Trauma and suicide – a workplace issue?
100 years ago, the greatest cause of death for young men, was war. Now it is suicide.
According to the latest data from ONS (which is considered to be under reported by at least 50%) 5,965 suicides were registered in the UK in 2016 and a person dies by suicide every 107 minutes.
Today at the health and wellbeing conference I have been attending sessions about suicide and trauma because lots of our clients are looking at best approaches, not only for prevention, but also for dealing with the aftermath of an incident which can have terribly detrimental effects on the workforce.
I was aware that there were certain workplaces which were going to be at higher risk of encountering trauma, but what I hadn’t quite appreciated was its prevalence and the level of risk in certain industries.
Recent suicide statistics
Martin Coyd, Head of Health and Safety for Mace, looked at suicide in construction and specifically at the statistics which emerged last year which showed that, unlike the Australian statistic which many of us had been familiar with (that you were 6 times more likely to die by suicide than from working at height), in the UK in 2016 you were 15 times more likely to die by your own hand than by an accident at work. There were in fact 30 workplace deaths in construction as opposed to 454 suicides.
Nor is it by any mean about only young men. The statistics peak at age 40-44 and Martin lays the blame squarely at the door of modern living – with the purpose and role of men a big part of the issue.
Suicide risk factors
Martin raises an interesting point here. A US study on suicide in construction stated “Historically, no one has really cared about men in the middle years. They’re considered kind of a privileged population, and they have everything going for them,” (Sally Spencer-Thomas, CEO and co-founder of the suicide prevention-focused Carson J. Spencer Foundation,). Obviously the reasons for the high rates among men in construction are multi factorial (use of alcohol, shift working, migratory workforce, money uncertainty) but you can’t help but intuitively agree that this may be at least part of the problem.
The issue of male suicide was addressed later by Andrew Kinder, head of mental health services for Optima health – the author of a recent book co-authored by Sir Cary Cooper (The Crisis Book: Overcoming and surviving work-life challenges). He identified the following about suicide rates
- Men choose more violent methods than women
- Rates peak in spring
- Rates higher in unemployed than employed people – debt is a significant factor
- Cancer and a range of other physical health conditions increases risk
- Rates among women are rising and are at their highest for 10 years
He also identified generally increased risks for
- Physical and sexual abuse through childhood
- Population wide events such as natural disasters
- Lifetime aggression
- Celebrity death – rates rose by 17% following death of Diana princess of wales
- War decreases suicide risk
Both he and Dr Steven Boorman CBE spoke of the personal impact of having counselled someone who had taken their own life or discovering the person having done so. Steven had not only worked in A and E, dealing with some horrific incidents, but also for Royal Mail. And he spoke movingly of the impact on him and others in the workforce of discovering a young apprentice who had only been with the organisation a few weeks, hanging in the middle of the office.
Boorman pointed to how out of his depth he had felt at the time, in the 1990s, with no processes available to help, and people looking to him as the one with medical knowledge, to come in and wave a magic wand to make it all better.
Aftermath of suicide at work
The improvement in resources and knowledge was a theme throughout these presentations pointing at considerably more nuanced processes in dealing with the aftermath of trauma.
Andrew Kinder recommended in the aftermath of a workplace suicide:
- Onsite trauma support
- Reassurance to managers
- Practical steps (memorial book, one minute silence attendance and funeral liaison with family, )
- Follow up to office
- Counselling support via counselling service or EAP
Boorman also indicated that there was far more available in terms of an excellent range of free resources and an alignment about what good looks like from a workplace management perspective.
Railway suicides and impact on train drivers
The railways provided further food for thought in an area where huge progress has been made over the last few years in dealing with the aftermath of suicide and trauma with Tanya Stacy head of Occupational Health for East Midland trains looking specifically at the number of suicides on the railways and the impact on drivers. Dr Richard Peters from Network Rail the potential for post traumatic stress disorder among survivors and witnesses of workplace accidents and fatalities.
For East Midland trains, until recently, there had been a one size fits all approach involving automatic leave for 2 weeks on full pay (resulting in the employee being at home alone, with no need to approach a doctor or talk to their manager). This approach had resulted in an average of 66 days sick leave per traumatic event.
