PTS "the forgotten side effect of workplace tragedy"

I agree - I suppose the problem arises when someone has to recognise and and provide the right level of support for the person.
On a similar theme, someone was telling me today that she had permanent damage to her hand, because the waiting list to see the specialist was so long, by the time she got to see him/her it was too late to treat it successfully. I suppose if the GP knew this he caould have 'fast tracked' her? But to be able to assess this he would need to be a specialist.

I agree 'we' should never dabble in anything we are not trained to do.

Counselling or otherwise, those trained up to a recognised qualification sit in a better position than those who are not.

And I agree Alan you sit in a better and more qualified position than I on the evidence you present here.

However there is a need for intervention at some stage and there would not be recognised counselling qualifications if they are not worth the paper they are written on, especially when the courses and examination criteria are designed and implemented by those in your position or possibly higher qualified.

Now where would be the sense in that?

There is a need for employers to manage stresses and they should be held accountable if they fail to ensure a working environment where the stressors are kept to a minimum.

No offence taken as I am only following a national structure of counselling training set up by someone as highly regarded as yourself.

I don't think this should offend anybody. You can't 'dabble' in things like this.

I am afraid that counselling is frowned upon by professionals as it is unregulated and conducted by non professionals and whilst it may have some positive outcomes, in true PTSD or PSD cases will cause significant problems and will do nothing to assist the sufferor. Sorry but counselling is no substitute for qualified psychological assistance, it is just cheaper and used as a makeshift remedy in most cases. I am sorry fi this offends counselors on the site but facts are facts and the medical evidence is irrefutable. Your wouldn't ask a paramedic to perform open heart surgery for heart block, so why do we tolerate counsellors performing a psychologists role? I had to sit nineteen, three and four hour written exams and four interview case studies as well as six hundred practicing hours before being allowed to speak to the public, I am not going to allow a counsellor no matter what certificate they hold to speak to my clients. Your freindly lawyer.

As a lawyer dealing specifically with veterans who suffer anxiety spectrum disorders including post traumatic stress disorder and anxiety disorder, I am afraid to say, which will annot most people here, which is not my intention. In almost all PSD or PTSD cases a reliance on substance abse is a key indicator, within twelve weeks of the stressor. Anything less is likely to be a lower and easily treatable anxiety disorder. Most ADS injury can be reformed with twelve or less hourly sessions of CBT or TA. There is much that can be done but isn't purely becasue of the lack of NHS funding. Your friendly lawyer (who is also a qualifed psychologist).

Wayne

I never said counselling was a listening only service, I merely agreed with you that there is a requirement for listening, and suggested that this should extend to line management. Whether or not the line manager is 'the best person to listen', he should still listen or he will be unable to understand the issues and problems and more importantly he will not be able to undertake a stress risk assessment.

Good line managers generally appreciate that what is in the employees best interest is often also in the company's best interests. Many employees I see turn to their line managers for support, and have a very good relationship with them. I suspect though that most who have a very good and supportive line manager rarely need to be referred to occupational health.

I am well aware of the principles of counselling; in my occupational health practice I frequently work with counsellers, clinical psychologists and psychiatrists and will recommend the most appropriate depending on the employee's needs. I also recognise that counselling does not suit everyone. There are also times when the employee wants and needs specific advice and a 'you should do' approach.

While I can recommend as much as I like, I cannot force management to fund counselling. Fortunately in most large organisations and many medium sized organisations I work with, counselling is provided. We do, however, have to recognise that the employer is not responsible for providing healthcare to employees, that is the role of the NHS, and many employers simply cannot afford counselling in just the same way that many employers cannot afford an OH service.

Hi Tony,

I agree but unless it saves money then they don't listen!

Also I disagree that line managers are the best people to listen because they do not have a blank agenda to help the person with a problem; it is always and will always be in the company’s best interest. It is not about responsibility it is about safety and the managers (unless otherwise counsellor trained) are not trained to do this.


