Psychological trauma in the workplace – Identifying and preventing disorders, managing crises, Ph. NEUVILLE, Éditions LIAISONS, 2004
I. REACT AS QUICKLY AND IN THE BEST CONDITIONS
The crisis cell is the node of the system. It must be set up prior to any crisis and its members must be able to be mobilized at any time. The design of a memo of the people (internal and external) to be contacted urgently with a reminder of the emergency procedures is very useful.
An information note, specific to each company, can be made available, after the occurrence of a crisis, for the personnel who are victims or involved. This note makes it possible to give the first immediate advice, while waiting for the arrival of the psychological unit.
The importance of prevention through training has already been mentioned. The training provides prior knowledge of the effects of stress caused by a serious incident; she also provides stress reduction methods as well as prevention techniques. So many ways to protect personnel, at the time of the incident and long after it.
Along with the training of responsible personnel, the speed of intervention is the other crucial condition for the proper conduct of a crisis management program. Rapid intervention offers the double advantage of alleviating symptoms in the short term and greatly reducing the risk of problems, sometimes very serious, in the long term.
Critical Incident Stress Management aims to protect and support staff, while addressing Traumatic Stress Reaction Syndrome which can lead to reduced performance, increased absenteeism and mental health issues or physical.
II. INTERVENTION STRATEGIES
In all companies where there is a potential risk of serious incidents, it is strongly recommended to take preventive measures.
First, there is primary prevention or the interventions that precede the traumatic event. This aims to ensure that acute stressful situations occur as little as possible, and makes it possible to prepare for them through structural-organizational measures.
Secondary prevention aims to intervene at the time of the occurrence of an incident characterized as traumatic.
These prevention programs must be designed and adapted to the specific needs and characteristics of each professional environment.
1 — Primary prevention
Primary prevention or interventions that precede the traumatic event aim to reduce and prevent the onset of mental health problems. Prevention strategies, developed according to the professional environment and the risk of incident or accident, also contribute to reducing the negative impact on the human and financial level in the company.
Awareness and training consist of providing them with information on the organizational measures to be adopted, preparing them to identify traumatic events and their possible consequences. The goal is the safety of personnel. At the end of the training, participants will be able to define a prevention strategy adapted to human risks, to assess the social and economic consequences of a psychotraumatic event and to prevent them as best as possible by implementing appropriate means of intervention. .
This training indicates in particular, with the elaboration of a consensual protocol, the elements of procedures to be followed after an incident, the precise provisions which must be taken answering the questions: to whom, when and how is it reported that a incident has occurred, what action should be taken, etc.
In an emergency, it is naturally necessary to contact the emergency services and the police, then mobilize the external psychological assistance unit for victims. Before the arrival of the psychological cell, in the moments following the event, an information note is given to the attention of the staff who are victims or involved. This note aims to:
– to inform the victims about the symptoms “logically” felt immediately or later;
– to communicate on the immediate mobilization by the company of specialists in psychological trauma;
– to give some indications on what to avoid doing when you are in a state of shock. This involves, for example, strongly advising against watching violent films or television news. Seeing images of violence in a state of shock does indeed present a real danger for the psychic balance of which the victims must be preserved as much as possible. From experience we also know that it is better to avoid any statement to journalists (especially radio, television). It is common to painfully regret afterwards the words made “in the heat”, the words spoken in anguish or anger.
It is very important that this training program be regular, once a year for example, so as not to forget the procedures to be activated when a crisis occurs. Scenarios are offered during these “reminder” training sessions. The scenarios used can be based on the history, the types of pre-existing crises. Without this regularly renewed learning, experience shows that it is much more difficult to bring together all the capacities for reactions and actions when the crisis occurs.
2 — Secondary prevention
Secondary prevention encompasses all intervention procedures for “management of psychotraumatic events”. Secondary prevention aims to reduce and limit the human consequences of a psychotraumatic event through screening and early treatment.
It cannot be stressed enough how important psychological support immediately after the incident and on the scene itself is. The faster the intervention with mental health professionals, the more limited the traumatic consequences.
Among the means of managing post-traumatic stress, there are structured interventions such as defusing sessions (psychological cell) and psychological debriefing after a traumatic incident.
