Unfortunately, we all come across situations that are difficult to handle and may leave us stressed and confused. Normally we would be able to deal with this with our own coping mechanisms however; sometimes depending on the severity of the event or an accumulation of smaller incidents we may need additional support. This may be by trying to make sense of what has happened or by making sure to know how to do deal with that stress.

CISM is a program designed to piece all of that together by defusing the situation, debriefing the incident and follow up peer support. It is a confidential and voluntary service designed for all staff working at PHU (teams and individuals) following critical or traumatic incidents and is delivered by colleagues who have undergone specific training to be able to support you. 

 What is a critical incident?

A critical incident is a stressful event that has the potential to affect your mental wellbeing negatively and can ultimately cause psychological distress and impair your day-to-day functioning. It may therefore overwhelm your usual coping mechanisms. At work, this may include deaths of a patient or colleague, serious injuries or assaults, fires, hostage situation, sexual assaults or an accumulation of stressful incidents.

What can happen following these critical incidents?

Everyone responds to stressful events differently however, following traumatic events, signs of stress can last for a number of days, weeks, months or potentially longer depending on the severity of the event. Below are some of the most common stress reactions (physical, emotional, behavioural and cognitive) which usually pass quickly but occasionally, professional help may be necessary to work through this.

Signs of stress:

How can we help?

Defusing is a small process that takes place shortly after the traumatic incident and offers the opportunity to explore the immediate reactions to the incident and to provide information on good coping strategies.

Debriefing may take place for groups or individuals in the days or weeks following the incident and is designed as a crisis intervention tool. These sessions will allow you to talk about the incident in greater detail and to make sense of what has happened. It should also allow to bring closure to the incident and help to assist you to get back into your work environment.

Follow up support may be needed for individuals or groups after defusing and debriefing and will include further rest and informational sessions. Further education includes preparing for and managing stress tools as well as coping at work techniques.

If you would like to find out more information about CISM please contact CISM@porthosp.nhs.uk

GUIDANCE FOR STAFF WHEN COLLEAGUES HAVE MENTAL HEALTH DIFFICULTIES AND / OR DISCLOSE SUICIDAL THOUGHTS

There may be occasions at work when a colleague or another staff member says or discloses something that raises your concern for their mental health and wellbeing. There is a variety of support available for both you and the staff member and a process to escalate concerns.

If the staff member shows signs of distress or reports concerns about their mental health, you can assist them by sharing your concerns and gaining their consent to signpost them to relevant support or by escalation. It is important to recognise that you are not a mental health specialist and are not expected to assess the staff member’s mental health but to work with them based on the information provided to seek the appropriate resources or support. 

If you are seriously worried about the colleague’s / staff member’s safety but don’t have their consent to share your concerns, then you can still share the information “in their best interests”. It is important to remember that they are NOT your patient, so you do not have a professional confidentiality agreement with them. However, they are still a staff member, so it is important not to disclose any personal or sensitive information unless unavoidable.

Supporting someone who is experiencing suicidal thoughts or who is struggling with their mental health can be distressing. It is ok for you to ask for help too. You can also contact any of the above support groups including: Occupational Health. Care First. Aquilis. It is important to look after your own mental health and wellbeing.

CRISIS - the individual is clearly distressed and expressing thoughts of self-harm or suicide. They may have made plans and feel hopeless. The individual may be responding to external stimuli that although you cannot see or hear is very real to them.

If you suspect the individual is or could be a danger to others:

Maintain a safe distance from the individual but continue to communicate if safe to do so – de-escalate by remaining calm. Summon help – security or police. Explain it’s a staff member presenting as a risk towards others due to a suspected mental health crisis. The individual may be under the influence of substances – drugs or alcohol.

Try to ensure the safety of other by restricting direct access to the area the individual is occupying.

Remember your own safety is paramount.

MODERATE to SEVERE – the individual is clearly distressed and expressing thoughts of self-harm or suicide. They have no immediate plans and can discuss protective factors (reasons for living).

The individual is chaotic in presentation, some evidence of thought disorder or responding to external stimuli but are orientated to time, place and person and can be distracted enough to hold some level of conversation. Are not an immediate risk to self of others but may be vulnerable from others and in terms of self-care due to presentation / cognition and perception.

They may be concerns about drug or alcohol misuse due to evidence of this.

Has a support network who can assist with their safety.

Requires intervention but not immediate.

MILD – there is a concern regarding a staff member’s mental health but no immediate risk – expressed or perceived towards themselves of others and they are maintaining functioning – cognition, presentation, speech etc. There may be concerns about drug or alcohol misuse.

Occupational Health are open Monday – Friday 08.30 – 16.30. Contact occupational health for further advice.