At least 25% of individuals exposed to a traumatic event or series of events will develop at least one or more psychological illnesses.
Typical psychological illnesses arising out of exposure to trauma include depression, post-traumatic stress disorder (PTSD), grief and adjustment reactions and drug and/or alcohol dependency.
The most common categories of traumatic events include road, air and rail accidents, accidents at work, abuse (physical, sexual and/or emotional) combat and natural or other disasters such as the Hillsborough disaster and terrorist attacks.
Exposure to trauma can result in an individual suffering from one or more psychiatric disorders. A common misconception is that PTSD is the only psychological illness arising out of exposure to trauma. It is not.
Unlike a physical injury an individual may not immediately either experience or recognise the signs and symptoms of a psychological injury. In some cases where an individual has been experiencing signs of psychological distress, that individual may not associate their symptoms with trauma for weeks, months and commonly years. Such signs and symptoms may include nightmares, flashbacks, irritability, anger, concentration difficulties, low mood, fatigue and sleep disturbance.
Individuals suffering from a psychological injury or injuries caused by trauma exposure require urgent medical help. Such help may not always be available either at all, or in time, through the NHS.
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Here are the NICE recommendations.
Key priorities for implementation
Initial response to trauma
For individuals who have experienced a traumatic event, the systematic provision to that individual alone of brief, single-session interventions (often referred to as debriefing) that focus on the traumatic incident, should not be routine practice when delivering services.
Where symptoms are mild and have been present for less than 4 weeks after the trauma, watchful waiting, as a way of managing the difficulties presented by people with post-traumatic stress disorder (PTSD), should be considered. A follow-up contact should be arranged within 1 month.
Trauma-focused psychological treatment
Trauma-focused cognitive behavioural therapy should be offered to those with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event. These treatments should normally be provided on an individual outpatient basis.
All people with PTSD should be offered a course of trauma-focused psychological treatment (trauma-focused cognitive behavioural therapy [CBT] or eye movement desensitisation and reprocessing [EMDR]). These treatments should normally be provided on an individual outpatient basis.
Children and young people
Trauma-focused CBT should be offered to older children with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event.
Children and young people with PTSD, including those who have been sexually abused, should be offered a course of trauma-focused CBT adapted appropriately to suit their age, circumstances and level of development.
Drug treatments for adults
Drug treatments for PTSD should not be used as a routine first-line treatment for adults (in general use or by specialist mental health professionals) in preference to a trauma-focused psychological therapy.
Drug treatments (paroxetine or mirtazapine for general use, and amitriptyline or phenelzine for initiation only by mental health specialists) should be considered for the treatment of PTSD in adults who express a preference not to engage in trauma-focused psychological treatment.
Screening for PTSD
For individuals at high risk of developing PTSD following a major disaster, consideration should be given (by those responsible for coordination of the disaster plan) to the routine use of a brief screening instrument for PTSD at 1 month after the disaster.
If you don't feel your healthcare team is providing care in these terms let us know and we can do an audit, advise on solutions and make representations to your team.