Mental traumatization caused by violent events in the workplace How the BGHW can help Kerstin Wenske, BGHW Vancouver, October 16, 2018
What is a ‘ Berufsgenossenschaft ’ (or ‘BG’, for short)? As a statutory accident insurer, it is one pillar of the German statutory social security system. There are nine such accident insurers in Germany that are competent for the various branches of industry. They indemnify employers in the event of occupational accidents or occupational diseases. They are contact partners for preventing occupational accidents and diseases. They insure all their gainfully employed. Contributions are paid solely by employers. Indemnity against employers’ liability. The umbrella association of all industrial accident insurers and accident insurers for the public sector is the ‘Deutsche Gesetzliche Unfallversicherung ’ (DGUV/German Social Accident Insurance) with its regional associations in the individual German federal states. 2
Examples for violent incidents at the workplace Terror in the belgian capital – 34 killed by attacks in Brussels Shooting rampage in Munich shopping mall At least twelve dead after truck ploughed into Christmas market Gas station robberies Shop robberies Train drivers to experience a suicide on the tracks 3
Possible consequences of such a mental trauma Initially, an acute stress reaction may occur. • Usually sets in within a few minutes of the incident and fades within a few days. • Is, at first, a normal mental reaction to such an incident. • It shows as a blend of depressive symptoms, anxiety, anger, withdrawal, but also of hyperactivity. • It may become physically conspicuous as racing heartbeat, sudden sweating or also breathing difficulties. 4
This may also involve acute stress disorder • which occurs at least two days to maximum four weeks after the incident; • is mainly characterized by feelings of emotional numbness, by deteriorated cognizant perception and also by lapses of memory regarding the incident; • there are also feelings of derealization and experiences of depersonalization. 5
As a late effect, a post-traumatic stress disorder (PTSD) may occur. • Several criteria of the experienced trauma must be fulfilled for diagnosing (a life-threatening incident of catastrophic extent) • Occurs up to six months after the incident (no diagnosis immediately after the incident) • Symptoms, such as involuntary déjà vus of the trauma, overexcitement or avoidance behavior, must be apparent and persist for longer than a month. 6
Why does the BGHW have a problem here? • In 2017 there have been 953 BG-relevant cases with mental traumatization, which have been handled in Berlin – at a total of 8,087 reported accidents (about 12 %). • Often long waiting times for assigning therapists when therapy was needed. • Often tedious healing processes due to delayed reporting of accidents. 7
What have we done? Acute intervention (three different providers, up to five talks) Setup of an own network of therapists Training and specialization of own staff Seminars on the prevention of assaults and on how to deal with persons concerned, free of charge for our member companies Emergency plan for major harm incidents 8
Acute intervention Acute intervention is not to be equated with psychotherapeutic treatment. It pursues the following aims: • Psychoeducation (information and awareness-raising of normal endogenous reactions after a mentally strenuous event) • Stabilization (mitigation of acute strain reactions) • Reinforcement of personal intervention resources and coping strategies • Identification of cases showing health disorders or cases of impending health disorders 9
More on acute intervention • In 2017, acute intervention that had been offered was accepted in about one third of the cases. • In little less than half of the cases, there was no need to further contact a doctor or therapist. • Random samples from the 2 nd quarter of 2016 revealed that, in approx. 75 % of the cases, the persons concerned were able to return to work again within six weeks. • The costs for acute intervention in 2017 amounted to around EUR 702,800. Figures quoted from Kögler, BGHW, Monitoring Report of Mental Health Disorders, dated April 26, 2018 10
Setup of a network of therapists for further treatment • Personally established contacts with therapists and their acquisition • Contractual agreements with individual therapists Requirements imposed on therapists • Additional qualification in the field of trauma therapy • Preparedness to commence treatment within one week • Preparedness for comprehensive reporting 11
A traumatic experience as an occupational accident – how to proceed further? • The BG to be informed by the employer, person concerned, police or doctor – often on the same day • Telephone contact established by us with the person concerned • Offering acute intervention • Facilitate therapy placement on demand • Further rehabilitation planning in a personal talk with the therapist and the person concerned 12
What other possibilities do we have? • Short-term initiation of in-patient treatment • Appointments with specialized physicians (medication, sickness- leave attestation) • Special measures to be taken (e.g., driver training, workload testing and stress exposure in a protected area) • Talk with the employer about workplace design and return-to-work measures to be taken 13
What can be changed at the workplace? Moving to another subsidiary Worktime adjustment (e.g., avoiding work at night) Workplace equipment (e.g., installing cameras, mirrors in the cash desk area) Moving to another area within the corporation 14
What if returning to the previous workplace is impossible? Job-finding measures Assistance in seeking and finding other appropriate employment Trial work, practical experience If necessary, re-training or further education 15
Conclusions By setting up a network of stakeholders in the treatment of mentally traumatized persons, waiting times for therapeutic treatment can be reduced and immediate support be offered. Times for treatment or of incapability to work can be reduced. Chronification of ailments can be counter-acted to accomplish reintegration into previous employment or open up new occupational perspectives. 16
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