What is it?
Post-Traumatic Stress Disorder (PTSD) is a serious psychological and physical condition that can be caused by a frightening or distressing event such as involvement in a road crash in which people were killed or injured, or traumatic bereavement following a road crash. Around 5% of men and 10% of women will suffer from it at some time in their life. It is common following bereavement in a road crash or serious injury in a road crash, along with other conditions including depression.[1]
What are the symptoms of PTSD?
Symptoms may include, among other things: flashbacks, nightmares or frightening thoughts, sweating and shaking, numbness and feelings of detachment from others, inability to remember, deep fear, problems with concentration, problems with sleeping, anger and irritability and other symptoms.
How should PTSD be treated?
The first step for anyone who suspects they are suffering from PTSD should be to visit their GP. The GP should be able to arrange a professional assessment of your condition to find out if you have PTSD or another condition such as depression. The National Institute for Clinical Excellence guidelineson PTSD state that all PTSD sufferers should be offered a course of trauma-focused psychological treatment (trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing). Trauma-focused psychological treatment should be offered to PTSD sufferers regardless of the time that has elapsed since the trauma. The duration of the treatment should normally be 8-12 sessions when the PTSD results from a single event. Treatment should be regular and continuous and delivered by the same person. Drug treatments for PTSD should not be used as a routine first-line treatment for adults in preference to trauma-focused psychological therapy, but should only be considered in adults who express a preference not to engage in psychological treatment. [2]
The NICE guidelines refer to other forms of psychological treatment such as supportive therapy/ non-directive therapy, hypnotherapy, psychodynamic therapy or systemic psychotherapy and state there is as yet no convincing evidence for a clinically important effect of these treatments on PTSD. [3]
To read the full NICE guidelines on recommended treatment for PTSD, click here.
Cognitive Behavioural Therapy - what is it?
Trauma-focused Cognitive Behavioural Therapy involves talking with a therapist and includes learning skills that help sufferers to change negative thought processes. It includes the use of mental imagery of the traumatic event and an understanding of their symptoms as normal reactions to help sufferers work through the trauma and gain control of their fear and distress. [4]
Problems accessing diagnosis and treatment
David Bennett, director of the UK Trauma Centre, said: “When someone goes to their GP, their doctor may not actually be aware of PTSD and the fact is that there are very few who are aware of it. The person then faces the danger of being diagnosed with anxiety or depression and being referred for the wrong type of help.
“If it is a case of the doctor actually diagnosing the PTSD, there is still a problem in that there are not enough places offering help, especially to people suffering PTSD as the result of a road crash. These people may be referred to places such as Victim Support, but that is for victims of crime and does not specialise in supporting people who have been injured or bereaved through a road crash.”
According to the latest accurate figures (2002), 73.6% of GP practices have access to a counsellor. However, even for those with access to counsellors there is likely to be a waiting list, which could range from anything as short as two weeks to six months or more. [5] In addition to this, these counsellors will not all specialise in PTSD and the ones that do may not be easily accessible through the NHS, even though in the last few years, the number of NHS doctors offering psychiatric treatment has risen. The latest available figure stood at 8,330 in 2004. [6]
Mr Bennett said: “There are very few people trained in this field. Treatment on the NHS is extremely restricted with very long waiting lists and there are very few facilities for patients who are diagnosed with PTSD - very, very few.”
“Another problem is that the treatment that is available may not be provided by people who specialise specifically in PTSD. For example there are people in hypnotherapy who say they can help people to deal with stress, anxiety, trauma, smoking cessation and other problems, but a doctor who has done five years of medical training would not deal with all that. You have got to split these areas up as they are all different issues needing different types of treatment.”
John Eatock, from the British Association for Counselling and Psychotherapy, agrees that effective treatment is not always immediately available for sufferers of PTSD.
“Someone going to their GP will probably be referred to a primary care centre or psychological therapist working in primary care and although I am sure that these people would recognise PTSD, the waiting time for treatment will vary significantly. The waiting time is variable depending on where you are in the country and how treatment is set up in that area.
“If you have a road traffic collision and as a result suffer from PTSD, which will probably emerge a few months after the incident, treatment might not be available for months after that.”
Therefore, someone suffering from PTSD as the result of a road crash may not only be suffering the symptoms of PTSD several months after the incident, but also continue to suffer the symptoms while they wait for treatment, which could possibly then be the wrong type of treatment.
Mr Eatock concluded: “There is no specific treatment for victims of road crashes suffering from PTSD - none at all. Although normal PTSD treatment is often effective for victims of road crashes, it depends on the severity of the incident. And what you also need to remember is that it is not just the person who witnessed or was involved in the incident, but also their family and friends who might have been affected. For example if a man loses his legs in a horrific crash he may end up suffering from PTSD, but his wife will also be devastated by what has happened and may also end up suffering from PTSD. If these people do get access to treatment is might not always be the right treatment. Put simply, treatment for PTSD is hit and miss all the way.”
Are there any centres dealing specifically with PTSD?
