention Factors associated with vulnerability Mental health problems prior to traumatic event Weak social support increased risk Factors associated with Prevention Sound organisational and psychosocial work environment Systematic training of employees Social support from colleagues and proper follow up of employees after a critical event

8 2. Evidence continued-psychological Impact of Traumatic Events Those closest to the impact of the event may experience most ψ impact Psychological effects ripple out into the disaster community including staff Remember Hidden staff Impact mediated by trauma factors but also by characteristics of individual and their current situation

9 Trauma at work -Ripple effect Individual Close family Those they work with colleagues and clients Managers Company/organisation

10 Complexity

11 The reasons to look after staff How organisations can support staff How staff and teams support themselves

12 Reasons to support Staff LEGAL Organisations legal duty of care for health of their staff at work COST IMPLICATIONS Absence from work Presenteeism Turnover of staff and cost of retraining new staff Most important the Human Cost ETHICAL REASONS

13 OCCUPATIONAL HEALTH AND SAFETY AUTHORITY ACT XVII 2000 with subsequent amendments Malta measures that need to be taken by an employer to prevent physical and psychological occupational ill-health, injury or death, shall be taken on the basis of the following general principles of prevention, that is by - (a) the avoidance of risk; (b) the identification of hazards associated with work; (c) the evaluation of those risks which cannot be avoided;.. (i) by the development of a coherent overall prevention policy which covers technology, the organisation of work, working conditions, social relationships it shall be the duty of an employer to provide such information, instruction, training and supervision as is required to ensure occupational health and safety And (1) It shall be the duty of every worker to safeguard one s own health and safety and that of other persons who can be affected by reason of the work which is carried out.

14 3. Discussion of Evidence base for Interventions Can we prevent PTSD and other psychological distress associated with work place traumatic events? Can we screen pre-employment to select those most resilient? Can we train to mitigate the impact of some traumatic stress at work? When traumatic stress occurs do early interventions make things better or worse?-psychological debriefing debate Once traumatic stress associated with distress can the person be effectively treated and can they safely return to work?

15 Impact of event on staff mediated by Trauma related Factors Organisational Factors Personal Factors

16 Trauma factors associated with increased risk of developing problems-general Severity of the trauma and dose response-duration, intensity, cumulative events Direct exposure to the event as victim or witness, sometimes as perpetrator Serious injury or threat to life(self/other)during event Maintaining consciousness... Memory? Interpersonal violence Severe emotional reaction during the event and persisting afterwards, crying, shaking, vomiting, feeling apart from your surroundings (dissociation) Felt helpless during the trauma Events which include aspects of our innate fears (water and drowning, darkness being trapped, fire, heights and falling) Zeebrugge 1987 Body handling Events with personal meaning e.g. where children were hurt and injured especially if witnesses have children Events where there is someone to blame rather than an act of God Sexual Assault and Rape, CSA

17 Traumatic events specific e.g. for firefighters (Bergmann & Queen, 1986): Death/ injury of colleague or child. Rescue situations where it is impossible to reach a victim, especially a child Rescue of a burn victim whose recovery is unlikely and suffering is great. Multiple rescues of victims during which triage decisions must be made. On the way to a fire, involvement in a traffic accident in which the emergency driver may be at fault.

18 Trauma, organisational and personal factors- Stressors for Rescuers & Military Personnel on Humanitarian duties (Greenberg et al 2015) Identifying with Victims, Prolonged Exposure, Compassion Fatigue Indecisive and Poor Leadership Double Binds rules of engagement Poor support Poor group cohesion Lack of Information Lack of rest and relaxation Overwhelming conditions Personal safety/risk to own health and well being Lack of support from loved ones or losses and concern for loved ones safety.

