Mental health, disasters and what not to do
Author: Neil Greenberg, The King’s Centre for Military Health Research, King’s College London
Disasters, man-made or natural, may cause considerable ill-health and misery. Since 1980, when post-traumatic stress disorder (PTSD) first appeared in diagnostic textbooks, if not before, there has been a dramatic growth in interventions and approaches claiming to either prevent the mental health consequences of exposure to trauma or to provide rapid effective treatment of established disorders without the need to adhere to established treatment guidelines such as those published by NICE (National Institute for Health and Care Excellence) in the UK.
Such is the high profile nature of the psychological impact of trauma, especially over recent years with the rise in prominence of terrorism-related incidents, that media reporting of such events almost always includes some mention of what is being done to help the ‘survivors’ or ‘victims’. Often, media stories appear to suggest that the provision of ‘trained counsellors’ is a post-trauma necessity and that emergency-responder organisations should screen their personnel to ensure that they are psychologically robust enough to cope with the job. However, in watching those claims it is clear to ‘those in the know’ that such stories are not informed by contemporary science.
So what should be done? First, there needs to be a change to the narrative of a panic-prone public and of emergency response organisations failing to acknowledge the impact of working with trauma on their staff. A wealth of evidence shows that most people are far more resilient that the media suggests. In fact, whilst a sizeable proportion may experience short-term distress, developing a psychological illness is the exception rather than the rule.
Second, there is no evidence that short term interventions such as psychological debriefing or ‘trauma counselling’ for all are a good idea. In fact, the now considerable body of evidence into the use of such techniques shows them to have the potential to make things worse and cause harm. On the other hand, social support is highly protective and often freely available within community and organisational settings. In fact, many emergency response organisations have formalised this to some degree with the introduction of peer support programmes which specifically aim to monitor trauma-exposed staff and ensure that collegial support is available. The evidential message is clear, in the aftermath of a trauma people need the support of trusted colleagues, family and friends; they do not need ‘trained counsellors’.
Finally, whilst it would be wonderful if there were effective psychological screening techniques available so that organisations could screen-out vulnerable people and stop them from working in trauma-prone roles, this is not possible. Such techniques are not accurate enough and create many ‘false positive cases’ in which perfectly resilient people are incorrectly labelled as being vulnerable. They also provide false reassurance to the organisations that use them. Neither is it possible to screen people after trauma-exposure to detect if they have mental health disorders in need of treatment. We have recently finished the first randomised trial into post trauma screening and found a complete lack of effectiveness. However, screening within community settings, carried out carefully by a trusted health service, may well be useful.
In summary, supporting the bonds between people within communities and organisations, along with a temporary reduction in exposure to stressful situations as people recover are the best approaches. And, it’s still important, if challenging, to ensure that the relatively small number of people whose short-term distress does not resolve are able to access timely and effective evidence-based care.
Professor Neil Greenberg, The King’s Centre for Military Health Research, King’s College London: Professor Neil Greenberg is a consultant occupational and forensic psychiatrist. Neil served in the United Kingdom Armed Forces for more than 23 years and has deployed, as a psychiatrist and researcher to a number of hostile environments including Afghanistan and Iraq. Neil is an advisor to the Academic Department of Military Mental Health and also runs March on Stress (www.marchonstress.com) which is a psychological health consultancy.
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