International Handbook of Workplace Trauma Support

Rick Hughes, Andrew Kinder, Cary Cooper, Rick Hughes, Andrew Kinder, Cary Cooper

• Éditeur: Wiley-Blackwell
• Année: 2012
• ISBN:
  9781119942993
• Édition: 1
• Sujet: Psychology
• Sous-sujet: Industrial & Organizational Psychology

The International Handbook of Workplace Trauma Support provides a comprehensive overview of contemporary standards and best practices in trauma support that draws from the latest research findings and experience of international experts in the field.

• Reviews the major contemporary post-trauma intervention models in both theory and practice
• Includes Trauma Risk Management (TRiM), Support Post Trauma (SPoT), Eye-Movement Desensitization and Reprocessing (EMDR), Mindfulness and Psychological First Aid (PFA)
• Incorporates multi-cultural perspectives by reporting on the pervasive violence in South Africa, constant threats in Israel and emerging developments in China
• Includes social, psychosocial, psychological, and organizational dimensions to offer a detailed mapping of trauma support
• Provides latest thinking for supporting those in the military context

Part E

The Organizational Response to Trauma Support

Chapter 21

Preparing for and Managing Trauma within Organizations: How to Rehabilitate Employees Back to Work

Andrew Kinder and Jo Rick

Introduction

The focus of this chapter is to explore what an organization needs to put in place to respond to traumatic incidents and outlines the role of the line manager as well as human resources (HR) and occupational health (OH). This chapter is aimed at organizations where frequent traumatic incidents occur, although it is equally applicable to organizations where there is an unexpected trauma (e.g., a road traffic accident, witnessing an incident such as a fatality or the sudden death of a colleague, or witnessing a terrorist atrocity). Within this context, the definition of a traumatic event is where an individual has experienced a threat to his or her life or physical well-being or has suffered extreme emotional disturbance due to witnessing an incident that involves death or severe threat to another person's life.

The chapter identifies and draws on existing frameworks for risk management and rehabilitation that can be applied to the management and rehabilitation of employees following a traumatic experience.

Well-Being and Work

The workplace is important to us not just economically but also for our psychological and emotional well-being. It is often said that we spend most of our time at work, more time than for leisure or for domestic activities. A relatively recent review of the relationship between work and well-being (Waddell and Burton, 2006) highlighted that, in general, “Work is good for you.” On the other side of the coin, worklessness or unemployment is certainly not good for you and is associated with various mental health conditions and lower quality of life.

Waddell and Burton (2006) summarize the evidence in their review as follows:

There is a strong evidence base showing that work is generally good for physical and mental health and well-being ... the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence. Work is generally good for health and well-being.

Work, therefore, plays an essential part in promoting health and well-being, and the overwhelming majority of the working-age population are fit to work. There are those in work who may through illness or injury become unfit for their normal job for a while. Nevertheless, they will almost always become fit for work, and many in a relatively short time. The problem is that they may not be fit initially for their normal work, and it is the change in attitude by employers, employees, and healthcare professionals that will allow them to resume useful economic activity.

The Need for Rehabilitation

In 2008 a major review of the health of the working population was carried out in the United Kingdom. The review, led by Dame Carol Black, found that the economic cost of sickness absence and worklessness associated with ill health amongst those of working age is over £100 billion a year in the United Kingdom. Her report estimated that around 175 million working days were lost due to illness in 2006 which equates to approximately £11 billion per year in sickness absence costs, with long-term sickness absence contributing up to 75% of absence costs. The review identified that long-term absences accounted for only 5% of all episodes of absence but, when taken together, these long-term absence cases accounted for over 40% of the total working time lost. Much of this absence relates to mental health conditions. The review concluded that sickness absence not only is a drain on an organization's resources but also presents a public health and economic challenge.

The Role of Work in Recovery

Studies have found that the benefits for employees who return to work include a return to a sense of normality, increased self-esteem and self-respect, higher mental health and social inclusion, as well as financial independence. An organization which has effective return-to-work policies and procedures which are implemented successfully can reap benefits not just in terms of the employee's well-being but also for the organization's efficiency and productivity. A successful rehabilitation of an employee cuts out sick absence or ill health retirement costs and removes the need to rehire and retrain new people. Even when weighed against the management costs of supporting the employee back to work on a rehabilitation program and, for a temporary period, giving a reduced workload or hours worked, evidence from health settings makes the financial case for effective rehabilitation very strong. For example, recent work by the UK National Institute for Health and Clinical Excellence (NICE) found that, although based on a limited number of studies, international evidence for the effectiveness of interventions to return people to work following back problems were highly likely to be cost-effective.

There has also been a shift in the United Kingdom to focus more on rehabilitation and assisting people back into work. An example of this is the “fit note.” The UK government has recently introduced a new system to encourage those employees on long-term sickness absence to attempt an earlier return to work. They have replaced the old “sick note” with “fit notes” which give the GP the opportunity to say that the employee may be fit for work if the employer can accommodate adjustments to the employee's duties or hours of attendance. There is therefore an expectation that the line manager will be able to respond to such requests and they, in turn, will likely need additional support from OH and HR to ensure the organization effectively follows through these adjustments.

