How can trauma-exposed organisations improve staff well-being and resilience?

Dr. Annis Cohen, a Clinical Psychologist

We spoke to Dr. Annis Cohen, a Clinical Psychologist and one of TTI’s associates, about her work with organisations dealing on a day to day basis with individuals who have experienced significant trauma.

How did you initially become interested in trauma work and work with trauma -exposed organisations in particular?

After qualifying as a clinical psychologist, I specialised in working with people with psychosis and severe mental health difficulties. This involved working with many survivors of organised violence whose mental health problems had often been exacerbated by their contact with the immigration system and their experiences of isolation and deprivation in the UK. This led to my interest in working therapeutically with trauma, but also in  supporting organisations that carry out vital campaigning, legal and social support around these issues.

Can you provide an example of a particular project or piece of work that you found particularly rewarding, and why?

I found the work I did with Women for Refugee Women very rewarding. I spend a lot of my working life in the NHS which can feel rather slow and remote. It was great to work with a small organisation that strives to work in a grassroots way and has achieved so much. It was also very rewarding to work with such committed, passionate staff.

You have been carrying out a lot of work with organizations working in complex/emotionally challenging fields, and seeing first hand the trauma that employees (and sometimes volunteers) experience and how organisations respond, and perhaps could better respond to this. Some studies suggest that much of the trauma first responders and others experience comes from work/organizational stress as opposed to stress from doing difficult jobs. Is this your experience?

Yes, absolutely. Workload, bureaucratic burden and the difficulty in managing inflexible systems are often cited by staff as key causes of burnout. There’s a link to the concept of moral distress which is when people feel they are giving, or witnessing, care which clashes with the values that brought them into the work: this is also linked to burnout.

What are some of the key recommendations you would give to managers of organizations dealing on a day to day basis with these types of emotionally challenging/stressful contexts, to promote the wellbeing of staff?

Managers often approach TTI asking for counselling or therapy for their staff. While this has its place, we know that everyday social support within organisations, from colleagues and immediate managers, is hugely protective against burnout and in allowing recovery from potentially traumatising events. Many of my recommendations are therefore around finding ways to strengthen support and cohesiveness in the organisations, by developing formal and informal ways in which staff can connect with each other. I am also a big advocate of supervision or reflective spaces, where staff have protected time to reflect together on the emotional impact of their work, separate from any business or operational management. This allows staff to process the complex feelings that inevitably arise when working with people who have experienced extremes of organised violence,  allowing them to do this work safely.

Obviously, trauma is never fully preventable, and still a significant risk. What should managers be looking out for in respect of their staff ? Is there any guidance about when a manager should intervene and for instance, "call in the experts"? 

If managers know their staff well, they will notice changes in how they manage their work and respond to clients which will help them to realise something is wrong. The signs could be very individual, so what managers can most helpfully do is create a culture where staff are encouraged to be aware of their own mental health and feel safe to ask for support. It is important that organisations have a way of responding to critical incidents, for example if staff are exposed to serious harm. Short-term trauma responses following such events, such as intrusive memories or increased alertness, are very normal and usually decrease over time, with the majority of people making a good recovery from the event without mental health intervention. However, if this does not happen for someone, and they are not coping and are distressed, this would be a time where specialist mental health support would be indicated.

What strategies would you recommend to better embed wellbeing into organisational cultures?

Again, I would point to the importance of building strong peer support in the organisation. There are many ways to do this such as buddying systems and scheduled social time such as shared lunches. What’s important is that this is developed by staff so that it works for them. It’s also important for focus on wellbeing to be modelled from the top of the organisation.  Directors and other senior staff in the organisations TTI works with are often extremely committed people, and have had to be in order to achieve what they have. Sometimes, they will tell their staff to look after their wellbeing but they themselves don’t take holidays and work very long hours. If leaders model prioritising their own wellbeing, it gives permission for junior staff to do the same. A message I try to send is that staff wellbeing isn’t a luxury or an add-on: it’s something we must prioritise for in order for staff to be able to work safely with their beneficiaries.

You have been working with colleagues at TTI to develop an "audit tool" - can you explain what it is, what it does, and who should be using it?

It’s an audit tool that gives us an evidence-based framework to assess organisations. It helps us to look at the organisation as a whole, to consider how its work, structure, policies and operations currently support staff wellbeing, and what needs to be put in place to optimise this. It helps organisations to look at what staff are most at risk of primary or secondary traumatisation, and what to put in place to mitigate this risk. It will lead to a set of recommendations for the organisation, and is suitable for any organisation that is aiming to better support staff wellbeing. 

If this post generates questions, or people who read it want to contact TTI for advice or assistance, who should they contact?

More information about what TTI does is available on the website, and in our brochure. If you would like more information, please email us at info@tt-intl.org and we can direct you to the right person to help.

Stephen Palacino