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How to cope with the aftermath of accidents

Safety

An accident can have a devastating psychological effect not only on the victims and their families but also on co-workers who witness the event. Trauma counsellor Keith Guy tells David Taylor why construction has to catch up with other sectors in tackling post-traumatic stress disorder

IT IS only right that, in the aftermath of a serious ? perhaps fatal ? accident on a construction site our thoughts should be with the victims, their families and their friends. Their loss is real and tangible. We know they are suffering.

But what about the people who witnessed the incident or were in some way involved but uninjured? They too will be suffering.

All too often these people ? secondary victims of the incident ? are overlooked and left to suffer in silence. They might develop post-traumatic stress disorder, a debilitating condition that can lead to severe mental problems or even suicide.

Given its high accident rate, you might expect the construction industry to be up to speed when it comes to helping those who have witnessed a serious incident on site. But the reverse is true, says trauma counsellor Keith Guy.

'I'm just flabbergasted by the construction industry.

It's got nothing in place to deal with this problem and it's got a dreadful accident record, ' he says.

Mr Guy has years of experience in a broad range of industries but is now focusing on construction because of what he sees as a woeful lack of provision.

Both Mr Guy and his wife Nicola worked for Coventry City Council's in-house occupational health depar tment before moving down to Truro in Cornwall to set up Red Poppy, a company specialising in occupational psychological health and safety and offering trauma management services to employers.

'In other dangerous workplaces, like the offshore and petrochemical industries, they have had systems to tackle trauma for years. The construction industry is light-years behind , ' says Mr Guy.

While at Coventry, Mr Guy treated a wide range of psychological ailments ranging from alcoholism and drug addiction through to phobias and depression brought on by workplace stress, bullying, assault or injury. 'A lot of our referrals were building workers employed by Coventry Contract Services and this is how I learned about the problems in construction, ' says Mr Guy.

Many of his clients had already sought help with their problems but were still suffering.

'We were seeing people who'd been through the whole mental health system and still had the symptoms, ' he says.

Mr Guy's search for a solution to these psychological problems led him to the Human Givens Institute, a professional body representing carers and teachers and devoted to research into the 'givens' of human nature ? our emotional and psychological make-up. Through the HGI, Mr Guy discovered the Rewind Technique, a relatively new method of treating post-traumatic stress disorder.

'At Coventry we set up a two-year research project to test Rewind and the results were absolutely excellent, ' says Mr Guy. 'In some cases we managed to sort people out in just three sessions.' Both Keith and Nicola Guy agreed that they wanted to focus on the human givens approach to counselling and so, on the back of their research into the Rewind Technique, they left Coventry for the West Country to set up Red Poppy.

Through a network of 150 associates across the UK ? mostly qualified counsellors, psychotherapists and psychologists ? Red Poppy offers a range of services tailored to each case.

In most of these, a psychological de-brief a few days after a traumatic event is enough to assess the impact on a witness. Any signs of PTSD can be identified at this stage and treated promptly. Missing the symptoms at this early stage can allow them to become embedded and debilitating ? Mr Guy says he has treated people for t rauma they had suffered up to 40 years previously.

That PTSD is a serious risk to health cannot be doubted. It can lead to depression, psychosis and an inability to function normally. Victims suffer insomnia and f lashbacks and they try to cope by avoidance ? absenteeism is common ? or by substance abuse.

They may also refuse to acknowledge their own suffering and become a danger to others. By tackling psychological trauma, employers could be pre-empting further serious trouble for their business, as well as their staff.

Although Red Poppy offers a service to all employers, Mr Guy is especially keen to work in construction. Shortly after setting the company up, Mr Guy contacted Richard Boland, principle inspector at the Health and Safety Executive, to discuss trauma counselling in the construction industry.

'We said that it seemed that the construction industry has nothing in place ? and the HSE agreed with us', says Mr Guy.

There may be a number of reasons why const ruct ion fails so dismally to add ress psychological trauma, but one major reason must be that the workforce is largely transient and it is therefore difficult to keep track of individuals.

Prevent ion is bet ter than cu re, so any cont ractor's priority must be to safeguard against accidents.

Mr Guy makes the point that the 1974 Health and Safety at Work Act 'spells out a duty of care which relates to the psychological as well as the physical'. But he accepts the suggestion that the industry is currently so focused on the prevention of accidents that it has yet to turn its attention to coping with the af termath.

'It indicates that people don't understand psychological trauma or know how to cope with it', says Mr Guy.

Psychological de-briefing might sound like a rather specialised area of mental health treatment, but you need no medical qualifications. Mr Guy says:

'Contractors should be training their people to do this in the immediate aftermath of an accident ? it could save a lot of trouble. It could even save lives.'

Coping with trauma Contractors should have a system in place to deal with the psychological impact of traumatic incidents, says Keith Guy of the Red Poppy company. Essentially it should consist of:

1 Crisis management. Identify all staff who might be affected by witnessing the incident and make sure they know help is available;

2 Defuse the situation. Trained staff (for example, a site foreman or health and safety officer) mount a holding operation to offer support;

3 Psychological de-briefing by professional consultants or (in larger organisations) in-house occupational health specialists;

4 Trauma counselling for those who need it;

5 On-going monitoring and treatment in cases of PTSD.

Psychological de-briefing is an essentially preventative activity, says Keith Guy of the Red Poppy company. 'Steps 1 to 3 should render step 4 unnecessary.'

Signs of stress Secondary victims of serious traumatic incidents do not always realise immediately that they need help. Some symptoms are normal and natural and include:

Sadness or gr ief ? inevitable af ter a fatality;

Powerlessness ? suddenly aware that some things are beyond our control;

Guilt and relief ? guilt that you did something to cause, or nothing to prevent, the incident. It is common to feel guilt and relief at the same time;

Fear ? of things or activities that you once took for granted;

Anger ? towards people or an organisat ion who you feel are responsible for the incident.

Other symptoms might include:

Flashbacks;

Mood swings;

Withdrawal from social interaction;

Chronic tiredness, inability to sleep, irritability or jumpiness;

Use of alcohol or drugs in order to cope;

Feelings of hopelessness or suicidal thoughts.

These too are natural in the immediate aftermath of an incident, but if they persist for more than a few weeks the individual could be suffering from post-traumatic stress disorder and will need further treatment.