Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Dangerous Behaviour: Open Programme Workshop, London, 25.04.15

Due to the cutbacks it has become near impossible for individual applicants to attend the “Difficult, Disturbing & Dangerous Behaviour” workshop which is now almost exclusively an “in-house” bespoke programme. None-the-less, Mosaic Training are hosting an open course in London on 25th April. As this may be the only opportunity this year and you are interested, you should act quickly. The workshop costs only £89.95 and details can be found here

Filed under: Impact Training, Other Mental Health, psychosis, self-harm, Suicide, trauma, Violence, , , , , , ,

Facing Danger in the Helping Professions

Just received a copy and I have to say it’s a great read! Get a copy – available via Amazon or through the Open University Press – recommend it to friends and review it on Amazon.

Filed under: Impact Training, Other Mental Health, psychosis, trauma, Violence, , , , , , , ,

PTSD and the Amygdala’s Fear Regulating Function

An interesting piece of research throwing further light on the role of the Amygdala and it’s fear regulating function. Interestingly the authors suggest that the size of the amygdala may predict vulnerability to PTSD>

PTSD linked to smaller brain area regulating fear response.

Filed under: trauma

Young People who Die in Custody

An important report from the Prison Reform Trust:

http://www.prisonreformtrust.org.uk/Portals/0/Documents/Fatally%20Flawed.pdf

Filed under: Impact Training, Other Mental Health, self-harm, Suicide, trauma, Violence, , , , , ,

Facing Danger in the Helping Professions

We now have an estimated publication date of 8th April 2013.

Pre-orders can be placed with OUP at http://www.mcgraw-hill.co.uk/html/0335245838.html or Amazon at http://www.amazon.co.uk/Facing-Danger-Helping-Professions-approach/dp/0335245838/ref=sr_1_1?ie=UTF8&qid=1350583250&sr=8-1

Further information about the book can be found at www.facingdanger.com

Filed under: Impact Training, Other Mental Health, psychosis, self-harm, Suicide, trauma, Violence, , , , , , ,

NHS Trust Guilty Following Fatal Stabbing of Care Worker

Care staff are having to work with increasingly challenging service users, often inappropriately placed, without adequate training or supervision. Another tragic death …
Central Bedfordshire Council

20 July: Sentencing of former Dunstable care home owner and county NHS Trust
A county NHS Trust and the owner of a former Dunstable care home have been sentenced after being found guilty of safety failings following the fatal stabbing of a care worker at a private residential care home in Dunstable.

Kathleen Bainbridge, 58, from Luton was killed at Abacus House, on Princes Street, on 24 August 2007 by resident Stephen Flatt, then aged 55, who attacked her with a knife from a kitchen. Fellow care worker Barbara Hill, from Dunstable, was also attacked when she went to help her colleague.

A joint investigation by the Health and Safety Executive (HSE) and Central Bedfordshire Council found that Abacus House was not the correct care facility for Mr Flatt, who had been placed there by the Hertfordshire Partnership NHS Foundation Trust.

A trial at Luton Crown Court heard he had been diagnosed with bipolar disorder and that Abacus House staff had no expertise or training for dealing with people with this disorder, or for managing violent or aggressive behaviour.

Hertfordshire Partnership NHS Foundation Trust was yesterday (19 July) fined £150,000 and ordered to pay costs of £326,346 for breaching Section 3(1) of the Health and Safety at Work etc. Act 1974 for its failings in relation to the fatal incident after being prosecuted by HSE.

The council brought proceedings at the same time against the owner of Abacus House, Chelvanayagam Menna, who was fined £75,000 and ordered to pay costs of £338,996 after being found guilty of breaching Sections 2(1) and 3(1) of the same Act.

After the sentencing HSE Inspector Karl Howes said: “This was a tragic incident that left a family without a wife, mother and grandmother. No-one expects to go to work and never return home.

“Care homes have a duty not only to protect the safety of their residents but their staff as well. The NHS Trust failed to adequately assess the risks that were posed to staff and other residents from placing Mr Flatt in Abacus House.

“I hope this will make all NHS Trusts and care facilities carefully consider the procedures that they have in place during patient placement.”