Processes now focus on ensuring that there is preparation in place, on training managers to have conversations, and on an understanding that every individual is different, and that there is no one size fits all approach:-
“IF THERE IS ONE THING I WOULD LIKE TO SAY ABOUT DEALING WITH A TRAUMA IS DO WHAT IS RIGHT FOR YOU” – Paul Trigwell – Journey to Recovery
Given that every 31 hours someone in the UK throws themselves under a train, East Midland made witnessing suicide an occupational hazard and therefore looked at the hierarchy of risk. Where could they support designing it out for example? Even though Network Rail have been taking steps to make it harder to use common suicide spots, people just use places which are more remote – there are even websites where people share the best points.
As part of their review they identified good practice in other rail companies. The French railway companies appeared to be particularly proactive with average lost days of 4 so they had a look at what had impacted there.
The programme East Midlands devised included
- Setting up a driver buddy system
- Training new starters on what to expect. Expectation management was found to be key, also looking at explaining to people in recruitment the kinds of situations they might encounter
- Giving staff trauma support packs containing a variety of information, in writing in a pack which they can refer to when they are at the point of needing that. This included information on the journey to recovery and getting back on track, how they might expect to feel, information on attending a coroner’s court for example
- Created a suicide prevention group
- Brought in trauma support training from the Samaritans
Guidance for managers
The approach looked at ensuring that people were well looked after by the organisation in a way which worked for them and included the watchful waiting recommended by the NHS for the following year. It educated managers on having conversations – signposting facts such as just because someone handled trauma fine the first time around, it may not be the case for second or subsequent episodes. That dealing with trauma is an incredibly individual process. The results of their work include bringing average days lost down to 13.5, but there were clear benefits for motivation and engagement outside of this.
With responsibility for the health, safety and wellbeing of 39,000 people Network Rail created an internal standard dealing with those who witness or are part of traumatic events. Dr Richard Peters, CMO for Network Rail discussed the prevalence of PTSD and difficulties in diagnosis.
- PTSD is severe and disabling.
- It can contain symptoms such as re-experiencing the condition, avoidance and numbing and hyper arousal.
- There is effective treatment available but people delay seeking help and further complications emerge from the fact that it may take years for a case to present and may not be triggered until there is a further traumatic event.
Network Rail’s standard
At Network Rail there was no consistent process for managing traumatic incidents, no tool to identify people suffering from trauma and no pragmatic process until the arrival of the standard (which is available to buy from their website).
The standard comprises an effective and consistent process to be applied by managers and responsible persons following traumatic incidents in the workplace aimed at supporting the pro-active management of the risks of psychological and physical injury following traumatic incident and improving the health wellbeing and resilience of staff.
The standard involves identifying the employees at risk after a traumatic event, effective support for them, referral to support services as required and control measures to reduce the risk of development of a mental health condition.
It involves such practical measures as ensuring the responsible person on site identifies who has been involved or may have witnessed the event, making sure they are accompanied on their way home or back to the depot, making sure, if they wish to stay at work that they are safe to be working and are accompanied. It also involves informal conversations with the line manager between 24-96 hours after the event, talks about lifestyle and resilience, recognition that the event was traumatic, signposting symptoms to look out for and also what other support is available from the organisation.
The standard combines NICE guidelines with TRIM and uses a combination of watchful waiting and support from the manager involving a staged approach to conversations over the weeks and months to come including looking out for changes in behaviour and worsening mental health symptoms. It also involves the completion of a trauma questionnaire the results of which are shared with the employee and from which recommendations for next steps will be taken.
Network Rail are looking at how best to ensure the standard is well communicated internally and whether it can be extended to the families of victims – as not everyone wants to talk to a trained therapist and may prefer to work within their current support system.
Across the presentations, there was an acknowledgement that dealing with a largely male workforce involved additional considerations such as a macho culture and the use of dark humour. It was necessary to think about language and how a message is communicated – using sporting heroes can be very effective for example.
In conclusion, for certain workforces it is becoming increasingly advisable, not only to train people in how to have a conversation with someone who may be thinking of taking their own life, but also to consider a protocol for dealing with the follow up to trauma and suicide. However, given that suicide may touch any work place at any time and the impact is huge – from copycat suicides, to anger among the workforce, to general demotivation and distress, any work place may be advised to consider both.
- Train managers to have a conversation to identify someone at high risk of suicide (even if this is certainly not always either straightforward or possible – better to at least ask the questions)
- Train managers to understand that trauma may develop from a number of different situations and triggers and that there are signs and symptoms they can look out for.
- Provide resources and training for people in jobs where there are likely to be traumatic events to understand what might occur so that they are prepared.
- There is no one size fits all approach to dealing with trauma – so blanket rulings on a certain amount of time off, for example, may not be helpful but a series of interventions and access to secondary care may work better.