Victims of physical and sexual violence are being failed by health care and criminal justice workers who do not recognise post-traumatic stress, according to the Royal College of Psychiatrists.
The college says that victims of physical and sexual violence are at risk of developing mental health problems.
“We treat whole people don’t we?” said professor Jonathan Shepherd, director of the Cardiff University Violence and Society Research Group. “We’re not just supposed to treat someone with a stab wound or broken bone.”
In his many years’ work as a surgeon, Shepherd has treated people injured by violence.
“I’m convinced the mental health problems that are inflicted are often more serious and long lasting than their physical injuries,” he said.
The college recommends in a report published on Wednesday, July 11, that health professionals who treat those affected by violence should be major advocates for victim health and well-being.
“We don’t have the concept of victim health,” said Shepherd, who is co-author of the report.
“It’s all very ad hoc. If you happen to find evidence that someone is depressed or has post-traumatic stress, you’re struggling to find someone to refer them to, and there’s not a well-trodden path in how to do it,” he said.
Working with the Home Office, crime departments, and the NHS, Shepherd and his research team have identified the need for integration between the crime and justice system and NHS services.
“They’re two separate worlds, so this guideline tries to join them up,” Shepherd said.
The team has designed a “stepped care pathway” so clinicians can refer victims of assault who might be suffering from mental health problems.
The guidance recommends that patients with signs of mental health problems as a result of violence should be referred by front-line doctors to third sector support services.
A charity such as Victim Support can provide emotional support and practical help. Where there is evidence of a more serious mental health impact, Victim Support or doctors in emergency settings need to refer patient to their GP. In cases of major mental disorder, the GP should refer patients to specialist mental health services.
Javed Khan, chief executive of Victim Support, said in a statement: “Greater collaboration between all the agencies and individuals involved, to ensure that more victims with trauma-related and mental health conditions are identified and appropriately referred, would benefit all involved – not least victims.”
The guidelines indicate that early identification of acute stress and post-traumatic stress can reduce the risk of chronic Post-traumatic Stress Disorder (PTSD).
“You can fix someone’s busted cheekbone and pat them on the back but you sometimes leave them with untreated depression or PTSD, so [the guidance] is to raise the profile,” Shepherd said.
Shepherd said that out of the 300,000 victims of violence treated in emergency departments in England and Wales each year about two-fifths will develop mental health problems.
However, the report pointed out that not everyone affected by violence needs formal mental health screening through counselling. “That’s been found to make people worse,” Shepherd said.
The guidance has been developed in partnership with the Royal College of General Practitioners (RCGP), the College of Emergency Medicine, and Victim Support.
Professor Helen Lester, medical director of the RCGP Clinical Innovation and Research Centre, said in an e-mail: “The RCGP welcomes this report. It is an important part of a complex and often stigmatised issue of real relevance to primary care.”
The report is called Managing the impact of violence on mental health, including among witnesses and those affected by homicide.
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