Persistent post-traumatic stress disorder

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6966.1439c (Published 26 November 1994) Cite this as: BMJ 1994;309:1439
  1. Cameron Stark,
  2. Jenifer Lee,
  3. Erica Robb,
  4. Brian Kidd
  1. Senior registrar in public health medicine, Research assistant Argyll and Clyde Health Board, Paisley PA2 7BN. Head, Tayside Area Clinical Psychology Offender Services, Psychology Unit, HM Prison Perth, Perth PH2 8AT. Senior registrar in psychiatry, Edith Morgan Centre, Torbay.

    EDITOR,—Brigitta Bende and Robin M Philpott report on a patient with post-traumatic symptoms 50 years after the precipitating events who improved after appropriate treatment.1 The NHS could do a great deal to treat post-traumatic symptoms in its own workers and so ensure that as few as possible develop similar syndromes.

    One study found that up to 61% of clinical staff who report assaults by patients experience symptoms of post-traumatic stress disorder, and 10% meet the criteria for caseness according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised.2 A Scottish Health Management Efficiency Working Group collected all accident report forms returned by the NHS in Scotland in one week3: 262 staff were injured, and the commonest cause of injury (82 cases) was assault. If this was a typical week around 4000 injuries due to assault could be expected to be reported in Scotland each year. If the American figures hold true at least 400 staff a year may experience post-traumatic stress disorder.

    Some health care settings have taken steps to reduce problems in staff after incidents,4 5 but in Britain the best example of an attempt at a coordinated programme may be that of the Scottish prison service. It has produced a structured response to assaults on staff, which is supported by a programme of management education.

    Immediate care includes the opportunity for privacy followed by a one to one interview with a person in a senior management or counselling position to assess the effects of the assault and allow an opportunity for the victim to talk about it. This is followed by a psychological debriefing. The victim is provided with information on possible psychological effects of the assault and on how to seek help if symptoms persist. Longer term care, if needed, is provided by an experienced clinical psychologist. Care is supplemented by the involvement of management, with flexible allocation of duties. This type of care has gained widespread acceptance even in the previously “macho” culture of the prison service.

    The NHS must do what it can to prevent its staff—its most important resource—experiencing similar problems to those experienced by Bende and Philpott's patient. This can best be done by acknowledging the frequency of violence and by learning from the example of other organisations and providing structured support for staff victims.


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