Republic of Ireland: Opening Minds to CISM

Article excerpt

The concept of workplace trauma emerged slowly within the Irish organizational consciousness in the early 1990s. Its arrival coincided with Jeffrey Mitchell's writings on critical incident debriefings and a vague but growing awareness in the minds of human resources personnel of an organization's "duty of care."

As a concept, critical incident stress management was grasped most guardedly Management feared it would serve as an acknowledgement of any risk to health and might legitimize needless absence from work. There was also a profound fear of "wrong footing" the +organization in any litigation process. Suggesting comprehensive CISM programs was generally considered premature and largely unwelcome.

Some organizations, however, were less cautious due to their greater exposure to critical events and their need to formulate an appropriate protocol. These businesses included banks (which experienced frequent robberies) and airlines, whose clinicians (including myself) were exposed to the North American practice of critical incident care from the outset. These businesses laid the groundwork for a slow and steady increase in the demand and supply of CISM in Ireland. As more clinicians working in the public and private sectors received training in critical incident debriefings, so, too, the expectation of post-incident care rose in the minds of staff and employers.

Not everyone was convinced. The subjective and anecdotal experience surrounding debriefings prompted clinicians to value them highly, but the research literature presented an inconsistent picture of efficacy or positive outcome. There was no evidence to show that debriefings positively affected posttraumatic stress disorder scores; some indicated that in fact PTSD scores may be higher after a debriefing. A few researchers wrote of emotional overload and re-traumatization (Dunning 1995; Schnyder 1997). This research controversy stalled CISM's use until the Cochrane report of 2002 allayed many of the fears and, for the first time, confirmed some of the values of debriefing.

Now, in 2006, well-established critical incident management programs can be found in security firms, hospitals, the prison service, the fire service, health boards, and other Irish businesses and industries where there is frequent exposure to critical events. These programs vary but generally combine the components of CISM as outlined by Mitchell.

Where no programs are in place, identification of the need for CISM in ad hoc instances and after one-time events depends on the awareness and training of in-house staff. Within management, the departments most alert to the need for CISM are health and safety personnel and human resources staff. …