Fiona Dunkley, a BACP senior accredited psychotherapist, supervisor and trainer, and Founder of FD Consultants, was pleased to address the audience at the Working with Critical Incidents Conference that took place in Edinburgh on April 17th.
From the 7/7 bombings (2005) to the Grenfell Tower fire (2017), Fiona explained to those present why organisations need a trauma management programme, below are the highlights of her presentation.
In the last 12 years, working as a trauma specialist psychotherapist, I have seen an increase in the demand for trauma therapy. The most poignant incidents where I have supported organisations and individuals include the London 7/7 bombings (UK, July 2005); Syrian civil war (Syria, ongoing since 2011); Ebola outbreak (West Africa, from 2014); Search and Rescue refugee crisis (Mediterranean, from 2015); Nepalese earthquake (Nepal, July 2015); Westminster terrorist attack (London UK, March 2017); London Bridge terrorist attack (UK, June 2017); Brussels bombing (Belgium, March 2016); anti-government protests, Istanbul (Turkey, July 2016); Juba attacks on aid workers (South Sudan, July 2016); and the Grenfell Tower fire (London UK, June 2017).
This is not an exhaustive list of major incidents, but as I composed it with a heavy heart, it reminded me just how much trauma has become part of our daily lives. As well as these high-profile cases, I support individuals with other traumas, including sexual violence, childhood abuse, bullying, transport accidents, domestic violence and medical health issues, which also impact individuals and families, with devastating effect.
We are exposed to trauma continuously in the media, as images become more graphic and stories more personal, and we are all vulnerable to vicarious trauma (sometimes named ‘secondary trauma’ or ‘compassion fatigue’). Vicarious trauma is the cumulative impact of indirectly witnessing trauma or hearing stories of traumatic content.
My passion is caring for the carer, and a great deal of my work is supporting emergency first responders, including the police, fire brigade, medical staff, and humanitarian aid organisations internationally. A previous article I wrote for Counselling at Work, ‘Caring for the Carers’, highlighted the psychological risks of working with trauma and explored coping strategies for the carers of our world.
It’s an area I know well, having worked in the NHS offering crisis support in The Havens’ forensic sexual violence units. I went on to join the counselling and trauma service, as the lead counsellor, at Transport for London (TfL), after the London 7/7 bombings. Later, I moved into the field of humanitarian aid work, offering psychosocial support to organisations including the Red Cross, Save the Children, Oxfam, Plan International, and Voluntary Services Overseas (VSO). I currently have a private practice, work internationally and undertake consultancy work, supporting individuals and organisations at risk of being exposed to trauma.
Responding in a crisis
It is essential that organisations have a thorough and well-rehearsed critical incident plan, which needs to incorporate a trauma management programme. This should clarify what psychosocial support is available for staff throughout every stage of a critical incident, including early intervention, specific treatments for trauma, follow-up and recovery. A well thought-through critical incident plan saves lives and helps people recover quicker. Staff need training, guidance, knowledge and clear policies. The reality is that major incidents almost always catch us unaware; therefore, forward planning is essential.
As the lead on InterHealth Worldwide’s Responding in a Crisis (RIC) service between April 2014–April 2017, I gathered a significant amount of crisis response data. During that time, InterHealth managed 188 critical incidents for 89 client organisations. The prevalence of each type of incident is shown in percentages, and the findings are below:
It is noticeable that incidents of both sexual violence, kidnapping and hostage-taking have increased over the last three years. These figures could be impacted by increased numbers of individuals reporting incidences, and more organisations having systems in place to encourage reporting. However, unfortunately, the research is demonstrating that the overall risk to aid workers of being involved in a traumatic event has increased.
Organisations need to give careful consideration to how they will implement the stages of a trauma management programme; and to illustrate this, I turn now to two high-profile cases. Both Peter Moore, who was held hostage for just under three years in Iraq, and Megan Nobert, who was raped while working in South Sudan, agreed to speak to me in detail about their experiences.
They both hope that some of the learning points that came out of their own horrific experiences will be taken forward and implemented into organisations’ critical incident policies.
A trauma management programme
Having worked with organisations for as long as I have, I appreciate that trying to design an organisational trauma management programme is no easy task. Even as an experienced psychotherapist, I’m aware that the information surrounding early intervention is confusing and controversial. Further research is essential in this crucial early stage of trauma support. Below, I have attempted to decipher the confusion and explain, briefly, some of the controversy. Drawing on my experience, I recommend that an organisation’s trauma management programme should include the following:
Working within the field of crisis response, it’s not unusual to receive calls from managers or HR personnel, anxiously demanding that: ‘we need counsellors here, now!’ My role is to contain the anxiety and to manage the situation by grounding and stabilising the individual at the end of the phone, by offering clear support and advice, and explaining the appropriate trauma interventions. Typically, I create a pause moment and give the caller permission to take a deep breath and reflect on the situation, so individuals become informed and responsive, rather than anxious and reactive. This is the challenge of managing a crisis call, as anxiety is highly contagious: ‘Well-intentioned, mental health practitioners should not “parachute” uninvited into a disaster zone, particularly if they have no knowledge of the local culture, language, mores and religious sensitivities.’ Counsellors or peers trained in trauma awareness, PFA and crisis response can be helpful in these early stages, but general counsellors or counselling are not.
In short, it is essential for all organisations to have a critical incident plan, which includes a trauma management programme that is tested yearly through a simulation training programme. Assessment and triage need to be carried out early on after an incident takes place, and administration processes are important to set up during the immediate response. Psychological first aid can be a useful model to offer as well as providing psycho-education, normalisation and resourcing for staff after an incident.
The benefits of PFA are that it can be facilitated by appropriately trained peers and can be useful even during a long-term crisis incident (such as working and living in war zones). Peer support programmes are also worth considering, so appropriately trained staff are available and at hand immediately during a crisis to support their colleagues. Psychological debriefing should not be activated until the incident has ended, and needs to be facilitated by mental health professionals, and is time sensitive. If individuals are identified as having ongoing psychological difficulties four weeks after an incident, there are excellent trauma specialist therapies available. Support for families needs to be included in the critical incident plan, providing information sheets as required, and family liaison support when necessary. This includes having access to specialist trained family support officers.
About Fiona Dunkley
Fiona Dunkley is a BACP senior accredited psychotherapist, supervisor and trainer and is the founder of FD Consultants, offering psychosocial support and trauma specialist services to humanitarian aid organisations. Fiona worked within the NHS, with emergency first responders and was the lead counsellor at Transport for London. She helped develop a critical incident plan after the 7/7 bombings. She has presented on Good Morning Britain as a trauma expert and given many talks internationally.
Fiona’s new book, Psychosocial Support for Humanitarian Aid Workers: A Roadmap of Trauma and Critical Incident Support, is available now by Routledge. Get your copy today: click here