26. Trauma and Mental Health
A Significant Issue?
26.1. It has become clear to me that mental health should be a major management issue for the NHS and NHSH in particular. I am not an expert in trauma but I have spoken to people who are. I am persuaded that a significant number of people employed in NHSH have suffered and some continue to suffer from significant mental health issues as a result of their experiences, many of which can be described as traumatic given their repetitive and intrusive nature in disruptive and damaging situations. Trauma appears to be a more common experience than might be thought. I am told that some employees have the symptoms of Post Traumatic Stress Disorder (PTSD). It is important to have the ability to diagnose and deal with PTSD appropriately.
26.2. As one former employee told me:
"A person with developing mental health illness is not well enough or confident to stand up for themselves...The long-term effects - like PTSD - should not be underestimated and has daily impact e.g. dealing with emails, phone, challenging conversations, sleep patterns. There was no neutral counsellor/ advocate to speak to early enough until the unions made themselves involved after nearly a year off sick. Discussion with colleagues only reinforced negative issues, and there was nowhere to take issues."
26.3. One well informed member of staff advised me that, in his view:
"NHS Highland does not take PTSD seriously, as they would an overtly physical illness. They should ask why a person has developed this condition and act to mitigate distress. This applies even to Occupational Health, at senior staff level."
26.4. He expressed concern that:
"When these people go to interview with a manager who will put them back to work in proximity to where they were abused, they won't be able to think and will be drawn back into the trauma memories. They will experience dissociation from the here and now, and will relive (for example) being trapped, with someone looming over them and shouting with an angry face. They may be silent, but that does not indicate acceptance. They are not participating. They won't remember what is said. They are unable to represent themselves."
26.5. I am told there is thus an issue about by whom and how they are looked after. This requires a different approach to the standard investigation and advocacy in say a grievance setting.
26.6. Another well informed employee told me:
"The legacy effects of working in an emotionally unsafe system, and the culpability that can come from an uncomfortable awareness of having been involved and complicit in something inherently wrong, but where there was no voice, can be traumatic in itself. There will be advantages, if not a need, for people most affected, to have time and space make sense of, heal and recover even as the organisation moves ahead. If there were a way to achieve this, we might take the learning and wisdom into the future."
26.7. More generally, this is a leadership issue. Trauma-informed organisations recognise that trauma is widespread in the lives of individuals, families and communities and that trauma can be perpetuated in organisational culture and practice. This may well be the situation for some of those affected in NHSH.
26.8. I note that the Scottish Government commissioned NHS Education for Scotland to develop a framework for Transforming Psychological Trauma. In that regard, I also note that:
"When an individual or a team struggles or cannot evidence insight and perspective on the impact of their distress or behaviour that can be traumatising to others, the wider system needs to step in and up. Senior leaders need to be able to actively visibly demonstrate competencies and teams around them have a duty to the wider organisation where a leader is known to be struggling."
26.9. I am told that the business process means that all administrative staff have access to mental health records and that this breaches confidentiality. There can be conflicts of interest for staff working in occupational health who are handling records and cases from departments where they have relatives.