Republic of Ireland: opening minds to CISM.

The concept of workplace trauma emerged slowly within the Irish organizational consciousness in the early 1990s. Its arrival coincided with Jeffrey Mitchell's writings on critical incident debriefings and a vague but growing awareness in the minds of human resources personnel of an organization's "duty of care."

As a concept, critical incident stress management was grasped most guardedly Management feared it would serve as an acknowledgement of any risk to health and might legitimize needless absence from work. There was also a profound fear of "wrong footing" the +organization in any litigation process. Suggesting comprehensive CISM programs was generally considered premature and largely unwelcome.

Some organizations, however, were less cautious due to their greater exposure to critical events and their need to formulate an appropriate protocol. These businesses included banks (which experienced frequent robberies) and airlines, whose clinicians (including myself) were exposed to the North American practice of critical incident care from the outset. These businesses laid the groundwork for a slow and steady increase in the demand and supply of CISM in Ireland. As more clinicians working in the public and private sectors received training in critical incident debriefings, so, too, the expectation of post-incident care rose in the minds of staff and employers.

Not everyone was convinced. The subjective and anecdotal experience surrounding debriefings prompted clinicians to value them highly, but the research literature presented an inconsistent picture of efficacy or positive outcome. There was no evidence to show that debriefings positively affected posttraumatic stress disorder scores; some indicated that in fact PTSD scores may be higher after a debriefing. A few researchers wrote of emotional overload and re-traumatization (Dunning 1995; Schnyder 1997). This research controversy stalled CISM's use until the Cochrane report of 2002 allayed many of the fears and, for the first time, confirmed some of the values of debriefing.

Now, in 2006, well-established critical incident management programs can be found in security firms, hospitals, the prison service, the fire service, health boards, and other Irish businesses and industries where there is frequent exposure to critical events. These programs vary but generally combine the components of CISM as outlined by Mitchell.

Where no programs are in place, identification of the need for CISM in ad hoc instances and after one-time events depends on the awareness and training of in-house staff. Within management, the departments most alert to the need for CISM are health and safety personnel and human resources staff. Health and safety personnel are fully cognizant of legal requirements and employers' liabilities and are alert to the psychological risk posed by specific events.

The profile and status of health and safety personnel in Ireland has been heightened by the Health and Safety Act of 2005, which insists on dedicated health and safety personnel and risk assessment. Consequently, the development of a health and safety portfolio is fast becoming a very important and significant aspect of any management team.

Public service organizations have developed a network to share both information and understanding of good practice in CISM. They commissioned a research paper to review the status of CISM in the emergency services in Ireland in 2003 and have conducted well-attended conferences to share the experiences of other countries.

On the supply side, a number of private providers service businesses for whom an in-house clinician is not feasible. Businesses aiming toward self-sufficiency in CISM use specialists to help establish a system that will later be self supporting. There are many combinations in place, reflecting mostly the varying resources and needs of each work organization rather than the many clinical perspectives on the subject.

References

Dunning, C.M. 1995. Fostering resilience in rescue workers. In A.A. Kaluyjian (ed.), Disaster and mass trauma: global perspectives on post disaster mental health management. Long Branch, N.J.: Vista Press.

Mitchell, J. 1983. Guidelines for psychological debriefing. Emergency management course manual. Emmitsburg, Md.: Federal Emergency Management Agency 

Schnyder, U. 1997. Crisis intervention in psychiatric outpatients. International Medical Journal, (4): 11-17.

Wessley S., S. Rose, and J. Bisson. 1998. A systematic review of brief psychological interventions (debriefing) for the treatment of immediate trauma-related symptoms and the prevention of post traumatic stress disorder (Cochrane Review). Cochrane Library, Issue 3. Oxford, U.K.: Update Software.

Stephanie Regan, Dip. Soc. Admin., M.Sc. Psychotherapy

Stephanie Regan manages a private practice in Dublin and provides employee assistance and critical incident stress management services to businesses and hospitals in Ireland. Her firm is known for its specialized trauma care and has trained and developed crisis response teams and peer support teams for the public and private sectors in Ireland, Contact her at [e-mail].