In my last blog entry ('Am I Worth It?') I wrote about the importance of individual staff in the international aid, charity and public sectors seeking support in times of difficulty. I also promoted the practice of them being more routinely encouraged to review their psychological health and overall well-being. In this particular entry I want to shift the focus to organisations as wholes - emphasising how beneficial training, awareness-raising and general preparedness for dealing with staff-care issues can be. By this, I do not just mean senior managers and HR, but also employees working at all levels, whose responses to their colleagues and peers can count for a lot when crises and challenges arise. FD Consultants are often called in to support staff in the wake of a difficult event. This can be something as broad in scope and large in scale as a major terrorist attack, or something like the death of a staff member at work, which, whilst much smaller in reach, can be no less de-stabilizing. It tends to be that we, as FD Consultants, are seen as the 'experts' with special tools and skills to step into the aftermath of frightening or upsetting situations and leave those affected feeling calmer and more secure. In many respects, our trainings and amassed experience as counsellors and trauma specialists stand us in good stead for this. We can help identify people's needs after a difficult event and either provide, or guide them, towards appropriate support. However, when contacted in such situations, FD Consultants will often advise organisations to hold back, bide their time, and consider what they themselves might be able to do, to address a situation where staff-care is a key concern. After all, it's peoples' colleagues - known to them and with familiar faces - who are likely to be the first to notice or respond to anything that affects their ability to feel focused, safe and well at work. For this reason, there's a strong case for teaching workforces how to do this sensitively and effectively before bringing the specialists in. FD Consultants offer a range of established and bespoke training courses which promote their aim of 'caring for the carers' by showing staff how they can start to do this within their own teams and organisations.
If your organisation needs any support or help with the topics covered in this blog please do get in touch with us today. We can offer tailored training programmes to suit your business needs so that you can be safe in the knowledge that your staff are equipped to cope in tough situations. Felicity Runchman MBACP (Accred), MA Counselling & Psychotherapy
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'Is it worth it, this money from our budget being spent on me?'
'Shouldn't my organisation's resources be put directly towards its' beneficiaries?' 'I'm so fortunate compared to the people I deal with through my work. I'm not sure I feel comfortable focusing so much on my own needs - isn't it a bit indulgent?' When staff are offered counselling or put forward for psychological health consultations through the types of organisations FD Consultants (FDC) works with (international aid agencies, charities and public sector providers) the comments and questions listed above typify a concern I commonly hear. Pared down to its' most basic components, the concern seems to be 'am I worth it?', 'will this be of value?', and 'do I, myself, deserve the care and support I strive to offer others?'. Staff working within the sectors FDC supports are usually highly conscientious, driven by strong values (such as justice, equality and compassion), and acutely aware of the relative good fortune they experience in comparison to those their organisations may set out to assist. It's not uncommon for such staff to also feel frustrated having seen their organisations' resources being previously used in ways they perceive to be wasteful. It's therefore little surprise that such individuals can often be cynical and resistant to the idea of taking some time out at their organisation's expense - time to sit with a psychologist or psychotherapist and consider their own psychological health and general wellbeing. This resistance is something I always see fit to gently challenge - bringing to light that those very same strengths that generally motivate, sustain and serve staff in the aid, charity and public sectors so well, can easily tip over into proving disadvantageous, and, in some cases, even hazardous. The line between a strong work-ethic and the kind of workaholism that can lead to stress and burnout is a thin one. Similarly, potential consequences of holding strong values and ideals can be a rigidity and reluctance to engage with anyone who thinks differently, or a heavy and crushing sense of disenchantment that kicks in when these values and ideals are seen not to be upheld by others. Focusing solely on meeting other peoples' needs at the expense of one's own can also leave a person feeling depleted, with little left to give, and, over time, becoming resentful - not to mention stirring up a ripple-effect of similar emotions amongst colleagues and loved ones. Taking time-out for a standard stand-alone psychological consultation (usually a pre-assignment resilience consultation or mid/post-assignment consultation review) can help individuals working in these sectors to recognise and preserve their precious strengths and protect against them becoming exhausted or overstretched in some of the ways described above. In such consultations an FDC consultant will typically guide an individual to think about their role, and how they manage health, relaxation, work-life balance and maintaining a good support network, as well as encouraging them to consider how they manage stress and challenges in the workplace. A brief exploration of personal history and recent life events will also help to highlight anything in a person's role that might potentially be 'triggering' or evocative of issues from their past. Gaining insight into such connections and possibilities can be hugely helpful. So many people are strongly motivated (either consciously or unconsciously) to do the work they do in order to address things they themselves, or others close to them, have personally experienced. What better incentive? However, again, this is something that can can render an individual vulnerable if not explored and managed with care. Therefore it can be important to give it careful consideration. When something particularly traumatic or challenging occurs in connection to an individual's work, such as a critical incident, or within their personal life, such as a bereavement or relationship breakdown, allowing the opportunity to talk the impact of this through with an FD Consultant (in, for example, a initial trauma-assessment or assessment for counselling) can help the individual concerned to manage as best they can. This may mean taking some time off, or making time for a short-series of ongoing trauma or general counselling sessions. If taking time to treat, rest or recover from a physical injury is acceptable, we'd encourage people to consider psychological trauma or stress in the same way. Although staff can sometimes feel understandably apprehensive sharing difficult or sensitive material relating to their pasts in a work-related psychological consultation, my response to this is that it's not so much what happened to them as how they have handled it and moved forward that FD Consultants are most interested in. I also point out that FDC appointments are largely confidential (although, of course, there are some legal, ethical and professional limits to this which are always explained at the start of any consultation) and anything fed back to an individual's organisation will always be shared with them first. 