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Managing the psychological impact of distressing and traumatic incidents: six steps to build a successful strategy

When organizations encounter sudden, unexpected and disruptive events, business continuity plans aim to quickly restore operational functioning. However, without stabilising the people who deliver those operations, the best laid plans may only be partially successful. Liz Royle looks at six steps that organizations can take to manage this area.

Managing the emotional impact of a distressing or traumatic event should begin before an incident has happened – particularly for organizations with a predictable risk of encountering them. Strategic planning ensures a proactive, clear and consistent approach for safe systems of work and faster recovery from the people perspective. This article sets out six steps required for a successful strategy and some of the questions that should be considered before implementing any plan.

Step 1: Assess the nature and type of risk
Step 2: Create a clear rationale for intervention
Step 3: Identify responsibilities and engage key people
Step 4: Develop procedures and prepare resources
Step 5: Train staff
Step 6: Test, monitor and evaluate.

The steps themselves should be reassuringly familiar but how do they relate to the psychological aspect?

Step 1: Assess the nature and type of risk

When it comes to distressing and traumatic events, it is worth keeping in mind the following definition:

Psychological critical incident: An event or series of events that may cause significant emotional or physical distress, psychological impairment or disturbance in people’s usual functioning.

There are four main areas to consider and the examples shown for each below are not exhaustive!

  • Major incident: e.g. act of terror, active shooter, multi-casualty incident, line of duty death, man-made disaster (e.g. chemical leak, fire) or natural disaster.
  • Incidents related to the organization’s activities: e.g. armed robbery, transport / heavy machinery accident, violence or physical assault. Some employees will have repeated and extreme exposure for instance emergency services workers, cash handling and transit services, security professionals.
  • Secondary trauma: e.g. repeated exposure to others’ trauma as part of role (think social worker / journalist / emergency services).
  • Unpredictable ‘life events’: e.g. the sudden death of a colleague or suicide of a member of staff. These events can have a huge impact on colleagues. Shock and grief can impact on a team’s functioning just as heavily as a cyber-attack or flood.

Risk management plans can be a good place to start when considering hazards and threats arising from the organization’s activities or certain roles within it but think more broadly. People may be at risk directly or as a witness. One of the most challenging workplace events is a line of duty death. The ripple effects are significant as many people who are not directly involved will be impacted by the recognition that “it could have been me.” This can have a major impact on operational functioning and productivity.

Initial questions to consider in step 1:

  • What are the potential risks to your organization in these four areas?
  • What are the likely frequency and severity of these?
  • Who has been identified as potentially at risk? As well as those directly involved, who may be psychologically affected by these events? Related teams, call handlers / reception staff? 

This is not about wrapping people up in cotton wool but identifying risks in order to address them. As with any assessment, the control measures will be appropriate to the level of risk.

Step 2: Create a clear rationale for intervention

It is important to consider exactly what you are trying to achieve by implementing a support programme. These may be things that the organization is seeking to improve, address or change. Each organization will have a slightly different perspective on this and there will be many people within the organization who think that being proactive and supporting employees is a bit ‘pink and fluffy’.

Any policy must therefore have a clear rationale with an analysis of associated costs and benefits. Often, we find that the people closest to the operational ‘frontline’ have the strongest motivation to address trauma but struggle to convince those with power and influence to implement changes. We can’t be emotional about this topic and have to make a sound business case.

So why should an organization invest in being proactive?

Save money? Early intervention and effective treatments result in financial savings including reduced sickness absence, and costs of sickness cover or overtime and recruitment.

Reduce employee turnover? An effective psychological critical incident programme can contribute to better working relationships and increased employee satisfaction resulting in the organization being able to attract and retain high quality workers.

Increase productivity? As symptoms of mental distress escalate, the individual is likely to experience deterioration of focus, decision making, concentration and assessment of risk. The organization is also negatively affected by mistrust and cynicism towards leaders. If the organization is not perceived to care then why should its employees?