And your explanation of counsellors/counselling is not about a fragmented society or not having friends/family. The skills used are the important factor and that is allowing the person to be the focal point without subjecting them to personal opinion and 'you should do's'. Allowing them to talk and working with ‘their’ issues is key free from advice.

The mistake here is to suggest that you have to have special needs for counselling. Counselling is a confidential talk based service for anyone and for any reason because ultimately it is for no one else to judge if the problem is too small to see a counsellor.

And please don’t insult my intelligence about counselling being a listening only service. You have no idea about counselling and demonstrate your naivety. And if I wanted to teach management about the rights and wrongs then I would not have trained in counselling but gone for employment law and CIPD.

I would like theemployers to begin to look at staff as humans, just like the rest of educated society and that people are affected by things and they need the help and support to work issue through.

Again I stress not everyone but those who need it should have access to it through the company they work for.

Wayne

Listening is very important, but the people who should be listening are line managers. There is a danger that by offering an alternative you are allowing management to avoid their key responsibilities.

Counsellors provide a very important service, and as you say there is an abundance of evidence to demonstrate their effectiveness (substantially more than for antidepressant medication) but in my view the main reason we need counsellors is because society has fragmented so much that people have lost the extended family and friends who they should be talking to and getting support from. As you say, the primary skillset is simply understanding with humanity.

Evidence shows that for PTS the best person to talk to is a colleague who was there too, and understands. This means line managers and workplace colleagues. We should be encouraging and empowering this, rather than substituting with counselling, keeping counselling for those few who for various reasons cannot get support from colleagues, or need more extensive support.

I do share your concerns over management blocking any initiatives in this direction, usually through fear of litigation rather than lack of understanding, believing somewhat simplistically that if they don't tell staff about post-traumatic stress none of them will get it. There is, however, no legal requirement to provide access for one to one counselling as you suggested although it is a clear recommendation by the Court of Appeal to avoid stress litigation (Hatton v Sutherland, but see Daw v Intel)

I feel your skills could be put to far better use in educating line management and HR staff rather than offering a listening service only.

Hi Tony,

How about LISTENING to the people who feel affected – possibly by some traumatic event?

In my company the heath and safety committee have called repeatedly for access to a person or to send someone on training to be able to just talk to staff and listen to a wide range of concerns.

Having the qualifications and working towards higher qualifications at present I have spoken to the HR manager and suggested that I am ready to step into this role as long as the company arranges continuous 1 month supervision for me.

The HR manager refused this and suggested to me it doesn’t work (talking therapy today has been given a massive boost in England, to the tune of hundreds of millions, by the government to make it more accessible through the GP service to intervene at an earlier stage of mental health) and has opted for issuing a telephone number should anyone need it.

As I said WHO is qualified to see signs? And why give the power to block access to some uneducated individuals that are in a position that is supposed to work with the company on personnel issues including welfare i.e. HR managers.

The employer has to ensure the welfare standards allow for one to one consultation even if it is to talk about the weather getting them down.

By gaining trust the person will tell you the problem and you don’t have to use anything specialist, that is just absurd. The idea is not diagnosis but allowing a person to move forward or to a more ‘normal’ and rational state of being. If there are complicated issues then yes I agree a referral or sign posting service may be required but we must start at the beginning and stop labelling/diagnosing.

There is no need for TESTS there is however a need for humanity and acceptance that these problems do occur, to everyone and anyone at some stage, and something in work can be a contributory factor. Some of the other threads refer to management drinking more than floor staff. Perhaps if this management had a door to knock once a week to discuss the stress levels than this may not be an issue.

And of course this would all be confidential, even to the highest company directors and confidentiality would only be broken to supervision or the mental heath services or police IF a person has disclosed harm to themselves or others, breaches of the children’s act or serious involvement in criminal activities.

