Special Hearings — Mental Health Workshop — 1997-11-20

PROF SIMPSON: Thank you, I think that's again a tremendously important point.  I think the general point I'm trying to make which I think we need to consider is - it in fact echo's back to our question about debriefing, what we've got to do is the best we know how at the time but if we leave it at that then we never know more than we know at the present and that's not enough because the victims that we need to serve deserve absolutely nothing but the best.  This year they deserve what's best - this year and next year, they deserve what's best next year.
 Therefore we need to evaluate and I think it should be made a condition of any form of private or Government funding for example, that there shall be evaluation because the history - medicine is particularly good at giving us examples of things, it seemed like an awfully good idea - that theoretically and by hunch and by all sorts of things, seemed like brilliant ideas but they didn't work.
 To choose one example that comes to mind, there was a period when they first began caring for premature babies - when the fact the babies had breathing difficulties, it seemed obviously a brilliant idea to put them into an incubator with very high concentrations of oxygen except the babies went blind.  And nobody had wanted to blind babies, it was by an effect that nobody had predicted or thought but it took a while because nobody had thought of building in an evaluation to say: "Funny, they're living a bit longer but most of them are going blind, I wonder why that's happening"?
 There are lots and lots of unintended outcomes - you don't get what you expect and you often get what you didn't expect, therefore it is actually - I think, irresponsible for us to embark upon large-scale social attempts to do anything - including therapy and counselling, without some evaluation.  
 That doesn't have to be expensive, particularly if at a central level there is a development of tools - of valuation questionnaires or methods or ways of doing it so that the community groups that may be carrying out the programme, don't have themselves to hire consultants or to spend a year doing that - to make methods available easily and cheaply.  
 Then it's simply a question of often handing out questionnaires or doing very simple structured interviews with people and gathering the data.  And again, it's not necessary that every community group should be able to do that themselves, they have far greater skills of other sorts.  
 But that there be a service available so that such groups who can then administer these tools, can get them back and someone else can perhaps analyse that data and give it back to them as information - what worked, what didn't work, what your - somehow that outside involvement is also useful in that - I mean, one of the great examples in this field which I again recommend to your attention, is there was a great Israeli project called: "Cohagh" that was used to deal with providing the sort of care that you are thinking of in terms of veterans of some of the middle eastern conflicts - that one was especially well evaluated and in fact was an entire issue that we produced when I was on the board of the Journal of Traumatic Stress entirely devoted to these evaluations.   
 And what they found was - this was a very expensive, very carefully designed project, the therapist earlier on thought that they were doing wonders, the patients were very polite - they didn't want to disappoint these nice keen people who were trying so hard so they said it was marvellous but when they were evaluated it was turned out to be of absolutely no value whatsoever.
 That was sad for those people who enthusiastically believed in it but it means that the Israelis are not wasting more millions doing again what didn't work, they're no doing things which hopefully do work a lot better.  So that sort of process - and in some ways the involvement of some external folks or a national group servicing the local community groups, may actually have an advantage in that people may be more inclined to tell someone who isn't part of the core group that's helping them, where it didn't help or what they don't actually appreciate.
 They may not always be keen to tell us that to our face, so a combination of local expertise and national servicing of that may both help to sharpen, to focus, to improve the programmes.  We must do the best we possibly can for our victims now but that hopefully won't be what we're doing in five years time, in five years we should be a lot better by learning from each of the mistakes we make - we must make mistakes but the difference isn't between miraculous people who never make mistakes and silly people who don't.
 Every year my New Year's resolution is: "Dear Lord, let me make new mistakes next year".  I learn enormously by making mistakes and the only person who makes no mistakes is the person who does nothing and that's perhaps the biggest mistake of all.  Let us make mistakes, let us make creative and fruitful mistakes but we must have a way of learning from them so that we don't make the same ones again.

CHAIRPERSON: Thank you, there's an appeal from the floor to make a comment.

FLOOR: Just for one minute ...[inaudible]

CHAIRPERSON: Can I just ask that you use that microphone there?

FLOOR: Oh, I thought my voice was ...[inaudible]

CHAIRPERSON: We've got to record it.

FLOOR: ...[inaudible] go at also some of the aspects Doctor Simpson was talking about now.  What I want to say now as I'm hearing these questions from the ...[no sound] that this is an area that is quite important, especially when one realises that now one is looking at how to alleviate the problems or PTSD symptom formation and how to evaluate them as you call it and how to make tools to look into the community and help further on.
 As much as I'm aware also of what the psychologists have been talking about in creating a human resource method that will not be so completely focused in - sort of, only psychological medical terms, that debriefing problematic is quite interesting because it also involves expertise isn't it? - it also involves the knowledge of trauma counselling, trauma work because actually what it really is - from the latest papers, is that is has - it does not stop PTSD so much but people who have been debriefed properly tend not to have chronisity in their PTSD.  
 The minute you get there, immediately now those areas that we could move in where this violence is pervasive and also the personality part - I don't really know how much it is relevant in this case, but what I wanted to say was that it is known that children of PTSD's - especially those from the war, are also coming out in PTSD. 
 So, what I want to say is that, let us - these are not easily things to ...[indistinct] question and answer and then go for, it needs that indaba of how are we going to solve these things, how are we going to go into them because it's not just going to be evaluation - it's not only going to be the formation of the human resource, it is going to look at what the community itself wants.
 We are not just going to send out and evaluate but we want to hear from the community what they want from us in empowering them or them empowering themselves.  This is actually now the beginning of the new paradigm, so we have to tread on it with braveness, without comprises but - for Christ's sake, with hell of a professionalism.  That's all I want to ...[intervention]

CHAIRPERSON: Good point, thank you.  I'm delighted to hear a lady with a broken leg telling us we must tread bravely into the future.  ...[inaudible]