19 The Drops Of Rain Make A Hole In The Stone, Not By Violence But By Oft Falling Lucretius

20 Personal factors Condition of the boat as it faces the storm Previous storm damage? How equipped is the boat for the conditions (resources, training) Can it get back to the yard for minor repairs (R&R) Where is the anchor and the safe harbours Bio-psychosocio-spiritual preparedness

21 Psychology professions Face to face with personal stories of events and their impact EMPATHEIA to feel inside- Empathy evokes the same feelings in the therapist. Distress may come from Work with distress of individual Helplessness at legal/social barriers Concerns of re traumatising client Looking after others, carers,interpreter, team

22 Not all Negative - Emerging concept Vicarious Resilience Journal of Transcultural Psychiatry December areas identified VT, VR, work satisfaction, and cultural flexibility Workers also build own resilience through seeing growth of those they work with /52/6/743.abstract?rss=1

23 How organisations can support staff

24 How can organisations help? Culture including training of execs and senior management Stress Management Policy Risk Assessments with aim at risk reduction Training and preparation for staff specific to their role On going support in situ and access to support for critical incidents Clear clinical pathways for those needing intervention including support for return to work Review of lessons learnt in audit cycle

25 Organisational culture Culture that recognises from the top down that no matter how good the ship there are circumstances in this work when anyone can become overwhelmed and benefit from support Culture needs to promote psychological mindedness Without this any risk assessment, training or intervention is unlikely to have maximum impact

26 Stress Management Policy for organisations Positive indicators The stress management policy is contextually and culturally appropriate. Policy includes plans both for response to routine sources of stress and to critical incidents Recognizes that the differing support needs of different groups of staff The policy recognises that sources of stress can be personal,routine work related as well as major incidents and that the effects of these can interact and be cumulative.

27 Risk Assessment Stress Risk Assessments should be undertaken with a view to looking at how the risks may be reduced Issues of Screening staff. Complex -see Antares document for a good discussion. Not proven to prevent problems in staff but may help identify both to individuals and to the organisation additional support requirements

28 Training Staff should be fully trained for the role they will carry out Trained in stress and how to mange it How to identify and when to seek help and from where they can obtain it Especially important for volunteers

29 Ongoing monitoring of stress Can take place in supervision and management sessions and at annual appraisal Needs to be a way of feeding back to the organisation if there are problems and links to assessment and support if needed

30 Specific incident support programmes Programmes triggered to provide a structured response to a stressful incident Often have a name so easy to identify what will be done and by whom e.g.( Assist, TRiM, SPoT) Usually involve meeting of staff involved and information about normal responses to stress Practical information and support of line manager/buddy Watchful waiting with access to further help for those needing it

31 Critical Incident Support Psychological First Aid advocated rather than Psychological Debriefing Key role for Mangers in supporting staff and communicating sense of containment Psychological First Aid care delivered in first few weeks after the incident to individuals showing acute stress reactions. Aims to establish sense of safety, reduce extreme acute stress-related reactions, strengthen coping mechanisms and social support, and connect individuals to resources/services that help them address their problems ng.pdf

32 Evaluation by RMG Generally positively received by staff The right type of support post incident ( immediate) and support which enhances the employees perception of how the organisation is treating them was shown to help reduce symptoms in the medium term and absence in the longer term Psychological care programme needs to be integrated with the organisational procedural response

33 End of Review Incident review -acting on unmet needs Ensuring there is a time to review what has happened and how people have coped, lessons to be learnt R& R may be helpful after particularly stressful period Important to identify anyone who needs further help such as referral for assessment and therapy

34 How staff and teams support themselves

35 Resilience training for teams and individuals Concepts of hardiness (Kobassa) but all can improve Maintain flexibility and balance as we face stressful circumstances and traumatic events There are behaviours, thoughts and actions that can be learned or developed. Importance of the role of the Manager

36 Individual Identify own triggers Identify own coping styles +ve and ve Learn to use cognitive, social and behavioural adaptive coping mechanisms Supervision and appraisal Team Resilience building Communication Role of Managers Time to reflect on own needs Group supervision Peer support

37 Either at individual management or organisational level seeking to strengthen the surviving and healthy part

38 Case studies: Team Individual MUS Individual

39 Surgical team/hospital Sudden illness then death of colleague Grief complicated by organ donation Group intervention Schwartz round Outcome Care home incident Attacked at work. Medically unexplained voice loss and social phobia. Screamed and screamed thought she would die -noone came Raised issues with managers no action TF CBT Assertiveness Outcome Individual/Team Management referral: car accident difficulties with team and managers since TF CBT Better but not cured EMDR- big T

40 Thank you