Councillor Budge Wells, Deputy Executive Member for Sustainable Communities, Services at Central Bedfordshire Council said: “The legal process has been long and difficult, particularly for Mrs Bainbridge’s family but also for her former colleagues – especially Mrs Hill.

“Of course the trial of Stephen Flatt had to take initial priority and once this was concluded the police instigated a further investigation of the Trust and care home owner. However the Council and HSE cooperated closely on their investigation from the outset and were in a position to progress with proceedings as soon as the police cleared the way.

“All concerned in the case hope that the right lessons are learned from this tragedy and that nothing of a similar nature occurs in future.”

Filed under: Impact Training, Other Mental Health, psychosis, trauma, Violence, , , , , , ,

Open Courses “Trauma: Post-incident Staff Support”

The Post-incident Staff Support course is now available to individual applicants through SITRA:

    SITRA – Post-incident Staff Support

Trauma: post incident support staff

24 May 2012, Southampton

14 November 2012, Southampton

Suitable for all managers and supervisors who have responsibility for supporting staff after an incident at work e.g. an assault, a suicide, an allegation.

By the end of the course participants should:

• Have a good understanding of the psychological and emotional needs of staff following an incident at work

• How to prepare themselves in anticipation of an untoward incident at work

• Be clear as their own role in the immediate aftermath of incident

Trainer: Dr Iain Bourne

Price: member £89/ non-members £129

Book now

Filed under: Impact Training, trauma, , , , , ,

Open Courses “Trauma”

The “Trauma” course is now available to individual applicants through SITRA:

SITRA – Trauma

Trauma: frontline staff

16 April 2012, Southampton

23 October 2012, Southampton

For anyone who wishes to gain a clearer overview of psychological trauma, whether it is the result of a recent overwhelming event, or the effect of prolonged childhood trauma.

By the end of the course participants will:

• Understand the difference between Type 1 traumas (recent overwhelming events) and Type 2 traumas (prolonged/repeated childhood abuse)

• Understand how both types of trauma lead to different outcomes and support needs in adult life

• Be aware of the range of strategies available to assist service users, both immediately and in the long-term

Trainer: Dr Iain Bourne

Price: member £89/ non-member £129

Book now

Filed under: Impact Training, trauma, , , , ,

New PTSD program answers need for comprehensive treatment

July 02, 2009

Jul 02, 2009 (DEFENSE DEPARTMENT DOCUMENTS AND PUBLICATIONS/ContentWorks via COMTEX) — 7/1/2009 – LANDSTUHL REGIONAL MEDICAL CENTER, Germany (AFNS) — Symptoms of combat stress and post-traumatic stress disorder for wounded warriors include continual nightmares, avoidance behaviors, denial, grief, anger and fear.

Some servicemembers battling these and other symptoms, can be treated successfully as an outpatient while assuming their normal duties, but for others; however, returning to work and becoming their old selves again were challenges recognized by several mental health professionals across the European theater.

“We were looking at how we can best meet the needs of our clientele, and we were identifying that a lot of the Soldiers needed more than once a week outpatient, individual therapy and probably needed more than once or twice a week group therapy,” said Joseph Pehm, the chief of Medical Social Work at Landstuhl Regional Medical Center.

The solution came in the creation of an intensive eight-week therapeutic Post-Traumatic Stress Disorder Day Treatment Program called “evolution” that began in March 2009 at LRMC. During the eight-hour days, patients enrolled in the program participate in multiple disciplines and interests, including art therapy, yoga and meditation classes, substance abuse groups, anger and grief management, tobacco cessation, pain management and multiple PTSD evidence-based practice protocols.

“I am a great believer in the kitchen sink, meaning I throw everything, including the kitchen sink, and something will stick,” said Dr. Daphne Brown, chief of the Division of Behavioral Health at LRMC. “And so we’ve come with all the evidence-based treatment for PTSD that we know about. We’ve taken everything that we can think of that will be of use in redirecting symptoms for these folks and put it into an eight-week program.”