'I actually learned a lot about myself in that hour so feel much more confident about starting my assignment'. 'I've come to realise there are a range of relatively simple things I can do to promote my own wellbeing and that this will have a positive impact on my team and the people we serve'. 'I can see now why that experience affected me so much so have a lot more self-compassion and strength to move forward in my work' Above are some of the types of comments we've heard as feedback from individuals who've engaged with the types of psychological health consultations FDC provides. We're more than the tools it takes to do our work so if we pay for our vehicles, IT systems and operational equipment to be serviced, why not give ourselves as humans and individuals the same kinds of treatment? Burnout, stress and unprocessed trauma amongst staff can have such a detrimental effect on individuals, teams and, ultimately, the people their organisations serve. Therefore it can be a meaningful long-term investment to seek to combat them. Felicity Runchman MBACP (Accred), MA Counselling & Psychotherapy Today at 12.30pm the BBC World News Channel ran a piece talking about the mental health of aid workers. As my regular followers know, this is an area I am extremely passionate about and feel that wider discussion is needed on the subject to support humanitarian aid workers, and those working in the armed forces or as first responders. We should be educating, not only individuals working in these roles to be better prepared to manage their own mental health and look out for those around them, but also to educate organisations so they can implement strategies to support and protect their staff/volunteers. Unfortunately I wasn’t available for the interview on the programme but I was very pleased to provide them with interesting statistics to support the discussions. The statistics come from my own research for my book, Psychosocial Support for Humanitarian Aid Workers and are as follows:
Organisational support of relief workers deserves more systematic and thorough research. Ongoing exposure to trauma creates occupation-specific health needs. Despite known occupational hazards, anecdotal reports indicate that employers offer little social or psychological support in the field or after assignment. Explanations differ. Nongovernment organisations may have unrealistic expectations of workers’ adaptive capabilities, combined with limited resources. One survey of non-government organisations’ human resources staff found that psychological support of workers was considered less important than that of the local population. Furthermore, workers themselves may feel that their suffering is less relevant as well. These findings have implications for humanitarian agency employee practice as well as research. Prior to service, workers—both expatriate and national staff—should be informed of the risk of potential exposure to trauma and related psychological effects. Organisations should develop and facilitate appropriate evidence-based support services in the field. Humanitarian agencies should offer culturally appropriate medical and psychological support for national staff during service, and they should put systems in place for ongoing support following agencies’ departure from the site and expatriates’ return home. I also carried out a survey on the types of critical incidents we managed over three years (Dunkley, 2018)
There has been other research carried out which was used to support the findings in my book, including:
There is a significant body of evidence to demonstrate that workers directly exposed to traumatic events, including transportation disasters, physical attack, shootings, harassment and accidents, during the course of their work have an increased risk of developing PTSD, major depression, anxiety and/or drug dependency (Breslau, 1998). A study that examined the mental health of national humanitarian aid workers in northern Uganda concluded that over 50 per cent of workers experienced five or more categories of traumatic events. Additionally, respondents reported symptom levels associated with high risk for depression (68 per cent), anxiety disorders (53 per cent) and PTSD (26 per cent), and between one-quarter and one-half of respondents reported symptom levels associated with burnout (Ager et al., 2012). A recent longitudinal study indicated humanitarians are at increased risk for depression, anxiety and burnout during deployment and after returning; aid workers also had lower levels of life satisfaction compared with pre-deployment levels, even months after returning from the field (Cardozo et al., 2012). Overall, as the demand for humanitarian relief work continues to grow, continual trauma exposure has important implications for occupational mental health. Research on psychological effects of relief work is limited and should look more broadly at trauma-related mental health outcomes, including depression, anxiety, and alcohol use in addition to PTSD. Having conducted a lot of research in this area and with many years of experience Fiona discusses how organisations can prepare their staff before deployment in her new book “Psychosocial Support for Humanitarian Aid Workers”. Get your copy today to find out more, available from Amazon. The third blog in this series shares a short snip of my presentation at the BACP Conference which focusses on developing a ‘trauma management programme’ part of a critical incident plan. The Trauma Management Programme should define every stage of a critical incident, from early intervention, trauma-specific treatments, follow-up, right through to 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. I would recommend that a Trauma Management Programme include the following: Immediate Crisis Management The situation is often chaotic in the initial stages of a critical incident. Thus the immediate stage of any crisis is all about practical support, and deescalating and defusing the situation. Five