Increase employee morale, health and wellbeing? Supportive management involvement, as part of the post incident procedures, leads to organizational empowerment and reduced stress for managers (and ultimately increased productivity again), through employees being healthier, happier and better motivated. Leadership and morale are both closely linked to resilience and peer support, and can actually help protect individuals against traumatic stress. 

Maintain reputation as a socially responsible organization? There is a wider cost to society arising from psychological critical incidents. Unresolved distress and trauma can lead to family breakdown, violence – inside and outside the home, alcohol or drug abuse and even suicide and homicide.

Protect against litigation? Good procedures for psychological recovery and rehabilitation can reduce exposure to reputational damage and the financial costs of prosecution or litigation. A sound policy will ensure that the organization is able to meet the requirements of health and safety legislation in respect of risks arising from potentially traumatic incidents at work.

Reduce human distress? Last but by no means least, if we get it wrong the results can be devastating in terms of the human suffering and the ripple effect to families and colleagues.

These driving forces will have varying relevance depending on organizational aims and vision.

Initial questions to consider in step 2:

  • What are the top priorities for your organization?
  • Is there consensus on this?

It is important that all those involved are in agreement as to the most important driving forces. For instance, a trade union that perceives the focus as being solely cost-driven rather than welfare-oriented may provide challenges. These two rationales shouldn’t be incompatible but it’s down to how it is presented to all involved!

Step 3: Identify responsibilities and engage key people

Now that you have established the risks and a clear rationale for action, the next step is to engage all involved. The larger the organization the more potential stakeholders there will be to consult with. In order for the plan to be effectively implemented this consultation should be thorough so that any resulting policy dovetails with existing practice.

Avoid simply delegating responsibility to an Employee Assistance Programme or Human Resources. Responsibility should be shared through all levels of the organization.

The organization is responsible for driving the initiative forward, providing the necessary resources (including appropriate professional support), conducting psychological risk assessments for employees and monitoring the overall effectiveness of the process.

Managers and supervisors are responsible for encouraging a working environment where issues of psychological impact may be raised in a supportive and timely manner, identifying when intervention is required and which members of staff may require further assistance.

All employees (at every level) have the responsibility to engage in health and wellbeing initiatives and observe safe systems of work.

Professional support teams, whether this is done via the Human Resources department or an outsourced Employee Assistance Provider, are responsible for providing clinically effective group and individual interventions, liaising with senior management regarding implementation and trends and advising on rehabilitation plans.

Initial questions to consider in step 3:

  • What health and welfare resources are available to employees who are identified as needing further support?
  • Does the service offer effective trauma treatment? N.B. In the UK, many people are unaware that guidelines produced by NICE (National Institute for Health and Care Excellence) specify that non-directive counselling is not usually appropriate for crisis and trauma reactions. It can actually re-traumatise and delay recovery.
  • How has post-incident support been viewed traditionally? Is it acceptable or implicitly stigmatised?

Step 4: Develop procedures and prepare resources

The procedure following a critical incident can be very briefly simplified into three stages each requiring its own detailed process.

1) Identification of critical incident and those in need of support: Managers are the obvious choice for doing this but need to be aware of the major factors predicting psychological trauma and how their team is responding to an event. Responsibility for requesting assistance can be widely shared for example between managers, trade union representatives and employees.

2) Immediate support: Ideally some form of initial support will be put in place before employees leave the workplace. This is informal, focused on safety, practical and welfare needs and may be carried out by a manager or colleague trained in psychological first aid. Information handouts should be made available that normalise responses and offer basic strategies to manage crisis reactions along with sources of support and advice.

3) Follow up intervention and monitoring of recovery: From the point of the incident occurring onwards, assessment is continually required for identifying current and emerging needs. For many people, education and support in the workplace will be enough but you need to consider how and where you will refer those individuals who need a higher level of care. Processes for accessing specialist trauma support and mechanisms for rehabilitation should be clear.

