Trauma and PTSD (Adults)

This guidance was updated on 27/02/20 – Note change in referral into the Rivers Centre

People with psychological trauma may present with a range of issues.

There are two main pathways within NHS Lothian to access treatment as outlined below, depending on whether the person has single event or complex PTSD. Please note that patients can no longer self-refer.

The Voluntary Sector will also offer alternatives.

Services available.

The Rivers Centre will organise an initial assessment with patients who are referred and meet referral criteria. At this initial assessment, the patient will have the opportunity to speak one-to-one about their trauma, how it is affecting them in their life, and a management plan will be collaboratively developed. If appropriate, the patient will access the Lightbulb Group, which is a 5 week long PTSD psychoeducation group treatment programme run at the Rivers Centre.

The Rivers Centre is currently unable to offer individual treatment.  If individual treatment is required, patients will be referred on to their local Mental Health Team for assessment and consideration for treatment.

The Rivers Centre is trialling a newly developed group treatment programme for Complex PTSD, but patients are recruited into this from the sector Mental Health Team waiting lists. Therefore, referrals for patients presenting with Complex PTSD should be directed to sector Mental Health Teams

1.    Post-Traumatic Stress Disorder – single event.

People presenting with a primary diagnosis of Post-Traumatic Stress Disorder (PTSD) to a single event trauma (eg physical assault, sexual assault, road traffic collision), can be referred directly to The Rivers Centre.

People will be offered a brief assessment appointment and a matched care model will be used.  Treatment options will be discussed including group treatment based at  The Rivers Centre , treatment based with our colleagues in the sector mental health teams, or options within the third sector.

Diagnostic criteria for PTSD (ICD-11).

“Post-traumatic stress disorder (PTSD) is a disorder that may develop following exposure to an extremely threatening or horrific event or series of events. It is characterized by all of the following:

1. re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. These are typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations;
2. avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events; and
3. persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.” (ICD-11)

2.      Complex Post-Traumatic Stress Disorder

People presenting with Complex Post-Traumatic Stress Disorder (C-PTSD) or psychological difficulties associated with a history of sustained and repeated trauma in childhood or adulthood should please be referred to the sector-based mental health team.

These people will be offered assessment by their local mental health team and options regarding treatment can be discussed.  Treatment options will include group based as well as individual treatment.

Diagnostic criteria for Complex  C-PTSD (ICD-11).

“Complex post-traumatic stress disorder (C-PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse)

All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterized by severe and persistent

• problems in affect regulation;
• beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and
• difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”  (ICD-11).

Voluntary Sector and Counselling Services

• Voluntary sector services offer services too. For those who have been affected by childhood trauma please see Health In Mind’s services which offer help: https://www.health-in-mind.org.uk/services/trauma_counselling_line_scotland/d15/
• Counselling may also be useful for people with no significant psychiatric symptoms who are considered appropriate for such an approach. CounsellingAdults.aspx

For Veterans of the Armed Forces

Veterans First Point (V1P) is a Scotland-wide resource which can give a wide range of help to those who have served in the Forces, including those struggling with experience of trauma: https://www.veteransfirstpoint.org.uk/. Veterans’ families can also self-refer where needed.

Please also see Stress and Emotional Crises Pages on RefHelp for other services which may be useful for support