3 — The emergency cell (defusing session)
The defusing sessions take place in groups of a maximum of ten people, or individually, under the guidance of duly trained specialists. They are intended to help victims to better react to the stress caused by a serious incident, to better recover their balance and to avoid the appearance of a state of post-traumatic stress. The defusing sessions must absolutely take place very soon after the incident (ideally within 12 to 24 hours) and be followed by a debriefing. We invite the people affected by the event to speak openly about what happened, to dare to discuss it. These first exchanges make it possible to lower the degree of individual stress. However, in this first stage of the emergency, we avoid making the victims talk too much on the spot; it is above all a question of reassuring them before they leave the premises or resume their duties, by providing them with information on the symptoms they are experiencing or will experience in the hours that follow. They are informed that it is not just any mental disorder, but a normal reaction to an unusual event, to a situation of acute stress. The first physical symptoms experienced are headaches, backaches, allergies, insomnia and in the longer term coronary heart disease, high blood pressure, ulcers, asthma, immunological dysfunctions and poor general health.
During these sessions, the advice given in “the note for the attention of victimized personnel” is also taken up. Medicalization should be avoided if possible.
This emergency intervention allows leaders to have the immediate support of a specialist who will guide them in their steps and take care of traumatized people by immediately providing them with a listening ear and will establish a diagnosis for the implementation of the debriefing. The defusing time is therefore also used to organize, a few days later, the psychological debriefing, individual or collective, depending on the situation of one or more people involved in the event, with the same team of psychologists.
4— Technical debriefing
The technical debriefing precedes the psychological debriefing. It enables critical judgment to be made on the relevance of the procedures applied during the crisis. It also makes it possible to highlight any malfunctions and to launch the first bases of a reflection on their improvement.
The technical debriefing must be meticulously prepared by all the actors of the technical staff who are invited to participate. It is a question of satisfying the “requirement of truth” of the victims, of making the choice of the interlocutors, the one who will have to announce a death, for example.
5 — Psychological debriefing
The concept and practice of debriefing originated in the US Army during World War II. The aim pursued then was to improve the operational capacity of combatants.
During the 1960s, the method was transposed to the civilian environment. In France, this technique (readapted) gained momentum in 1994-95 during the attacks.
As practiced today in I ‘Hexagone, debriefing is a technique developed by specialists such as Professor Crocq. It is a method encouraging victims to express what they feel confusedly, what comes to their mind spontaneously, and not to tell what they know.
The debriefing belongs to the immediate post corners. Debriefing sessions following traumatic events represent structured psychological and collective approaches, through which we come to the aid of those who have suffered the effects, by reducing the intensity and duration of the physical and affective reactions of stress. It thus aims to prevent the onset of post-traumatic stress disorder. It can be practical either individually or in a group depending on whether the event affected a person or a group, such as a work team. It is reserved for established groups: people who know each other, are used to working together, and will have to do it again after the event. It is intended to treat both the group and the individuals.
This brief (one or two sessions) and structured intervention ideally takes place within 48 to 72 hours following the incident and at the site of the trauma. It allows victims to openly exchange their thoughts, feelings and reactions. The sessions must be led by experienced specialists, mental health professionals and bound by professional secrecy. Thus, there is much less risk of confusion between individual interests and common interests and no hierarchical pressure. However, information that may contribute to the proper functioning or organizational improvement of the company may be mentioned during the systematic verbal report to the site manager, at the end of the debriefing.
During the session, participants will be asked to verbalize what they experienced during the event in order to put their perceptions, memories and emotions in order, and to restore meaning to the event by himself. It is also a question of providing a theoretical contribution in order to reassure the participants as to the normalization of their traumatic reactions and to help them find ways to overcome them. Among other things, the debriefing makes it possible to avoid the feelings of frustration and isolation inherent in any psychotraumatic syndrome. A traumatic event occurring in a professional setting makes the individual switch from a professional involvement to a personal involvement. The debriefing is a space of transition between the personal moment that is the traumatic event and the dimension of the professional identity common to each member of the group. It therefore makes it possible to pass from one situation to another.
The debriefing is carried out in groups of ten people maximum with one or two speakers, depending on the seriousness of the event, subject to professional secrecy.
— When: 48 to 72 hours after the event.
— With whom: group of 5 to 10 people involved.
— Who: mental health professional trained in this technique.
— Objective: makes it possible to carry out a technical assessment, to give everyone a voice so that they can put words to what they felt, discuss the event in a constructive way thanks to the involvement of the psychologist, find answers to the problems felt and be aware of the possible occurrence of symptoms in order to deal with them.
