Coping with Post-Traumatic Stress Disorder: a vital issue for security staff and employers

29 Aug 11

Private security operative Danny Fitzsimons is now serving a 20-year sentence on conviction in an Iraqi court of murdering two colleagues. His narrow escape from the Iraqi gallows is a terrible warning to everyone who works in the security industry: potentially, post-traumatic stress is a killer.

Less severe but much more common cases of trauma can result in depression and behavioural problems for staff in the workplace or on site. Left untreated, the condition may result in avoidable accidents, extended sick leave and dismissal – not to mention a major legal liability for the employer.

Unfortunately, most employers are unable to recognise the symptoms of trauma, far less engage with affected employees and guide them to seek treatment.

This is why PTSD Resolution has introduced Trauma Awareness Training for Employers. The registered charity provides free trauma treatment to veterans, and such has been the demand for help from employers of veterans that PTSD Resolution has now established a series of one-day seminars to help company owners, line managers and HR staff to recognise and deal with the problem of trauma, however it may have been caused.

Sheer scale of the issue

No-one knows how many people are hurting or killing themselves or others as a result of mental trauma, but there are some clues: two private security officers committed suicide in one week in May this year, more Falklands veterans are now thought to have killed themselves since the war than died in operations and the US Veterans’ Administration suicide prevention Helpline is now receiving over 400 calls each day from ex-service people who are desperate to have something done about the chaos in their heads.

Regarding the potential scale of the problem, the Royal British Legion has noted that there are some ten million veterans and dependents in the UK. An estimated 20% of ex-servicemen and women exhibit mental problems from war zone deployment (that figure’s produced by the US Veterans Association). Overall, mental health disorders account for one-in-five of all work days lost and cost UK employers £25 billion each year (NICE, 2011).

Post-traumatic stress, PTSD, battle fatigue or whatever, it doesn’t matter what you call it (except in court, where arguments over minute differences in mental health classification can mean life or death) .The long and the short of it is that traumatic events can leave scars, injuries that may not emerge for years and may have terrible consequences when they do.

Trauma changes people in many ways. It can make them more aggressive, angry, nervous, depressed, vigilant, guilty, paranoid or any combination of the above, as well as causing extraordinarily vivid flashbacks and nightmares where, as far as the sufferer knows, he or she is actually back in the original experience.

This can be hell, for the one who is experiencing the problem and for everyone around him or her, so many sufferers stop going to work or going out at all in order to avoid the triggers.

For security operatives who may have left the Army in the first place because of problems caused by trauma, there is a triple-whammy problem here: the social support and discipline the Services provided has been removed. Using their skills and making a living depend on going back into the ‘hot zone’ – and this makes it almost impossible to avoid the triggers that make the post-traumatic symptoms worse.

Trauma is usually caused by being involved in or witnessing events that involve actual or potential death or injury. In many cases there are initial symptoms that subside over a few days or weeks, and it is usually best to let this happen by itself – ‘critical incident debriefing’ where everyone involved in an incident is given counselling is now thought to cause more problems than it solves.

However, if the symptoms have not subsided after a month, or have become noticeably worse, it’s time to do something about it.

Education and correct training for staff

If you have members of staff who have been exposed to violent scenes, or are going to come across them in their current employment, they need to be educated in these facts and through the correct training.

There is a chance that in the past or as an employee now you are or will be affected adversely by the things you see and do. This is normal, and will fade in many cases. If it does not fade in a month or so, or if it is getting worse, it is a good idea to seek help.

You are not going mad and this is not a sign of weakness. It is a normal reaction to events and can happen to anyone: even the most robust and apparently stable individuals. Everyone has a threshold beyond which they can be traumatised.

It’s ok to talk about it, but it won’t necessarily help. Treatment is what you need. The sooner you get on with it, the sooner you’ll be able to get back to normal life.

Your doctor probably won’t be a trauma specialist. In fact, you will probably know a great deal more about post-traumatic symptoms than your GP. The NHS guidelines do not recommend medication for post-traumatic symptoms, but many GPs still offer antidepressants to new trauma cases. Insist on a referral.

There is a strong chance that, with appropriate treatment, you will experience a good recovery.

Managers should develop a company culture that is responsible not macho. Operational machinery is maintained regularly and repaired when necessary, so at the very least it is rational to adopt the same approach with your people.

If you manage people who may experience trauma, keep an eye on their behaviour. If someone is involved in an incident and seems to have changed, it may be a sign that they will need help. Let them know that you are aware of what they have been through, that the company policy is to be open about stress reactions and to get help if necessary so that everyone can continue to work well.

If the employee does not seem to be returning to their normal attitudes, demeanour and behaviour after a few weeks then open a dialogue about how they would like to be helped to recover.

Develop a relationship with an organisation like PTSD Resolution that has experience of heavy duty post-traumatic reactions and can deliver brief interventions that return people to work.

The cost of a typical course of treatment should be very much less than the expense of supporting an unwell employee down the line or, worse still, coping with the collateral damage if someone does something unfortunate while traumatised in your employment.

Troubled by trauma: a Case Study

To understand the issue of trauma it’s important to appreciate its effects on sufferers. As an employer, you may be concerned with the impact on client work and relationships and the bottom-line. That’s totally understandable, but there is also a story of personal suffering and anguish behind each case of trauma.