Please have a read of the BACP website http://www.bacp.co.uk/information/education/whatiscounselling.php

A bit of emotional literacy and pro-social good relationship management where employees "feel" included and there is a sense of 'positive regard for all' would provide a high degree of palliative mitigation to the more fear driven, anti-social even toxic climates exacerbated by ongoing cascade of pressures and already demanding commercially competitive environment.

Wayne

As you will know from your training, besides the obvious signs of distress, the most important sign is a change in behaviour. Otherwise you are quite right, colleagues and employers may never notice, likewise GPs. Specialists may only spot problems if they start asking very specific detailed questions, at which point overdiagnosis becomes the greatest problem.

We have seen waves of overdiagnosis of various conditions over the years. Someone decides we have been missing serious illness, we are told to be vigilant, we suddenly find thousands and thousands of people with the signs and symptoms, spend millions treating them, then someone with a little common sense comes along and brings us back to reality. In many cases a key driver has been big business making money out of the treatment.

Unfortunately the reality is that, in scientific terms, tests have 'sensitivity' (the likelihood that the test will pick up everyone with the condition, false negatives) and 'specificity' (the likelihood the test will pick up people who don't actually have the condition, false positives). Unless the test has very high sensitivity and very high specificity it is not actually useful. Rare conditions tend to have very high false positive rates on tests. We have yet to find a really good test to identify those at risk of developing PTSD or in the early stages of doing so.

Perhaps a better title for this piece would be 'the hidden side effect of workplace tragedy'.

Hi Tony,

I Agree with your comments; however who in the company structure is trained to see signs?

Companies do not consider that a day or two away from work to process the information and then having the option to discuss may prevent 'real' problems in months or years down the line.

There is too much pressure on staff to accept the reality and the companies are insensitive to believe that a warm cuppa and a fag is enough.

With the insight we have into these and other conditions why cant staff be treated as humans with feeling, emotions and complex cognitive reactions/ responses. One box does not fit all.

The only person that I know of that has faked PTSD was under the treatment of a psychologist who was coaching him. The company was successfully sued and the the person had a nice little earned and will gladly tell you that the psycologist was planting conditions in him that were never there ie sleepless nights and bed wetting.

It is easy to demand that 'something must be done', but this subject has been extensively researched, and a number of key points need to be understood.

Post-traumatic stress reactions are common, and most specialists consider them normal. In almost all cases they will settle down without any specific intervention.

Post-traumatic stress disorder is a specific diagnosis, some psychiatrists believe again that mild symptoms are very common and a normal response. Severe PTSD that is disabling is rare but very treatable by specialists. It is extremely rare to suffer long-term disabling PTSD that does not respond to treatment.

Sadly, it is common to see large numbers claiming PTSD when compensation is available. This can hamper the identification of those genuinely affected and needing support, and leads to negative views of those genuinely ill. Anyone encouraging these compensation claims needs to understand the damage they can do.

Early interventions, including 'critical incident debriefing' cause significantly more harm than good, and should only be attempted by experts in their field. There are very few experts in this field, certainly not enough to provide a widespread service.

In almost all cases, the best support comes from colleagues and friends, particularly those who were also present and understand what actually happened. Support includes keeping teams and colleagues together rather than sending them off sick or isolating them.

The most important message is to keep an eye on people known to have been involved or witnessed traumatic events, and offer specialist support if clear signs of distress become evident.

For those who want clear guidelines, see
http://www.nice.org.uk/CG26

Tony

The manifestation of PTS disorders are not just limited to "one off" personal or even witnessed traumatic events but will also be acquired over time when our normal 'fight/flight' reaction to stressors, even arguably minor events, results in the coping, tolerence and adaptive mechanisms (GAS) becoming exhausted where escape is not perceived an option as in the workplace.

Human resources just like any other production line equipment requires not only a set of "given conditions" in which to "function" let alone thrive and give of their best potential performance but routine and planned maintenance if their functioning is to be reasonable constant and sustainable over time.

