Are People Still Saying It Doesn't Work (CISM)?

The questions about the effectiveness of Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM) and peer support have persisted for a while now, with barely any description of the procedures being challenged.

One of the most powerful presentations at the recent ACISA Conference in Auckland was given by Jeffrey Mitchell, who cited study after study demonstrating the usefulness critical incident support strategies, across a range of work groups. Dr Mitchell's message was clear and to the point. The research which generally criticises CISD is flawed because it rarely describes the debriefing methods used. This only tells us that we don't know what doesn't work. To conduct research on CISD on it's own, or to provide this as the only form support is usually inappropriate, as CISD has always been designed to be used as part of a CISM program. Some 80 pages of handouts provided at the Conference illustrate a wide range of studies which time after time show that CISM, when used appropriately and provided by trained personnel, is a program which provides powerful, cost-effective support and assistance to those affected by the stress of critical incidents. Any problems which do exist are more likely due to misapplication of the process, or lack of training by those providing support, rather than faults in the theory behind CISM.

In the next few years, professional journals are likely to carry an increasing number of articles supporting the effectiveness of CISM strategies. To date, most of the criticism has come from those who have minimal, if any, first-hand crisis intervention experience. The weight of evidence for the benefits of CISM is growing steadily, especially among those who regularly respond to the needs of those affected by stress and trauma. The demand for CISM programs is such that, according to Dr Mitchell, "CISM is emerging as a standard of care". People looking to find fault with CISM programs need to remember that criticism can be a healthy form of review, only as long as it's constructive.

Footnote - A recent report (Dec '97) by Wayne Corneil and Sharon Kirwan of Canada showed that a comprehensive CISM program with 921 nurses across four regions of Canada, resulted in saving of nearly 3 million dollars from reduced employee turnover. For every dollar spent on the CISM program, the estimated value of return back to the employer was just over seven dollars.