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TRAUMA ADVICE -  INTRODUCTION

 

 Access to the best trauma treatment is one of the principle aims of TSUK and it is one area that we have so far failed to make a great impact. To some extent this is because by the time TSUK was established, more than a year after the Boxing Day Tsunami, the prime time for extending treatment to sufferers had already been passed. We recognise that any efforts we make now in improving what is on offer is likely to be of more help to the survivors of future disasters. Nevetheless it remains a worthwhile goal.

'Trauma' has a reasonably precise medical meaning - it is a serious or critical bodily injury. This definition is associated with trauma medicine practiced in an emergency scenario. In psychiatry, 'trauma' has another meaning and refers to an experience that is emotionally painful or shocking with the potential to cause lasting mental and physical effects. As I write this, the news on the television is describing a horrific murder, and mentions that the police officers on the scene are being offered 'stress and trauma' counselling. It has become a truism of terrible events and it easy to come away with the impression that there is an army of psychiatrists and counsellors out there, just waiting to respond to this need. This is a long way from the truth.

To experience trauma after a terrible event is natural and is not by itself a condition requiring specialist help. Most people find their own way of making sense of what has happened to them, but for a smaller number what has happened is so intense that this is not possible. They suffer a reaction that can last for years, known as Post-Traumatic Stress Disorder (PTSD). The best known examples of this are soldiers returning from combat and indeed a recognition of the potential for PTSD in the military context has done much to drive the extension of specialist PTSD help in the UK. The  Royal College of Psychiatrists has a good introduction to PTSD.

The purpose of the trauma pages on this website is to indicate what help is available and how to access it.

SYMPTOMS

a) Flashbacks and nightmares
b) Being permanently 'on-guard' (hypervigilance)
c) Avoidance of the experience (leading to numbing and increasing withdrawal from society)
d) Physical effects, uncontrolled limb movements, headaches, panic attacks

In severe cases combinations of these symptoms can amount to being disabled.

TREATMENT IN THE UK

Outside of specialist psychiatric treatment the kind of help that is likely to be offered by a sufferer's own GP is

a) Access to group therapy, meeting with people who have been through similar events. This can help to create a context in which expressing feeelings or describing experiences becomes easier.
b) Medication, specifically
antidepressant tablets - probably not in the expectation of a cure but more to bring some relief from the severity of the symptoms.

Specialist psychiatric treatment is likely to consist of combinations of the following:

Cognitive Behavioural Therapy (CBT) is a way of helping a sufferer to understand why they are recting in the way they do and then to develop techniques for making the symptoms more manageable. A video describing cognitive behaviour therapy (mainly in the context of obsessive-compulsive behaviour) can be accessed here.
 
EMDR (Eye Movement Desensitisation & Reprocessing) is a technique that uses eye movements to target the subconscious. It can help in the processing of flashbacks and in the bringing to the conscious mind memories that the brain has suppressed.

Both the above treatments are recommended by NICE, the National Institute for Clinical Excellence for treating PTSD. Their comprehensive guideline document last updated in March 2005 can be downloaded here

ACCESS TO TREATMENT

In the UK, within the NHS, all treatment is accessed in the first instance by contacting your general practitioner (GP). Your GP ought to be able to make arrangements for assessment of your needs. This assessment is likely to be beyond the expertise of the average GP and will be carried out by a locally based psychiatric team. This may be in the first instance a psychiatric nurse who will then decide whether to pass the sufferer onto a clinical psychiatrist. All the people in this chain should be following NICE guidelines.

Following the assessment a course of treatment will be decided. It is likely to involve some medication. Assuming a diagnosis of PTSD is made, then specialist psychiatric help will be required.

It is at this point that the system is likely to struggle. It is commonly supposed that there is a shortage of psychiatrists in the UK. Strictly speaking this is not true - there are about 3000 psychiatrists available to be called on by the NHS and this is a better patient to psychiatrist ratio than, for example, is found in the USA. This, however, is not the whole story. Only a small percentage of these will be experienced in PTSD and hence a locally available facility may not be possible. NICE guidelines are just that - they do not confer a patient the right to a recommended treatment.

This is unsatisfactory. People connected to the Boxing Day Tsunami who are struggling to get proper trauma treatment are invited to get in touch with the TSUK so that we can put pressure on the relevant government departments.

Although the opening of this text referred to the desireability of prompt treatment for PTSD is is often the case that symptoms do not appear for some time, often prompted by another event such as the loss of a partner. It happens that the average time for a serviceman to seek treatment for PTSD following combat is over 14 years. The Red Cross offered £600 to tsunami survivors seeking specialist treatment - this offer was removed after 6 months. Clearly, there is a lack of appreciation of what trauma treatment involves, even at the highest and apparently experienced level.

For those brave souls willing to pursue their own path a useful starting point could be the Humanitarian Assistance Unit, operated by the Deprtment for Culture, Media and Sports (DCMS). The web page is not especially informative but does give a means of making direct contact with the relevant government department.

It may be helpful to contact NHS Direct.  There is also some useful advice from the government department dealing with emergencies.

 

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Tsunami Support UK: Support and information to people affected by the tsunami.