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Friday, 18 June 2010

Guidelines for mental health professionals interviewing veterans with PTSD ...

You could probably alter that title to 'Guidelines for mental health professionals interviewing anyone with PTSD'; some of the guidelines are probably relevant to people with other disorders.

1.  Layout of the room 

Ensure that the seating is arranged so that the person you're interviewing isn't sat with their back to the door or a window.  Let them pick where they want to sit.  Your seating should be arranged so that neither of you are made to feel vulnerable and that you can both exit the room promptly and safely should the interview become uncomfortable, or in the worst case scenario, should either of you feel you are at risk of physical attack.  Think about what you can do to facilitate this change the next time you walk into the interview room.


2.  Preperation

If someone has provided you with reports from other mental health practitioners because they have just moved areas, do the person the courtesy of reading them before the interview.


3.  During the interview

Mental health problems related to PTSD tend to be about a single or multiple traumatic experiences, don't do anything to trigger a reaction.  You're a professional, act like one.  Make sure you are facing the person that you are talking with.  Make sure that they know that you have their attention.  Do not sit sideways on to them, ignoring them while shuffling through their reports, having asked them a question.  A person without a mental health problem would probably find your manner rude and insulting.  Imagine how a person with PTSD is likely to act?

Do not expect an intelligent person that has been getting treatment for a number of years for PTSD to sit there and open up all their scars for you in a 40 minute interview.  They know the system, but more importantly, they know themselves and will not open up to you in that format of interview.  It takes time and patience for a professional interviewer to be successful.  You have to build a bridge and earn that person's confidence and trust.  If you're not prepared to do this, you have failed in your role as a mental health professional.  Try instead to discuss the symptoms that they are experiencing and be gentle with the person you're interviewing; after all, you're there to provide 'care and support'.


4. The last stage of the interview

Make sure you allow sufficient time for the person to be able to walk out of the interview room in a calm a state as possible.  Remember that you have been probing scars during the interview that, for veterans, could result in a reaction of higher levels of stress and possible physical violence, depending on the severity of the condition and the sufferers 'individual' experience.  Don't prime an emotional bomb with inappropriate behaviour as an interviewer and then send it out onto the street.  If something bad happpens as a result of your inappropriate behaviour as a mental health professional during an appointment with a patient, you are partly responsible for whatever it is and should be either formally disciplined and or/re-trained, or if you are unwilling to be re-trained - your services should be dispensed with.


5. Mental Health Professionals' attitudes towards PTSD

Some practitioners, mainly psychiatrists, from the many people that I've discussed matters with over the years as a PTSD sufferer, believe that PTSD doesn't exist and that it is therefore not a recognised mental health condition.

If you, as a mental health professional, fit that bracket - it's time to find another profession.  It takes a lot for a veteran to open up about PTSD contracted as a result of their duties.  We were conditioned to cope and carry on doing our various jobs.  To lock our emotions down and to face dangerous circumstances without thought for our own safety.  It took me 12 years to be able to start to open up about my experiences.  If a veteran comes up to you and opens up, show a little respect and understanding and don't write a dismissive report saying that they're fine when you have quite a few reports consitently diagnosing their condition.


6.  Policies for continuation of care for people moving from different regions to yours

This paragraph is for chief executives, managers and other departmental policy makers.  You don't need to make a fresh start on cases where a person has been getting support for PTSD where it's well documented in their file, especially where mental health professionals, as well GPs have written a report underlining the situation specifically to ensure the continuation of care.  Taking this step causes great difficulty and you risk alienating the patient. Stop using the policy of 'fresh starts'.  It's nothing more than a way to present a barrier against receiving care from the NHS in order to help your budgetary matters.

I strongly recomend that where a person has moved areas and has well documented reports confirming the diagnosis of PTSD that you undertake your duty of care as soon as possible.  Please remember that in the case of veterans that have war pensions for their disability, they are to be treated as a priority patient under the guidelines and arrangements between the NHS and the Veterans Agency.

In my experience,  not one mental health professional was aware of this long standing agreement.  You need to raise awareness of this policy.


Thanks for taking the time to read this, especially if you work with people that suffer with PTSD.

If you suffer with PTSD, please feel free to add your own comments and observations.

Wolf

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