The different beneficial effects of psychological debriefing
- The collective debriefing makes it possible to avoid an excessive individualization of the care so as not to send the victim or the witness back to isolation.
- It promotes the expression of the work collective and thus preserves the cohesion of the team by strengthening the ties of belonging.
- It reassures by informing about possible changes in the symptomatology (because the latter, little known, can be worrying), which increases tolerance to normal suffering in the circumstances and helps to reduce the risk of depression.
- It helps to “normalize” the event, minimize feelings of guilt and tame the traumatic experience while promoting a return to balance and avoiding medicalization.
- By recounting the event, the victim exposes himself again, in thought, to the traumatic event, which promotes desensitization which can lead to a reaction of reviviscence (flashbacks, nightmares, etc.)
- Verbalizing facts, emotions and thoughts with a professional helps to understand the nature and logic of post-traumatic stress symptoms, which promotes their reduction.
- Debriefing restores some structure to the confused emotional situation in which the victims find themselves.
- It helps initiate the process of accepting trauma.
- It helps to integrate this experience, to question certain maladaptive ideas which may have developed.
- It helps to lessen the effects of exposure to a traumatic event and to speed up the recovery process.
- It makes it possible to quickly identify the most vulnerable people, to whom we will offer an individual interview and, if necessary, referral to a local network of appropriate support.
6 — Individual interview
At the end of the debriefing, people at risk are invited to an individual interview. The goal is to allow, in the confidentiality of the meeting, one-on-one, to address more intimate emotions and to direct, if necessary, the victim towards specialized care. One or more interviews may be necessary.
7 — In summary: The importance of a human crisis management program in the company
Promoting the psychological care of victims contributes significantly to the cohesion of the company and the confidence of its personnel. Pre-incident training and early post-incident interventions reduce the short- and long-term impact of psychotraumatic events. Conversely, the risks of failure to control the effects of such incidents lead to unusual behaviour, which is painful for the victims and harmful for them.
the company, as we have seen previously.
When a traumatic event occurs, the company concerned must activate the “psychotraumatic event management” procedure and mobilize experts in order to limit the damage on a human level and the additional financial costs that always result. It is important that the system chosen is known to all the managers of the company (for the training) so as to avoid any loss of time and distancing in the rapid implementation of the support.
Such strategies benefit the employees and the organization. Employees are better off for it: their morale and attitude towards work and their company are better, job performance picks up faster, and there are fewer long-term sick days, which benefits the business.
It is a management tool which, through its action, must convince managers of a human contribution to the value of the company.
The practical conduct downstream, to effectively manage a serious and traumatic event, is based on three aspects.
This is the work of the crisis unit, trained in the “management of traumatic events”:
— intervention of rescue and rescue operations;
— ensure immediate psychological assistance, by informing the actors involved in post-traumatic follow-up.
Establishment of psychological support for direct or indirect victims, at the very scene of the accident.
Active and permanent information of the persons concerned and of public opinion.
The crisis unit
It is a structure put in place in emergency situations which must respond to maximum mobilization and responsiveness. It is an operational command post on the site of the event to coordinate action on the ground. This place must be pre-equipped with all the means of necessary communication and tools such as the plans of the place of the event, in short all the information that the cell needs to function. Provision must also be made for the evacuation of the victims to one or more assembly points.
The purpose of the crisis unit is to coordinate the action of all the actors in the crisis in order to deal with exceptional situations as effectively and as quickly as possible.
Who participates in this cell?
This crisis management area is managed by a manager who has in-depth knowledge of the problem posed. He receives support from the crisis communication unit and is in close contact with company managers.
Overview of respective support
> The crisis management manager:
- identifies absolute emergencies;
- distributed the major operational functions, based on the structures provided;
- is organized to deal with all interface problems (sites, internal players, external players);
- informs the desired correspondents of the existence of the cell, its contact details;
- is the company’s spokesperson for press briefings throughout the crisis.
> The crisis communication unit:
- is the interface with the world of the press and with all the public waiting for information (victims and their relatives);
- develops messages;
- broadcasts messages.
> The psychological emergency unit:
- takes care of the psychological support of direct and indirect victims;
- manages the organization of groups for the collective debriefing sessions in the following three days.
> The logistics support cell:
- prepares the crisis room, dashboards, liaison equipment, computer systems, television and radio to follow what is said outside, etc. ;
- organizes the reception of people arriving at the crisis centre;
- anticipates all risks of malfunction.