The details of every case are different, of course, but there’s often an all-too-frequent pattern of decline involving the sufferer, their family, friends and work colleagues.

Here is Michael’s story (not his real name, but his history is)...

Michael completed 22 years service in the Army and retired with the rank of Sergeant. Much of his career in the services was spent overseas on operational duties in Northern Ireland, Sierra Leone, Kosovo, Iraq and then Afghanistan.

In Northern Ireland, Michael was ‘blown up’ twice, he says, luckily escaping serious physical injury. He witnessed many unpleasant scenes.

“At the time I wasn’t really troubled by it all and got on with the job. During three tours in Africa I’d seen killings and all manner of atrocities, but could do nothing about them because of my non-combatant status at the time. In Kosovo, I saw the aftermath of atrocities and mass burials. In Iraq there was all manner of death and destruction.”

Michael left the Army to work in Afghanistan as a civilian in a security role and was the victim of an attack by a suicide bomber: “This was the tipping point emotionally. I began to feel depressed. I was then posted to the Congo, where I felt really isolated and had time to dwell on the past. My marriage was under strain. I began drinking to avoid sleep and the nightmares that followed.”

On his return from the Congo life went further downhill for Michael: “My marriage broke up, I lost my job, was drinking heavily and started behaving outrageously, really. I was arrested and ended up sleeping on a park bench. I thought I had gone mad. I had given up. I was just going to drink away my pension and wanted to let it all end.”

His parents then managed to find enough money to send him to a psychiatric hospital. “I just wanted to hide,” he said, but he agreed to go. “It did no good. I was there for ten days and they wanted me to attend group CBT (Cognitive Behavioural Therapy), which involved everyone telling their stories, but it didn’t work. I might have been willing to tell one person but not a group, and it was also very expensive.”

Referral to mental health teams and counsellors

His GP referred him to the local NHS Community Mental Health Team (CMHT), who then referred him to one of their counsellors.

“A very understanding female who admitted that she had not dealt with anyone like me. She said she would introduce me to a programme which involved ‘re-living the event to exorcise the demons,’ she said. I found it just made me feel worse. I started drinking more, I had increasing numbers of nightmares and night sweats. I went back to the park bench.”

It was then that his ex-wife went to a seminar given by MindFields, the training arm of the Human Givens Institute, where she heard about treatment for post-traumatic stress.

She chatted to the speaker and was referred to myself, Piers Bishop, chief therapist at PTSD Resolution, which was then a new charity dedicated to the treatment of PTSD among veterans.

After some research, Michael’s wife persuaded him to visit me. Michael said: “I was very sceptical at the time and didn’t see how it would help, but I was at the end of my tether, so I agreed. I met Piers and he explained the process. I didn’t know what to expect. He didn’t ask me about my army experiences, but within days of the first double consultation session (two hours) the nightmares had stopped, and I began sleeping better.”

The stress sufferer continued: “After two more sessions, the flashbacks also stopped and I felt able to take myself off anti-depressants. Within six months I went back to work. Now, four years later, I feel I am back to normality. I have survived a redundancy, found a new job, have a new relationship, have resisted the temptation to revert to alcohol for support and have good relationships with my ex-wife and my parents.”

Trauma treatment: the way forward

Fortunately, effective treatment is now fully available – and it’s free to veterans and reservists of the UK Armed Forces.

PTSD Resolution - www.ptsdresolution.org - provides therapy to relieve mental health problems resulting from military service, so as to ease reintegration into a normal work and family life.

The PTSD Resolution national outreach programme has over 200 therapists. Treatment is on an outpatient basis, to support family and work routines. It is free, confidential, local, on a one-to-one basis, with no waiting lists and no referral is needed.

Therapy is brief and effective – generally within three to five one-hour sessions treatment is ended by mutual agreement. It’s unusual for further support to be needed subsequently.

PTSD Resolution offers employers trauma awareness training to support the successful assimilation of veterans and TA in the workplace. The one-day modular courses enable line managers and HR staff to recognise potential symptoms of trauma and identify a clear route to resolving any workplace difficulties

Patients are not required to talk about the events that may have caused the traumatic memory. The programme policy is that re-exposure is better done in the client’s visual imagination and while in a relaxed state, protecting confidentiality and reducing distress.

The PTSD Resolution network was launched in February 2010. This followed a three-year pilot programme which included a project with the Falklands Veterans Foundation that helped ex-services personnel recover successfully after experiencing the symptoms of PTSD (for 25 years in some cases).

Overall, the programme has had a better than 83% success rate in resolving the condition for the 150 UK Armed Forces veterans already treated. This is similar to the recovery rate in a recent study of 599 stress-related cases from the general population who were treated using the same therapeutic method: according to PTSD Resolution, over 70% reached a ‘significant and sustained improvement’ after an average of 3.6 treatment sessions.

Treatment is complementary to the work of other Armed Forces charities because it can resolve the immediate mental health issues that may be a barrier to qualifying for further help and assistance.

Piers Bishop is director of therapy at PTSD Resolution (Registered Charity No 1133188)

For further information visit www.ptsdresolution.org/tate (a dedicated web link is provided at the foot of this page)