20 - Debriefing health care staff after assaults by patients

Summary

EDITORIAL COMMENTS

This chapter reports an interesting and reportedly effective programme used to lessen the stressor impact of assaults by patients on staff in psychiatric inpatient settings. The programme is structured in an organizational health and safety approach and is associated with a positive framework of peer support, i.e. it emphasizes positive coping and outcomes, including reinforcing attachments. The peer support team members who respond immediately are backed by supervisors and a team leader.

The model provides for direct support to the assaulted staff member in this way, while at the same time, if the event is very severe or involves others, critical incident stress debriefing is provided. Follow-up occurs to check whether the individual needs referral for more specialized care. This model has been widely tested and found to be effective in returning staff to functioning, lessening staff loss and decreasing assaults in the hospitals where it has been implemented. Flannery also reports significant cost savings.

Although this is not reported as a controlled trial, the replication of this intervention appears to support its effectiveness. As an intervention, it Wts in the broader context of stress management, particularly Critical Incident Stress Management. The incidents, while disturbing, have a relatively low prevalence of post-traumatic stress disorder (PTSD) associated with them. It appears that the intervention is helpful in the ways claimed, and does not claim to prevent PTSD in this population, although it appears to be associated with lessening distress.