Centre for Trauma, Resilience & Growth is a NHS Independent Provider, operated by a network of qualified counsellors trained in trauma support. Referrals can be made by GPs, Primary Care Trusts, social services and health professionals. Clients can also self-refer for private treatment. [7]
Aberdeen Centre for Trauma Research
The Aberdeen Centre for Trauma Research (ACTR) was opened in 2000, funded by the University of Aberdeen and Grampian Primary Care NHS Trust. As well as carrying out research into trauma, it works closely with the neighbouring Traumatic Stress Clinic, where patients receive treatment. [8] The ACTR moved to the Robert Gordon University in 2006, and assisted in the development of a pilot scheme for establishing a Scottish-wide Sudden Trauma Information Helpline.
The helpline is not a counselling service but will provide information and advice on the issues that surface following a sudden traumatic experience including advice on: what are normal reactions to trauma; when should professional help be sought; what other kinds of support are available in the community; and advice on legal and financial issues. The helpline also has a website offering a range of information; however, most of the resources are restricted to Scotland.
Centre for Trauma, Resilience & Growth in Nottingham
This centre provides assessment and treatment for sufferers of PTSD. It accepts referrals from: the NHS (if funded by the relevant NHS Trust/ PCT); solicitors; Welfare & Occupational Health Departments of the Emergency Services; Occupational Health and Welfare Departments in the Private and Public Sector; any agency or organisation where employees and /or other relevant others may be suffering the psychological effects of exposure to traumatic events; or agencies caring for victims of torture or refugees with mental health problems arising from psychological trauma. [9]
CRITEC
This is a crisis intervention service based in the accident and emergency department at Leeds General Infirmary. Trauma victims and their families are offered immediate emotional care and on-going counselling.
Australian Centre for Road Trauma Support
The National Centre for Road Trauma Support (NCRTS) in Australia is a non-profitable charitable organisation which provides a national network of support for people who have been involved in a road crash. Among the people working for the organisation are mental health workers, personal care assistants and grief and trauma counsellors, all with qualifications and training in their field. The NCRTS provides support to victims of road crashes and information about death or injury following a crash, local community resources, support of counselling services, education and training available around Australia and overseas.
It offers a range of services, including counselling for anyone who has been involved directly or indirectly in a road crash. It offers a crisis intervention service which includes assisting the person with immediate needs such as dealing with the police, funeral, legal or financial concerns and offering long-term support for the person affected by the incident.
Another service provided by the NCRTS is a community outreach programme which provides families with practical support in the home, including childcare, respite care, assistance with household tasks, transport to medical appointments and support during coroners inquests and criminal trials. It has also developed a workplace plan to assist the employee and the workplace to identify support needs and develop strategies for creating a supportive workplace environment.
To visit the NCRTS website click here.
What should I do if I think I may be suffering from PTSD or some other condition such as depression resulting from a road crash?
You can call the BrakeCare helpline on 0845 603 8570 for help accessing assessment for PTSD. Alternatively, visit your GP armed with the BrakeCare bereavement pack (which explains the NICE guidelines on PTSD) or the NICE guidelines on PTSD themselves, which you can download from the NICE website.
Always insist you are assessed by a professional with experience in helping people affected by road crashes and with knowledge of PTSD and similar conditions. Always insist that any treatment you are offered is in line with the NICE guidelines and, again, delivered by a professional with the right skills and experience.
Conclusions and recommendations
People bereaved and seriously injured by road crashes are likely to suffer PTSD and other conditions and deserve to be given the treatment they need as soon as possible.
In order to get Pthese victims the help they need we need:
GPs to be more aware of PTSD and the required treatment
Skilled and experienced therapists, readily available through the NHS, specialising in the treatment of PTSD and other conditions for road crash victims
Government funding for more designated trauma centres accessible through the NHS, such as those in Nottingham and Aberdeen
Sources of further information
Assistance Support & Self-help in Surviving Trauma (ASSIST)
Brakecare
British Association for Behavioural and Cognitive Psychotherapies
Department of Health
International Society for Traumatic Stress Studies
MIND (National Association for Mental Health)
National Institute for Clinical Excellence
NHS Direct
The Trauma Centre UK
Centre for Trauma, Resilience & Growth (CTRG)
Trauma 999
UK Trauma Group
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[1] Post Traumatic Stress Disorder, NHS Direct, www.nhsdirect.nhs.uk
[2] Post Traumatic Stress Disorder: The Management of PTSD in Adults & Children in Primary & Secondary Care, National Institute for Clinical Excellence, 2005
[3] Post Traumatic Stress Disorder: The Management of PTSD in Adults & Children in Primary & Secondary Care, National Institute for Clinical Excellence, 2005
[4] Post Traumatic Stress Disorder, NHS Direct, www.nhsdirect.nhs.uk
[5] NHS Counselling: Developments and Best Practice, John Eatock, Lead Advisor for Healthcare Counselling and Psychotherapy, British Association for Counselling and Psychotherapy
[6] Department of Health, NHS Workforce Census Data, 2004
[7] Centre for Trauma, Resilience & Growth, www.nottinghamshirehealthcare.nhs.uk/trauma
[8] Terry Waite Opens Trauma Research Centre, University of Aberdeen, 2000
[9] The Centre for Traumatic Studies and Traumatic Stress Service, www.nottinghamshirehealthcare.nhs.uk/trauma.htm