points to consider in the immediate crisis phase: 1.) Safety and Practical support; 2.) Non-judgmental communication; 3.) Offer empathy, not sympathy; 4.) Empower the individual impacted; 5.) Offer information and implement clear administration processes. Screening Most people will recover from a traumatic event naturally, but having an evidence-based screening process, one that is culturally and ethically appropriate, can monitor individuals who may need further support. Screening should be carried out on a regular basis, ideally within the first week following an incident, then at one month, six months and one year follow ups. Family liaison support Family Liaison officers are necessary when a member of staff has died or they are unable to speak for themselves, perhaps through a kidnapping incident or being unconscious. The family liaison officer’s responsibilities include: being the point of contact between the family and the organisation, keeping the family informed, listening to the family’s needs, providing practical guidance, signposting for further support where necessary, and helping the family deal with the reality of the situation. The family liaison officers also need supervision and psychosocial support when necessary. Peer support Peer support programs are a great resource and support to national staff as they are versatile, cost-effective, and can offer support to staff that are harder to reach. Peer supporters are volunteers within the organisation. They will be assessed regarding skills and resilience, before being trained and offered supervision. This training should consist of trauma awareness & Psychological First Aid, management of sexual assault, stress & resilience, and training of the trainer (where necessary). It is often colleagues that notice the first signs of a peer struggling and are well placed to offer early psychosocial support, and by doing so, can improve an individual’s recovery. Psychological First Aid (PFA) PFA focuses on understanding trauma symptoms and building coping strategies and resources. PFA is educational, does not explore the incident in detail, and therefore can be offered to individuals who experienced the same event, but had different levels of impact and exposure to the traumatic incident. It can also be offered whilst an incident is still on going, such as working in a war zone etc. PFA offers a chance to triage and assess staff. The advantage of PFA is that peers can be trained to facilitate groups, making it an economical and accessible option. Psychological Debriefing Debriefing focuses on processing an event in detail and bringing a sense of closure to the traumatic incident. Individuals would be assessed to decide which debrief group they would be best suited depending on the level of exposure to an event. It is important to place individual’s who have had a similar experience and level of exposure together in the same group, so those who were less impacted are not exposed to further traumatic material. Although there is some controversy of using debriefing many organisations such as emergency first responders, Employment Assistant Programs (EAPs), NHS foundation trusts, various NGOs and United Nations departments are continuing to use various forms of psychological debriefing. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) have endorsed psychological debriefing (Tuckey & Scott, 2014). Initial trauma assessments Some staff members may choose not to attend a psychosocial group, or it may not be beneficial to them, depending on the nature of the traumatic incident. Therefore an initial individual trauma assessment, which can be carried out remotely, and covers elements of the PFA model, can be helpful. Specialist trauma counselling If an individual’s symptoms persist after 4-6 weeks we would recommend trauma specialist treatments. The main two treatments are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behaviour Therapy (TF-CBT), both of these models have been culturally adapted to be effective globally, although many countries do not have access to specialist trained therapists in these approaches. It is therefore useful not to overlook other trauma therapies that are also getting good results globally, such as Narrative Exposure Therapy (NET), and the Tree of Life Model (Denborough, 2008). Additionally, clinicians can offer these services remotely through various software applications and webcam. Follow up/closure It is good practice to offer follow up appointments one month, six months and one year after a traumatic incident, so staff feel that their experience of having been through a distressing situation is acknowledged, and that they are supported and valued by their organisation. Watch the presentation here: In this blog I’m pleased to share with you a second short clip of my presentation from the BACP Conference, focussing on vicarious trauma. Vicarious trauma, also known as secondary trauma, can be described as indirect exposure to a traumatic event through first-hand account or narrative of that event. People in the helping professions, counsellors and therapists, humanitarian aid workers, emergency first responders, journalists, police officers, doctors, and lawyers, may be at risk of vicarious traumatisation. Any person who has a significant relationship with a survivor of trauma may also come to experience vicarious trauma. Therapists and other helpers often hear stories of traumatic experiences in the course of their work. At times, hearing these stories may overwhelm them and lead them to experience, to a lesser extent, the same symptoms faced by the trauma survivors in their care. Vicarious trauma typically involves a shift in the world view of the helper. The helper’s beliefs about the world may be altered by repeated exposure to traumatic material. Compassion fatigue and burnout are related concepts that share some similarities with vicarious trauma, and a person might find themselves experiencing one or more of these states at the same time. Compassion fatigue is the condition of emotional and physical fatigue that results in the carer cutting off from their empathy to protect themselves from the impact of the work. It is often evidenced in carers that have been in the role for long periods of time. It becomes a way of their body protecting themselves. Individuals often have symptoms of feeling shut off, numb and detached. Burnout is a term sometimes used interchangeably with vicarious trauma, but this condition does not necessarily involve a traumatic element. People can experience burnout when they have a toxic work environment or when they feel themselves to be doing tedious or otherwise trying work without getting enough time for rest or appropriate self-care. Watch the presentation here (please note this is a very short section from a longer presentation): |
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