Blue Flower

Dr Karen Amendola of the American Police Foundation presents the findings of a study on shift work, shift hours and fatigue.

Key observations from the presentation delivered by Dr. Ceri Jones at the Police PTSD conference 2017

DEFINITION: Healthcare team members involved in an unanticipated patient event, a medical error and/or a patient related injury and become traumatised by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base.

Recent studies in the sector suggest that almost 50% of healthcare professionals have a second victim experience during their career, and that it leads to experiences similar to PTSD.

Like policing, the NHS operates in a life-changing environment that sees trauma of varying degrees on a daily basis for the majority of its staff. This daily exposure to trauma, and the association with specific incidents, has serious psychological effects on the worker including compassion fatigue, intrusive thoughts and images, difficulties separating work from personal life, decreased feeling of work competence, and burnout.

A pilot project is underway in the NHS. The creation of an Emotional Resilience Support Unit is underway at University Hospital London and Nottingham University Hospital. This sees a 3-tier approach involving training local leaders on supportive leadership of human factors, implementing peer support programmes, and access to an expedited referral network with external provision.

The second tier, peer support, focuses on providing 1:1 crisis intervention, support, mentoring, and debriefing initiatives. Acting as an ‘emotional first aid’ programme, it is available immediately or soon after a difficult work-related event and provides a confidential and safe place to talk.

The programme has been built around evidenced-based guidelines developed by the National Institute for Health and Care Excellence (NICE) on treating PTSD, and is designed to be delivered by staff with no pre-existing expert knowledge. Most importantly, there is no implication of legal liability beyond the normal NHS workplace duty of care.

The peer support programme provides a useful way to address the issues for an individual within an environment that is comfortable without the stigma.

It is not about implementing a clinical process. It allows the individual to reflect out loud to a colleague who understands the environment they operate in, and encourages their brain to process the information it has built up.

The Injury on Duty report produced by the Police Dependants’ Trust highlighted that there was a need for “…Not a counselling service but like an off-loading service. You know, we suck up so much trauma but there is no release for that…”. That is what the ERSU is designed to do, but it also has the next tier of support built in as well for when the peer support programmes are not enough.

NPCC

 

If you want to know why we are so passionate about the world of wellbeing there is no better way to illustrate than this simply stunning presentation by a person I would follow to the end of the earth, John Sutherland. As the 'french Sherlock Holmes' Edmond Locard posited, "every contact leaves a trace." This exchange principle is as valid in human interaction as it is in forensic science. John explains why...

 

Key observations from the presentation delivered by Dr. Noreen Tehrani at the PTSD conference, 2017

There are three key types of traumatic exposure, all of which exist within modern policing. All have a specific cause/effect result on the individual and the service as a whole, and all have specific triggers which can be measured through screening and surveillance.

Primary trauma is the direct exposure to traumatic events involving death, injury, attacks, accidents etc. A misconception is that this only applies to major incidents – it doesn’t. Everyday incidents can result in primary trauma.

Secondary trauma relates to indirect exposure from victims, offenders, materials, testimony, images etc. It is the immersion in an incident that often results in secondary trauma as the individual begins to re-live it from the victim’s perspective.

Burnout is the normal consequence of working in a high pressure and demanding role with scarce resources, high public expectations and limited capacity. It is compounded by an inability to reflect, rationalise, and retain (rather than re-live) incidents, and over time reduces an individuals levels of resilience.

As part of the wider risk assessments required as employers, some police forces have started to introduce screening and surveillance processes for their high-risk roles (currently this list includes those dealing with online child abuse, public protection units, roads policing, firearms, negotiators, and family liaison officers), with a national programme being introduced for all negotiators funded by the Home Office.

After completing a questionnaire which is scored to identify clinical symptoms, a determination is made as to whether the results are OK, marginal, or not OK, and whether ongoing screening is required. For those marginal or not OK, a referral is made for a psychological assessment.

6 times higher than the general public (ave), and PTSD symptoms were 4.7 times higher (ave.). Just over 19% of those screened (ave.) were experiencing symptoms of burnout – the highest being within roads policing (35%). Those operating within firearms specialisms were consistently lower than the general public average, but does not take into account those who have surrendered their firearms duties.

Screening shows when there is an underlying psychological problem – or not, and has a dramatic effect on the efficiency within Occupational Health units.

18% of officers referred to OH had no significant clinical symptoms, and their issues could be handled better by wellbeing advisors or through management action.

What screening and surveillance has shown is that, over time, it is better at recognising the warning signs before they become a critical issue, thereby providing opportunities to intervene before a crisis.

NPCC

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