Nicola and Keith Guy are experienced social workers and counsellors. Together they developed a special interest in trauma work and co-founded the Red Poppy Company. Their organisation is dedicated to increasing the awareness of psychological trauma, its impact on sufferers and its treatment.
Sarah is a 15-year-old girl who was violent, involved in drugs and prostitution, and prone to self-harming. She had received counselling and medication as well as help from social workers and youth workers. But no one identified that she was suffering from post-traumatic stress disorder (PTSD) as a result of seeing her mother raped and beaten by her alcoholic father.
After she received the correct diagnosis and treatment, the self-harm and addiction subsided and Sarah was able to engage constructively in counselling.
Sarah's story is not an isolated one. PTSD and psychological trauma are routinely missed by health professionals. Instead, sufferers are likely to be diagnosed with depression, anxiety or personality disorders and prescribed medication, or they may fall into the criminal justice system. Sufferers of PTSD may also include many social care staff and their clients. But it is a psychological condition which, when diagnosed, can be treated effectively.
Children are likely to be affected by:
But it is not just the victims of traumatic events who are
affected. Witnesses or those who hear third-hand accounts about an
incident are also at risk of developing this condition. This
includes social workers and counsellors, who may become traumatised
from hearing their clients' stories. Simply working in social care
for a long time can put workers at risk.
The traumatic event can happen a few days back or years ago in
childhood - and, unless the symptoms are treated, they can last a
lifetime. Key symptoms of PTSD include:
Social care workers often face situations that pose a risk to their psychological health as the sector is one of the most violent environments in which to work.(1)
Problems can sometimes be triggered by apparently "routine" cases. For example, two female social workers were intimidated each time they visited the house of a violent local family from whom they had taken a child into care. They were reluctant to involve the police as they did not want to make things worse. But the harassment escalated until death threats were made to the district office. Rather than tackling the family, managers moved the social workers to another office, but expected them to carry on with the care proceedings. Both social workers developed panic attacks and ended up taking long-term sick leave. Neither was able to return to work because of posttrauma symptoms.
Employers need to take PTSD seriously as it is now accepted as grounds for compensation. They need a clear set of policies and procedures safeguarding psychological well-being in the workforce, covering issues such as stress, bullying, harassment and violence.
Legal responsibilities include health and safety law that applies to risks from violence, stress and any other event that poses a risk to psychological health, just as it does to other risks from work.
Under the Health and Safety at Work Act 1974 employers have a legal duty to ensure the health, safety and welfare at work of their employees so far as it is reasonably practicable. Under the Management of Health and Safety at Work Regulations 1999, employers must consider the risks to employees, including the risk of reasonably foreseeable violence; decide how significant these risks are; decide what to do to prevent or control the risks; and develop a clear management plan to achieve this.
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (Riddor) require employers to notify their enforcing authority of an accident at work to any employee that results in death, major injury or incapacity for normal work for three or more days. This includes any act of violence towards a person at work. Also, organisations should have a plan for psychological health and safety issues. A confidential psychological service should be offered to whoever completes a Riddor form.
Carrying out psychological risk assessments is an integral part of managing stress in the workplace. Job descriptions need to be assessed for stress and, under health and safety legislation, preventive procedures should be put in place.(2)
But if an individual experiences a traumatic incident, early intervention and support should be available with an expert in psychological trauma.
Also, managers need to recognise that just because a worker remains at work it does not necessarily mean that they are all right or have recovered. Managers need to know where to find help and should be given psychological training so that they know how to respond to workplace incidents. They should be taught how to defuse situations and how to recognise the signs of psychological trauma injury and PTSD.
Good councils will have a qualified psychological service to
help employees. A general occupational health service will be
unable to provide this because doctors and nurses are not trained
to deal with psychological issues. As a result, the employer will
not fulfil its duty of care.
PTSD is an occupational hazard in social care and social work. But,
with the right monitoring and support, organisations can help their
staff deal with psychological trauma and maintain their mental
well-being.
Case studies - before and after treatment.
One client who was sexually abused as a six-year-old, 21 years earlier, says: "Before treatment the smell of alcohol made me want to be sick as I did if anyone touched my arms - the abuser used to grab my arms. I suffered flashbacks and dreams of what happened. I didn't like going out and was called a hermit. I was not a nice person to look at - this is how I felt inside.
"Now (following treatment) I don't have any more flashbacks and the smell of alcohol doesn't bother me any more. I feel like a different person, more confident and outgoing - whereas I used to be petrified. I don't feel like a six year old any more."
Another client had been issued with death threats two years before he started treatment for PTSD. He says: "I didn't feel safe at home or outside. I wouldn't take my four-year-old son into town and I detached myself from my wife and family. I regularly had flashbacks of the incident - sheer panic and anxiety. Having the problem diagnosed and treated has made me much more confident and I can go out to the pub again. I can communicate better with my wife. And I have gone back to work."
A treatment example: The rewind technique.
The rewind technique should be learned and practised under the guidance of an experienced practitioner. It is carried out in a state of deep relaxation.
Once relaxed, clients are asked to recall or imagine a place where they feel totally safe and at ease. Their relaxed state is then deepened. They are then asked to imagine that they have a TV set and a video player with a remote control facility. Next, they are asked to imagine watching themselves watching the screen, without actually seeing the picture, to create emotional distance.
Clients then watch themselves watching a "film" of the traumatic event. The film begins at a point before the trauma occurred and ends at a point at which the trauma is over and they feel safe again. They then imagine pressing the video rewind button, so that they see themselves quickly going backwards through the trauma, from safe point to safe point. Then they watch the same images, but going forward quickly, as if pressing the fast forward button.
This is repeated back and forth as many times as needed, at a speed dictated by the individual, until the scenes evoke no emotion.
If it is necessary to build up confidence so that they can face the fear in the future, for instance, driving a car or using a lift, the person is asked to imagine a scenario in which they are doing so, and feeling confident and relaxed. Once accomplished, clients are brought out of trance, and the work of the rewind technique is complete.
Abstract
This article looks at the impact of post-traumatic stress disorder on clients and the lives of social care staff and how it is routinely missed or misdiagnosed. Significant numbers of clients have undiagnosed PTSD, which impairs functioning and leads to dependence on the social care sector. PTSD is caused by violence, abuse and life traumas. Once diagnosed PTSD can be treated effectively and will free up clients to engage constructively with caring professionals.
References
(1) The British Crime Survey report, Violence at Work - Findings from the British Crime Survey, Health and Safety Executive and Home Office 1999.
(2) Regulation three, Health and Safety at Work Regulations, 1999.
Further Details
Contact the Authors
Nicola and Keith Guy can be contacted at the Red Poppy Company on 0845 2011334, or go to the Red Poppy website at www.theredpoppycompany.co.uk
Baby P case in Haringey
03 December 2008
World class commissioning learning resource
28 November 2008
Sharon Shoesmith removed after 'devastating' inspection report
Urgent Baby P report now with ministers
Review delivers damning verdict on Haringey child protection
Government Legislation
02 December 2008
Details of government consultations
28 November 2008
Private Member Bills
21 November 2008
