Post-trauma support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK.

Employers' duties of care under both common and statute law include the need to take reasonable care of the health and safety of the workforce. This includes both the moral and legal duties to consider the psychological needs of personnel following exposure to traumatic events related to the workplace. While this has been recognized within many high-risk occupations such the police, fire and rescue services and the military, there is also evidence that post-trauma support in the workplace is increasingly commonly provided not only among health and social services agencies, but within many private sector organizations. Over the past decade, however, there has been considerable controversy over the provision of early psychological support to personnel in the form of critical incident stress management (CISM) processes. In particular, one aspect of CISM, the use of psychological debriefing (PD) has come under scrutiny and criticism as two studies indicated that PD was ineffective and had the potential to do harm. Inevitably, this has provoked much uncertainty and confusion among some organizations as what should be the most appropriate support. It has also led to misconceptions and misunderstandings as to the aims and purpose of PD, together with inaccuracies of terminology, for example describing PD as 'counselling'. Despite the controversy, both CISM and PD continue to be provided on a widespread basis, often utilizing a framework of voluntary peer group support. This paper intends to (i) present a review of the current status of CISM practices, including the use of PD within various organizations in the UK and (ii) provide a clear framework and understanding of the main issues and to clarify conceptual misunderstandings. The history, principles and background of the use of post-trauma support in the workplace, charting trends over the past two decades, previous research, problems with the evidence base and current thinking and practice in the field are reviewed. The relevance and implications of the National Institute for Clinical Excellence Guidelines on the Assessment and Management of Post Traumatic Stress Disorder, which make recommendations for early interventions for post-traumatic stress disorder are discussed. Reference is made to the use of CISM and PD within both statutory and voluntary organizations in an international context.

[1]  E. Plionis Psychological Debriefing: A Leader's Guide for Small Group Crisis Intervention , 2006 .

[2]  Z. Solomon,et al.  Frontline treatment of combat stress reaction: a 20-year longitudinal evaluation study. , 2005, The American journal of psychiatry.

[3]  N. Greenberg,et al.  Peer-group risk assessment: a post-traumatic management strategy for hierarchical organizations. , 2003, Occupational medicine.

[4]  Simon Wessely,et al.  Psychological debriefing is a waste of time , 2003, British Journal of Psychiatry.

[5]  A. Dyregrov Psychological Debriefing: A Leader's Guide for Small Group Crisis Intervention , 2003 .

[6]  S Rose,et al.  Psychological debriefing for preventing post traumatic stress disorder (PTSD). , 2002, The Cochrane database of systematic reviews.

[7]  N. Jones,et al.  Commentary: Evaluating Psychological Debriefing: Are we Measuring the Right Outcomes? , 2001, Journal of traumatic stress.

[8]  D. Richards A field study of critical incident stress debriefing versus critical incident stress management , 2001 .

[9]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[10]  N. Jones,et al.  Preventing psychological trauma in soldiers: the role of operational stress training and psychological debriefing. , 2000, The British journal of medical psychology.

[11]  J. Bisson,et al.  Randomised controlled trial of psychological debriefing for victims of acute burn trauma , 1997, British Journal of Psychiatry.

[12]  I. Higginson The Aftermath of Road Accidents , 1997 .

[13]  R. Mayou,et al.  A randomised controlled trial of psychological debriefing for victims of road traffic accidents , 1996, BMJ.

[14]  J. Bisson,et al.  Psychological Debriefing and Prevention of Post-Traumatic Stress , 1994, British Journal of Psychiatry.

[15]  Mitchell Jt Stress. Development and functions of a critical incident stress debriefing team. , 1988 .

[16]  Mitchell Jt,et al.  Stress. The history, status and future of critical incident stress debriefings. , 1988 .

[17]  E. Lindemann,et al.  Symptomatology and management of acute grief , 1944 .

[18]  A. Dyregrov,et al.  A maritime disaster: reactions and follow-up. , 2003, International journal of emergency mental health.

[19]  K. Wheat,et al.  Early interventions following exposure to traumatic events: psychological debriefing and the law , 2003 .

[20]  G. Everly,et al.  The debriefing "controversy" and crisis intervention: a review of lexical and substantive issues. , 2000, International journal of emergency mental health.

[21]  G. Adshead,et al.  THE AFTERMATH OF ROAD ACCIDENTS. CHAPTER 13: PREVENTIVE PSYCHOLOGICAL INTERVENTION FOR ROAD CRASH SURVIVORS , 1997 .

[22]  A. Dyregrov The process in psychological debriefings. , 1997, Journal of traumatic stress.

[23]  J. T. Mitchell Stress. Development and functions of a critical incident stress debriefing team. , 1988, JEMS : a journal of emergency medical services.

[24]  J T Mitchell,et al.  Stress. The history, status and future of critical incident stress debriefings. , 1988, JEMS : a journal of emergency medical services.

[25]  J T Mitchell,et al.  When disaster strikes...the critical incident stress debriefing process. , 1983, JEMS : a journal of emergency medical services.

[26]  G. Caplan Principles of Preventive Psychiatry , 1964 .