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02nd July 2020

CMM: Tackling PTSD: why outstanding leadership, teamwork and communication are key

The following article was first published on Care Management Matters (CMM)

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Quality Compliance Systems (QCS) explores why the Covid crisis could lead to an increase in PTSD.

Slowly but surely we are winning the battle to contain COVID-19. But as the lockdown is gradually eased across the country, and we enter a ‘new normal’ many frontline workers will face another battle with their mental health .

Following the first wave, many will suffer from mental exhaustion, depression anxiety, burn-out. Some, however, when reflecting on their experiences, will develop PTSD. According to Professor Neil Greenberg, a PTSD specialist at King's College London, PTSD, ‘usually comes on a month after exposure to one or more traumatic events and almost always manifests by six months.”

Professor Greenberg, who chairs the Royal College of Psychiatrists (RCP) Special Interest Group in Occupational Psychiatry, believes that significant numbers of frontline care workers will develop ASD – which occurs in the first month following a trauma. But he says it ‘is likely that many of those who experience ASD will go on to suffer with PTSD too.’

PTSD: The Symptoms

But if you are a manager with no clinical training, how do you begin to help someone you suspect might have ASD or PTSD? The first step is to recognise the symptoms.

Professor Neil Greenberg, who has worked with the UK military for 23 years and was part of the 2018 National Institute for Health and Care Excellence (NICE) PTSD treatment guidelines development committee, explains that PTSD compromises four groups of symptoms, which when combined are life-limiting in that they ‘can interfere with people’s ability to have enjoyable relationships, working effectively, or at all, and from enjoying life.’

Professor Greenberg says, ‘Firstly, it is common for those with PTSD to have re-experiencing or intrusion symptoms. These include nightmares and repeated thoughts of the traumatic incident which they can’t stop and which cause them to feel distressed. People with PTSD also can suffer with a racing pulse, fast breathing or other physical symptoms, and feel on edge whenever they are reminded of the trauma.’

Professor Greenberg says that avoidance is second classic symptom, in that a person with PTSD will ‘seek to avoid talking about the trauma at any cost, nor will they want to go the place where it occurred.’

He goes on to say that PTSD ‘dramatically changes the way a person thinks about the world; put another way it can distort people’s perceptions of reality.

‘Many people presenting with PTSD believe that the world is no longer safe and is a dangerous place to be,’ he says.

Finally, Greenberg says that PTSD leaves a person in a hyper-aroused state. ‘A person with PTSD can find it difficult to sleep, be constantly on edge, suffer bouts of irritability and experience poor levels of concentration too,’ he explains.

How to tackle PTSD in your service

In terms of tackling PTSD, Professor Greenberg says that many scientific studies demonstrate that care teams do not need to rely on mental health professionals for the initial stages of dealing with trauma. He says that ‘being part of a supportive team can protect someone’s mental health’ after exposure to a traumatic incident.

Professor Greenberg says that supervisors, or managers, have a crucial role to play in ‘ensuring that ASD is identified at an early stage and try to ensure it doesn't lead to PTSD.’ Doing this, however, requires a culture of early intervention and psychological support.

Greenberg suggests, ‘Building a psychological scaffold around the organisation is the first step. In other words, that means preparing staff for the worst-case scenario and ensuring that you are best prepared to deal with it. This involves having a frank, honest and open conversation with staff to mentally prepare them for the pandemic. Next, supervisors should ask staff to write down a list of activities that keep them psychologically safe in challenging times. That could be taking a walk, going for a run or talking to a family member. Managers need to support and encourage their staff to actively engage in those particular activities whenever they feel distressed.’

Leadership, teamwork and communication are key

In a health pandemic, Professor Greenberg says that leaders need to regularly engage with staff to check on their mental health.

‘We know that moral injury is one of the key triggers of ASD and PTSD. Through the lens of the COVID-19 crisis, an example of a morally injurious act might be when someone passes away when a care worker, through no fault of their own, didn’t have the correct PPE and felt unable to intervene in the way they would have wished to.’

There is also very good evidence around managers feeling confident in speaking to staff about mental health. Greenberg says there is ‘plenty of evidence that a psychologically savvy manager is really important for protecting their team’s mental health. Whatever the issue, good leaders will get to the root of people’s anxieties at an early stage and then they’ll introduce practical steps that can be taken to help safeguard care workers, and the people they look after, from infection.’

Learning from the military

Professor Greenberg also believes that the care sector could learn a great deal from the military in terms of preventing and managing serious mental health conditions like PTSD. He advocates the PIES (Proximity, Immediacy, Expectancy and Simplicity) principle, which has been used effectively in military settings for over 100 years, saying that it could be adapted for the care sector.

Explaining the acronym in greater detail, he says, ‘In terms of “proximity”, if as a manager you notice that somebody is having a tough time, you should not simply send them home. Instead, you can support them by temporarily altering their job role. If, say, for example, a person is worried that, despite having the correct PPE, they might infect an elderly person, you might simply re-deploy them in a non-client facing role for a few days.

‘”Immediacy” is about identifying that someone has a mental health issue and nipping it in the bud early, while “expectancy” is reaching out to staff and reassuring them that it is perfectly normal to be distressed at times. It’s also about letting them know that while the expectation is that they will be okay, if for some reason they’re not, then you will get them the right help.’

Greenberg adds, ‘”Simplicity” is incredibly important. Sometimes all people need is a good night’s sleep, to speak to a loved one or to take a proper break. These are all practical steps managers can take without disrupting work patterns. Collectively, however, they make a big difference.’

That said, there will be frontline care workers who go on to develop PTSD. In these circumstances, Professor Greenberg recommends that managers support that staff member to access help through any appropriate source such as a trauma-aware employee assistance programme, the company’s occupational health team, or their own GP.

You can also download a Factsheet on PTSD and ASD below for free.

Download it for free here

 

 

 

 

 

 

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

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