Doctor Brown, Mr. Pehm and Sharon Stewart, a Red Cross volunteer who holds a Ph.D. in psychology, said the program is designed from research into the effects of traumatic experience and mirrors successful PTSD programs at Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as programs run by psychologists in the U.S.

“We are building on the groundbreaking work that some of our peers and colleagues have done and just expanding it out,” Doctor Brown said.

During treatment, patients begin the day with a community meeting where they discuss how well they feel and any additional issues or concerns since their last meeting. The remainder of the day depends on the curriculum scheduled for that week.

The first few weeks focus on learning basic coping skills such as how to reduce anxiety and fight fear, as well as yoga and meditation for relaxation. Eye Movement Desensitization and Reprocessing, an evidence-based practice for treating PTSD, is also conducted during the early phases of the treatment program.

“The concept behind EMDR is that, essentially, memories become fixed in one part of our brain and they maintain their power and control over our emotions as long as they are fixed there,” Doctor Brown said. “And if we can activate a different part of the brain while we’re experiencing that memory, we can help to remove some of that emotional valence from it. So we use physiological maneuvers to activate both sides of the brain.”

The goal at the beginning of the PTSD program is to provide patients with a number of tools they can use to help them calm down when feeling overwhelmed, especially before more intense therapy begins in the latter weeks. Cognitive processing therapy is used throughout the program. EMDR and prolonged exposure therapy are also available on an individual basis at the Soldier’s request. All three techniques are research-based treatments.

When life-changing events occur, Doctor Brown said perceptions about the world may change. For example, before Soldiers experience combat trauma they may think the world is safe. Following combat, a Soldier’s perceptions may change; a majority of the world may now seem unsafe. Cognitive processing therapy attempts to readdress experiences and reshift a Soldier’s perceptions.

Prolonged exposure therapy is behaviorally based and addresses a Soldier’s fears, which are seen as reflex reactions to a stimulus. To decondition the reactions, a patient is continually exposed to the stimulus by retelling the story repeatedly, minus the negative outcome. Doctor Brown compared it to riding a roller coaster over and over again to overcome a fear of roller coasters.

“So they’re getting EMDR, they’re getting cognitive processing therapy, they’re getting individual therapy, they’re getting group therapy, they’re getting education, anger management, self-esteem, relationship issues, grief and loss, yoga, meditation exercise, skill building — a little bit of everything across the board,” Doctor Brown said. “Not everything’s going to resonate with everyone who comes through, but something’s going to resonate for everyone who comes through.”

In addition to the overall core curriculum, Doctor Brown and her staff have programs such as pain management, relationship enrichment and tobacco cessation to help individualize treatment.

“The core of the group and individual education is consistent for everyone,” Doctor Brown said. “But we recognize that every patient is different, and we have to tailor make it to give an individualized treatment plan. We don’t keep people in pain management if they’re not in pain. We don’t give them tobacco cessation if they’re not smoking. So we do try and tailor as much of it as we can.”

Spirituality, relationship enrichment and gender-specific issues are also areas of focus.

“The program is holistic,” Mr. Pehm said. “It looks at people from different spheres, not just the medical model because everything is impacted when someone has combat stress or PTSD; not just the individual Soldier, but everybody who comes in contact with them.”

The intensity, length and “kitchen sink” qualities are not the only aspects that make this program unique, Doctor Brown said. It is a joint military and civilian effort accomplished entirely by volunteers. The staff is as diverse as the therapy options, and includes chaplains, social workers, Red Cross volunteers, psychiatrists, a nurse practitioner, enlisted psychiatric technicians, and graduate students. Brown said having a sundry of personnel keeps the program fresh and the staff excited.

“The patients get perspectives from people from a number of different backgrounds,” Doctor Brown said.

Thus far, the staff outnumbers the program’s participants.

“By design we started out small, and we were able to establish a really good working relationship with the local Warrior Transition Unit people … It’s been a wonderful working relationship with them,” Mr. Pehm said.

Evolution is currently on it second eight-week course, with five patients enrolled. The first class had four. The goal is to keep the class size small in order to benefit from the program’s intensity. Thinking small also helps keep the impact large by successfully returning Soldiers to their units, while also expanding access outside the WTUs. However, Mr. Pehm said they would like to expand the program to include patients from throughout the European Command.