Systemic failure to maintain a "given climate " in their relationship management that fosters or supports feelings of belonging or inclusion and "positive regard", by way of support and "approval", will undermine any sense of weel-being, self-worth and value to the point where a growing performance anxiety will manifest in poor performance and productivity - simple'ssss

I agree Karen,

I am working towards AQA's Level 4 Diploma in Counselling and I volunteer for CRUSE Bereavent Support as a counselling volunteer. I have BACP student membership and I am working towards being fully registered with them.

Many of my clients have PTSD from watching a death occur or finding the deceased. PSTD manifests in dreams, flashbacks, panic attacks and anxiety about the original trigger or the possibilty of it happening again.

My friend and colleague watched his manager die of a heart attack in the office. Luckily he has had the suppport of friends , our tutors and his own education to rationalise and talk through the event. Unless his working colleagues have contacted someone for private support and therapy then the company has done nothing to help.

Welfare seems to not be associated with ability and experience of the staff and colleagues at work.

If we were all robots or clones then the employers would have their day.

As an occupational therapist working with ex service personnel with PTSD I can confirm that witnessing events as well as taking part in them can have a detrimental effect on your health many years after the event, if it is not "processed" by the brain. In the case of our service personnel they have to carry on with their duties regardless and on average it takes 13 years to manifest itself into a situation where it has an impact on their living. some of course end up in prison or alcoholics as obviously their culture is stiff upper lip and you certainly don't talk about it otherwise your weapon is taken from you and you are dismissed! I would urge anyone, who goes through, or witnesses or even is emotionally affected by a traumatic event that they find a professional to talk about it, sometimes by continuing to process the event through your mind and rationalising it can help the healing process. Most health care professionals receive "supervision" and we use this to discuss difficult events or situations in pretty much the same way.

I was present during a car accident on the motorway. The car in front of me had a blow out, hit the embankment and rolled. I was first on the scene and assisted the injured lady whose ankle has been practically ripped off. I was completely fine during the incident, but afterwards stopped eating for about 10 days. I just couldn't face any kind of meat, as it reminded me of what I had scene. 22 years on I am still vegetarian! It wasn't called PTS back then, it wasn't called anything. Now I can see that's probably what it was. Strange how things can affect us!

I Agree Jo,

Also instead of providing an 0845 number for telephone counselling there are organisations who volunteer their services and will come into a company and offer face to face counselling to those affected for as long as required.

The employer’s attitude is very much in the sense of ‘right back to work there is nothing to see here!’

The trauma does not stop when those commands are issued and may manifest weeks later.

Only this week I have ‘forced’ the company I work for to update its first aid facilities after a friendly H&S inspection condemned the room as ‘unfit for the rats that may infest it’. Gladly he has given us the opportunity to improve and invest before a more formal inspection is carried out.

The problem lies in the attitude of the management who feel that as no major injury has been sustained in 10 years then the first aid room can be left in 10 years of dust and decay.

The attitude of 1 manager may affect the mindset and welfare of 100’s of staff.

Its not just a fatal incident that causes PTS. I have known several victims of accidents traumatised by their injuries, or by providing first aid to others or just psycologically affected by the fact that it could have been so much worse (near miss). Employers often have no idea of how to manage a major or minor incident, I would like to see more Occupational health assessments after injury, witnessing an incident or providing first aid to help people recover from a major shock. Business continuity plans should account for this potential in risk assessments.

You certainly don't have to be witness to the event to be affected by death or bereavement due to a traumatic event especially if it involves someone you are related to or know well.

Suicide is a classic example of this, and the effects are far reaching and can often have long term effects. Those left to pick up the pieces have to go through appalling difficulties, as I have experienced myself from an observers perspective. I certainly wouldn't want ot have to see my family affected in this way again or anyone else for that matter.

It took over 8 years to address all the issues and there is still a residue of outstanding issues that will have to be adjusted to. It is a life changing occurrence that no amount of time can fully repair the damage done.