Tegan Taylor: And another piece of news this week, Norman, a tragic bus crash in the Hunter Valley last week, ten people died, many are still in hospital. And when people are struggling to make sense of something so awful, we often reach for advice that feels right. But it might not actually be backed up by evidence.
Norman Swan: What we’re talking about here is the psychological trauma of such terrible incidents. And last week we had experts going on air advising people in the Singleton area and first responders that the most important thing they could do is talk about their experience and talk about their issues. In fact, that’s not what many years of evidence actually suggests. We’ve covered it many times on the Health Report. And in fact, in some cases, it could make things worse. Liz Scott is Associate Professor of Psychiatry at the University of Sydney. Welcome back to the Health Report, Liz.
Liz Scott: Good afternoon.
Norman Swan: Now, Liz, both the World Health Organisation and the US Department of Veteran Affairs have both reviewed the evidence and not been at all positive of talking therapy in the acute stages of trauma.
Liz Scott: That’s correct, Norman. And, as you say, there is a lot of evidence about that, which indicates that although we think that we’re trying to be helpful in terms of saying, well, people should talk about it and that will help to reduce some of the kind of mental health consequences down the track, the evidence is actually not there.
What the studies have suggested is not only is stress debriefing at the time or in the aftermath of these disasters not helpful but it might actually be harmful, which has led the WHO to say that psychological debriefing is not an appropriate mental health intervention in these circumstances.
Norman Swan: And what about critical incident debriefing, which is what first responders tend to get?
Liz Scott: First responders, by their nature of what they do are obviously much more at risk of some of the adverse mental health effects of being exposed to an event like this or of a series of events over time. So there certainly is evidence that providing organisational support is really important, allowing people to come together with their colleagues as part of a team. We know that resilience comes from the kind of group of being together, making sure that people have good education about what they’re likely to expect.
But again, expecting this idea that everybody should have this debriefing at the time or close to the time of the event has, again, been shown to be not helpful or potentially harmful, it doesn’t reduce the risk of outcomes like depression, anxiety, PTSD, substance abuse down the track. And it might actually, by increasing people’s physiological arousal and their memories and continuing the link between the memories and the physiological effects of that might actually cause them to be more vulnerable to those things down the track.
Norman Swan: So one of the problems last week is that people were being told that they should talk about it. So there’s two ways of talking. One is you can talk to a psychologist or you could talk to your family. But also, there’s this idea that bottling things in is bad for you. Is there any evidence for that?
Liz Scott: So I think the evidence is that people respond to these things differently. There’s a lot of individual variability. Some people are in a state of kind of shock or disbelief or denial, other people are much keener to kind of talk about it and express themselves. Other people just want to be hugged. But the majority of evidence is, whatever you do, it is better to do that within a context of your family, your community, people that you know, that you trust, that you love, and that having other people come in externally who you don’t know or you don’t trust is not necessarily the best way for people to be able to adapt to what has happened.
Norman Swan: So if you want to talk about it, feel free. And indeed, if you want to get professional help, feel free, but don’t feel that you have to do it.
Liz Scott: That’s right, this idea that everybody should do it, that it’s mandatory, actually will probably make some people feel worse, that they are being forced to do something that actually is not how they as an individual are better able to cope in the situation, and might also make some people feel that they’re doing the wrong thing, that there’s something wrong with them that they don’t want to talk about it. Not wanting to talk about it in these situations, if that’s how you cope as an individual, is a perfectly reasonable response and an adaptation to the events that have occurred. Down the track people may change their mind and need more support, but we need to respect that people are different and will respond differently.
Norman Swan: I remember an interview I did for the Health Report many years ago after the tsunami and talking to a Professor of Psychiatry in Tamil Nadu, who spent his time trying to prevent the Indian government sending in psychological debriefers, which is what they wanted to do. Because he was saying, look, we’ve gone into Tamil Nadu coastline, and what people want are plumbers and electricians and carpenters to help rebuild their houses, not a psychologist to ask them how they’re feeling.
Liz Scott: That is exactly right. I have a similar kind of aversion to people turning up in high-viz vests, you know, with ‘mental health’ on the back, as this sense that that is actually an intervention that’s going to be helpful for people, when people actually really need to be with each other. The idea about being together as a community and community cohesion is much harder if people come in externally, offering help that people don’t necessarily want or need at the time.
Norman Swan: Save it up for later when real symptoms may emerge.
Liz Scott: That’s right, exactly.
Norman Swan: Liz, thanks very much for joining us.
Liz Scott: Thank you for asking me.
Norman Swan: Liz Scott is Associate Professor of Psychiatry at the University of Sydney.