“Ideally, we’d like to max it at about 10 because it is so intensive,” Doctor Brown said. “These are folks we hope to remediate and return to the Army to be functional members again. Also, if they go back to their communities and their providers or spouses see the changes that have come about, that will increase the willingness or desire of more people to be here.”

Though few have completed this young program, signs of success have already started to surface.

“With the last group, the shift from ‘I have to be here’ to ‘I’m so glad I came’ was really phenomenal,” Mr. Pehm said.

“One of them said that he didn’t think he was getting anything out of the program,” Doctor Brown said. “It was about week six until he saw himself react differently to a situation that came up, and watched himself do it differently using skills that he didn’t know he learned. He went, ‘Wow, maybe I am getting something out of this.'”

It is too early, and the numbers are too small, to generalize the early trends, but self-completed PTSD checklists showed a significant decrease in reported symptoms for three of the four patients in the first cohort. Additionally, anxiety and depression symptom measures decreased.

“The whole idea is that we know all the changes aren’t going to take place here,” Doctor Brown said. “But we hope we give them enough learning to send them in a different direction. My hope is that we can build a program to provide valid, effective treatment to folks who have put themselves in harm’s way at the request of their country, and help them live happier and better lives.”

Filed under: Other Mental Health, trauma, , , ,

Professor helps train mental-health workers in Iraq

July 04, 2009

Victims of traumatic events sometimes get so hung up thinking about what happened to them that they can’t let go of their torment.

Rigid, “black-and-white kinds of thoughts” play over and over in their minds and keep them from moving forward in life, says University of Richmond researcher Kristen P. Lindgren.

“Those kinds of thoughts can keep people stuck in their lives,” she said.

A licensed clinical psychologist, Lindgren has studied a technique called cognitive processing therapy that helps people escape those thoughts.

She worked at the Department of Veterans Affairs hospital in Seattle with veterans of wars from Vietnam to Iraq. They suffer from post-traumatic stress disorder and depression, and Lindgren says the therapy was so helpful that the VA plans to use it as a treatment model nationally.

And now, it might also help victims of torture in Iraq.

Lindgren, an assistant professor of psychology at UR for the past year, recently spent eight intensive days training mental-health workers in the Kurdish region of Iraq.

Their goal is to help victims of the violence waged against the people of Kurdistan during the 1980s and 1990s.

It was the most attentive class she has ever had, Lindgren said. The workers, primarily physician assistants at community clinics who have limited opportunities for advanced training, were eager to learn new techniques.

“I’ve never had a group of students who were so focused and literally writing down every word,” she said.

Lindgren describes herself as “very much the junior partner” on the pilot project organized by Johns Hopkins University. The team included Johns Hopkins researchers Paul Bolton and Judith K. Bass, as well as Debra Kaysen, Lindgren’s mentor when she did postdoctoral studies at the University of Washington.

Lindgren hopes that if the mental-health workers find that the technique helps their patients, she can return to Iraq within the year to expand the training.

The therapy technique encourages people to identify thoughts that are stuck in their minds and to challenge that way of thinking, she said.

The patients learn to come up with thoughts that are more flexible but believable.

“It’s not about thinking with rosecolored glasses,” she said.

Lindgren is optimistic the treatment will help the Kurds. In Iraq, the technique had to be adapted to account for cultural differences. Self-esteem, for example, didn’t translate very well. “The closest we could get was respect,” Lindgren said.

They also had to account for illiteracy because the technique involves written homework for patients.

If the therapy with those adaptations proves successful in Iraq, that should help answer lingering questions about its worth back home, she said. Because the technique is research-based and developed in university settings, some still question how well the therapy works in the real world, she said.

“If this is not the real world, I don’t know what is in terms of getting outside the ivory tower.”

——

Contact Karin Kapsidelis at (804) 649-6119 or kkapsidelis@timesdispatch.com. To see more of the Richmond Times-Dispatch, or to subscribe to the newspaper, go to http://www.timesdispatch.com. Copyright (c) 2009, Richmond Times-Dispatch, Va. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

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