However, the rehabilitation of those who have been on long-term sickness absence can still pose significant challenges to both the employer and employee alike. Line managers as well as health professionals and human resources have a crucial role to play here, but it is line managers who need particular support and direction.

Additionally, there is a lack of specific and up-to-date guidance to aid workplace responses to trauma, and PTSD specifically. However, frameworks do exist which can provide a basis for thinking about what organizations need in place, for instance, in relation to legal guidance, risk assessment methodology, medical and psychological treatment, and best practice in relation to workplace rehabilitation. This chapter takes these existing frameworks and then goes through how they can be formulated in practice and within policy to aid those employees who have been subject to traumatic stress at work.

Legal Context

There are legal duties that any organization needs to comply with. Although these duties vary depending on the country's judicial and legal systems, most countries would expect the employer to provide a safe working environment. This would extend to physical as well as psychological considerations. Liability is likely to occur where the employer can reasonably foresee harm occurring due to an issue at work and does not take reasonable action to address it. Although the precise legal definitions and context will vary depending on the country, the following questions can be helpful to work through to decide whether or not there is some liability using the example of traumatic stress:

• Has the employee developed a real psychiatric injury? For example, the employee may have experienced a traumatic incident at work and been diagnosed with PTSD as a result.
• Were the working conditions such as to give rise to a real risk of the employee incurring psychiatric harm? For example, as the employee experienced the traumatic incident at work, the organization would have to argue that the incident did not cause the harm and that the employee had a pre-existing psychiatric condition – although the employee could argue that this pre-existing condition was made worse by the trauma.
• If so, did the employer know, or ought they (with reasonable care) to have known, that their employee was exposed to that risk? For example, the employer needs to answer this by referring to their risk assessment of the specific role and potential exposure to traumatic stress. If they had not previously done this, it will likely count against them. If they have not taken any action to reduce the risk or provide support to ameliorate the impact of a trauma, see the “Risk Assessments” section of this chapter.
• If the employer knew of the risk, what, if any, measures (which were reasonably practicable to implement) could or ought to have been taken to reduce the risk of such injury to that employee? For example, if the employer knew of the risk but their measures to reduce the risk of injury, such as trauma support, were either absent or not implemented as written in their policy, this would count against them. Employers may also need to refer to research carried out in the psychological and medical literature to demonstrate that their interventions were sound and based on best available evidence-based practice.
• If the employer did not know of the risk, did that failure materially contribute to the development of that psychiatric harm? For example, the employer would need to defend against the claim that not assessing the risk and not providing effective post-trauma support following the incident had led to harm to the employee.

Risk Assessments

Within the United Kingdom, the Health & Safety at Work Act (1974) specifies that an organization has a responsibility to proactively prevent psychological harm occurring to their employees through the work they carry out. The Management of Health and Safety at Work Regulations (1999) specifically requires organizations to carry out risk assessments to ensure psychological risks are minimized. Organizations would find it very difficult to avoid this duty especially where traumatic incidents frequently occur in the workplace during the course of an employee's work. However, organizations cannot provide totally risk-free environments, and therefore risk assessments should be carried out to cover:

• The activity or event that may give rise to harm.
• Who is at risk (including who might be at special risk).
• How likely it is that harm will occur.
• What are the realistically potential consequences?
• What are the procedures to control or reduce the risk?

Within an organization, the risk assessment would highlight the roles or locations where employees could be subject to a traumatic incident at work or where they work in a potentially dangerous or aggressive environment. In some instances the nature of the role means there is an increased risk of exposure to a traumatic incident in the course of work. Examples of roles specifically associated with risk of trauma include:

• Military personnel.
• Transportation workers (railways, maritime, aviation, and road).
• Emergency services (ambulance, fire, police, and forensic staff).
• Security service workers.
• Healthcare workers.
• Banking workers who work with customers plus retail employees.
• Offshore oil and gas industry employees.
• Employees working in heavy industry (e.g., chemicals).
• Nuclear workers.
• Postal workers.

However, it is important to recognize that in addition to these roles with higher risks, any worker could be exposed through experiencing physical attack, threat, armed raids, holdups, and/or verbal abuse, as well as even being terrorist victims or witnesses of terrorism.

Once a risk has been identified during the course of an individual's work, the organization needs to look at ways to materially reduce or control the risk (although this is not to say that the organization is specifically responsible for traumas related to acts of terrorism where this is unrelated to their work).

There are various levels in which risk management can be carried out (Rick et al., 1998), which the following steps highlight:

Selection of staff: Are recruits able to cope with the type of work expected and are they aware of the risks in their role (self-selection here is important and “realistic job previews,” where the potential recruits shadow a member of staff for a day or try it out themselves)? Do recruits have the necessary interpersonal skills to cope with situations that might lead to psychological trauma, especially in dealing with customers?

Adequate training of employees: Do employees need training to manage verbal or physical aggression? Ar...

Table des matières

• Cover
• Title Page
• Copyright
• About the Editors
• List of Contributors
• Part A: The Evolution and Development of Workplace Trauma Support
• Part B: The Legal and Business Imperatives to Manage Trauma Effectively
• Part C: New Understandings on Models of Trauma Support
• Part D: The Theory and Practice of Post-trauma Support
• Part E: The Organizational Response to Trauma Support
• Index