International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
 |
 |
Critical Incident Stress Management peer support team
Surrey & Sussex Healthcare NHS Trust
By: Tina Suttle-Smith
Strategic Medical Education Manager and CISM lead
Background
Surrey & Sussex Healthcare NHS Trust provides emergency and non-emergency services to a local population of c535000, employing around 4,800 staff.
The senior executive team supported the development and delivery of a Trust wide Critical Incident Stress Management (CISM) peer support team and programme in March 2019, to compliment the wellbeing services that it already provided through occupational health, employee assistance programme and staff mental health training. They were keen to pilot and review how a dedicated team can help support all employees within the Trust, on both an individual and group basis, following the stressors around critical incidents and events, as well as signposting to other support that the Trust could provide.
Following recruitment episodes, twenty Trust staff were trained on a 3 day individual and group programme in July 2019, a second group of thirteen staff were trained to support 1:1 individuals in October 2019.
The trained staff ranged from band 2 (ward clerk) and covering all bands up to consultant level and across clinical and non-clinical areas.
The peer support programme went live to all Trust staff in September 2019. Staff across the Trust were encouraged to self-refer to access the team so they could help stabilise and mitigate a crisis response, and encourage natural resilience and psychological wellbeing. The aim was to complement and bridge the gap between other services like organisational debriefs, counselling, or mental health interventions.
In March 2020 following the COVID pandemic reaching the UK , it was agreed that a further ten non-clinical staff would be trained up on a 3 day individual and group programme to support Trust staff, as our clinical peers were unable to find time to carry out this voluntary role.
Review
In the first two quarters of providing this programme, the team saw on average 21 individual referrals. In Q1 70% of these were chance referrals, where Trust colleagues recognising CISM peers stopped them in working environments and corridors to discuss any personal distress. By Q2 chance versus formal referrals evened out at 50% each, evidencing that our services were
becoming more well-known. In Q1 35% of the referrals were to support staffs following a clinical incident, with the remaining evenly spread around patient, colleague deaths, anxiety, stress and verbal abuse from patients. In Q2 the work around supporting bereavements at work increased to 40% with the aforementioned issues still being a focus of referral.
During COVID, the CISM team saw a threefold increase in the number of referrals they received to 66 over the 3 month period of April-June 2020. The increase was evidenced mainly through formal referrals from staff members which accounted for 65% of referrals received.
During this time, those CISM peers who were able to and not working full time in COVID clinical areas, were more visible wearing their branded t-shirts and were assigned to support every clinical and non-clinical area; attending morning handovers to support incoming and outgoing shift staff and capturing staff in breaks. We believe that the number of people we assisted through these informal drop-in sessions, way exceeded the formal figure of 66, but due to the volume of work we were all experiencing it was impossible to keep a tally of all these “non-formal” sessions.
Marketing of our service also increased with wellbeing CISM posters and banners being more prevalent in all areas.
With regards to reasons for referral there is clear evidence how COVID increased the anxiety and stress of Trust colleagues. Personal stress was mainly around personal health, family health and COVID; work stress was around PPE and the working environment; and anxiety covered both areas, particularly for staff that were redeployed to new areas.
The CISM team recognise that their role changed over the COVID months, as support fully focused on these anxieties as opposed to the core nature and ethos of the CISM Programme. We were though, all able to utilise the skills and training to at least normalise feelings if not the event, provide education and advice around coping mechanisms and through increased voluntary support from external counsellors and psychologists, signpost and refer for more qualified support where needed.
As we came out of the COVID peak, our 1:1 individual support has stabilised again to 20 sessions in this final quarter of our first year of providing a CISM service. The majority of our work is supporting post COVID anxiety and stress and the longer term symptoms staff are experiencing around difficulty sleeping, irritability, tearfulness and lack of energy. All we believe to be totally normal, after the experiences we have had over the last six months.
On average 70% of those that the peer support team see, only require the one initial meeting.
We have been happy with how many Trust staff “recovers” after their intervention, with on average per quarter 85% not requiring any additional signposting or intervention. Verbal feedback from those we support evidence how just having space to talk to someone and talk through options and coping strategies help.
Our group emotional support (noting whilst known in CISM as group debriefs, we moved away from this terminology in our marketing material, so that teams could differentiate how our sessions differ from organisational debriefs), has grown since September 2019. There was one session per quarter for the first two quarters and during the COVID peak we carried out five support sessions, although to note none were COVID related. Now as we pause we are finding more requests to offer group support to assist teams’ process and reflect on what they have been through, but to also continue to support other clinical incidents. Feedback from staff attending has evidenced strong personal benefit from being able to share personal experiences and listen to colleague’s views on incidents and have commented in their formal appraisal process the benefits of coming together as a team.
Learning and future planning
It is believed by the CISM peer supporters that the service we provide is beneficial; which has been gathered through soft data, with CISM peer support users approaching us to say “I do not know what we would have done as a Trust through COVID without CISM”, “I have spoken to friends in other Trusts and they wish they had CISM” “When my manager advised me to consider referring to you, I thought what is the point, what can they do, but you have done so much in helping me learn to cope” “The CISM team are visible and energetic – gold standard for dedication and care during this time”.
The CISM team are keen to expand their trained staff numbers to 60, and continue to make the service as representative of the diverse roles and demographics within the Trust as possible. It has also been acknowledged by the Trust of the need to develop greater clinical supervision for the team, by clinical psychologists.
Whilst as CISM lead I acknowledge the need and benefit of expanding our team, the Trust is also looking at introducing Mental Health first aiders, a role which I see as complimenting CISM well.
As peer supporter volunteers who all hold other full time roles, the more eyes we have in all departments who can spot, advise and teach colleagues with general chronic anxiety and stress, will enable CISM peers to use the skills we have gained over our training to support those who are more acutely stressed from a clinical incident.
For the current CISM team development and learning, we have all agreed that supporting colleagues during COVID, keeping a safe distance and undertaking support sessions whilst wearing masks has been truly challenging. Where once we would have been able to reach out and use touch to provide comfort and empathy we have had to focus on using our verbal skills much more and focus on how just our eyes can portray our concern, understanding and reassurance.
The CISM team are incredibly proud that in our first year we have supported 133 individuals, and multiple departments. On reflection, without COVID the numbers would certainly not have been so high, but it has certainly helped us sell the CISM concept to our Trust colleagues.
Our challenge now is to meet the Trust’s needs and request of continuing the visibility we had during COVID, whilst we prepare for the potential of surge 2, but also knowing that non COVID incidents will continue, and to plan our business as usual support as well. I know I speak for all of the team, when we say how privileged we feel to be part of CISM and know we have truly made a difference.
Tina Suttle-Smith
Strategic Medical Education Manager and CISM lead
 |
An Associated University Hospital of Brighton and Sussex Medical School |
Copyright © 2025 International Critical Incident Stress Foundation, Inc
International Critical Incident Stress Foundation, Inc is a 501(c)3 Non Profit