Initial questions to consider in step 4:

  • How will you identify a critical incident and who can start the response process?
  • Do you have incident logs or are you relying on managers to do this? In the latter case, you may be influenced by their subjective judgment of the situation if they are untrained.

Step 5: Train staff

There are different levels of preparation that can be considered by organizations and their relevance very much depends on the level of risk that has been identified. This may take the form of simple awareness building for all employees whether through training or informal input such as briefings or articles in staff magazines.

The higher the risk, the more relevant preparatory training is.

For those who are more likely to encounter critical events, preparatory training can be very beneficial. If they understand the nature of traumatic stress, and are aware of helpful coping strategies, they can take their part in healthy behaviours, feel in control of their recovery and have an expectancy of a return to full functioning. This will help them to be resilient and ‘bounce back’ effectively. It also has the added effects of reducing stigma and making everyone the eyes and ears for colleagues’ welfare.

Psychological first aid skills can be taught to managers or appropriate peer supporters. This ensures that managers have the skills to be able to identify and support employees experiencing traumatic stress reactions. It empowers them in being proactive with their support, avoiding many of the common problems caused by uneducated supporters and ensures that the appropriate level of support is made available to employees involved in traumatic or distressing incidents.

Initial questions to consider in step 5:

  • What training or initiatives are currently provided to support employees’ mental health / wellbeing?
  • Can these be adapted to include information on the new strategic plan?
  • If peer supporters, or psychological first aiders, are appropriate, who will they be and how many are needed to provide resilient levels of cover?

Step 6: Test, monitor and evaluate

Following implementation, an evaluation process is essential to ensure that the policy is operating effectively and not just sitting on the shelf gathering dust. There is no point in it looking wonderful on paper if it doesn’t work or doesn’t get used! Plans for managing the psychological impact of events should be tested as part of any other crisis simulation exercises.

Going back to step 2 and the rationale for intervention, organizations need to consider how they can best measure the effectiveness of the trauma support programme with regard to their original rationale for it.

Examples may include:

  • Sickness absence figures
  • Turnover rates and information from exit interviews
  • Information from workforce surveys
  • Information from team and branch meetings
  • Feedback from managers and peer supporters.

Initial questions to consider in step 6:

  • Who will be responsible for monitoring the implementation and effectiveness of any policy and when / how often will this be done?
  • How are concerns about the process captured and dealt with?
  • What action will be taken in instances where the procedures haven’t been followed, e.g. education of managers?

Conclusion

This article is a first step towards considering your plans and asking some of the right questions. Managing major incidents and roles that are vulnerable to secondary trauma brings additional, more complex challenges so always seek qualified, professional support. Planning for these risks involves many other aspects beyond the scope of this particular article.

A good strategy should be clear, simple, cost-effective and embedded in organizational culture. Where the human side of post-incident operations is handled well, there are great benefits for all concerned with a faster return to operational functioning so it is well worth the effort!

The author

Dr Liz Royle is an international author and speaker with substantial experience of the strategic management of trauma and proactive and responsive interventions for high risk organizations. Her professional experience of trauma was cemented during her time as senior welfare officer for Greater Manchester Police providing 24/7 critical incident interventions to police officers, developing post-incident procedures and managing responses to major incidents such as line of duty deaths and multiple fatalities. She was the lead person for the European Society for Traumatic Stress Studies (ESTSS) Managing Trauma in the Uniformed Services task force for eight years. Since leaving the police service in 2004, she took her skills and knowledge into the private, corporate and voluntary sectors. Dr Liz Royle has written trauma support policies for city councils, police forces and security companies and provided strategic and crisis response support to organizations affected by acts of terror, natural disasters, deaths, violence and serious accidents.

Dr Liz Royle will be speaking at BCI World in November.

Contact office@powertorecover.com

Note: The six steps described in this article are adapted from ‘Power to Recover: A complete guide to managing psychological trauma at work’ by Dr Liz Royle and Catherine Kerr (CPsychol).


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