The psychological impact of major trauma injuries

Over the last year, the covid-19 pandemic has shone a spotlight on the mental health crisis facing the nation. One group that is acutely aware of the restricted access to support services comprises major trauma survivors. 

Our NHS has been extremely stretched by covid-19 and serious accidents have still been occurring, leaving major trauma sufferers needing access to under-resourced and under-funded rehabilitation services, particularly mental health support. Psychological support for major trauma victims needs to be prioritised as part of a holistic approach to rehabilitation for major trauma.

A double whammy

Road traffic accidents cause a significant portion of major trauma injuries. While car use has dropped during the various lockdowns, accidents due to speeding, drink driving and carelessness have continued to occur. 

For example, for the year ending June 2020, 24,470 people were killed or seriously injured in road traffic accidents that were reported to the police. Instances of violence, such as domestic abuse or theft have continued to occur, causing major trauma injuries. The numbers of admissions to major trauma centres relating to self-harm have also risen over the lockdown period.

While it is vital that those recovering from a major trauma have access to physical rehabilitation, the psychological impact is substantial and can too often be overlooked. Major trauma survivors need access to the right support if they are to avoid serious implications, such as post-traumatic stress disorder (PTSD), anxiety or depression. The lack of access to mental health services is perilous for major trauma survivors: mental health has an enormous impact on one’s ability to engage with physical rehabilitation. 

Left untreated, PTSD and other psychological injuries can have an enormous impact on everyday life for major trauma patients, such as feeling scared of leaving the house. It can impact on relationships and family dynamics and can often cause the breakdown of relationships – creating a vicious cycle. 

A particularly problematic consequence of the psychological impact of major trauma is its impact on one’s ability to engage in physical rehabilitation. The common combination of chronic pain, sleep disturbance, fatigue and cognitive dysfunction (such as difficulty with concentration and memory), as well as the side effects of medication, make it difficult for a person to participate effectively in physical rehabilitation. 

The coexistence of underlying mental illness, such as PTSD, makes this significantly more difficult, given the complex interaction between all these factors; and risks damaging the patient’s long-term recovery process and limiting their final outcome.

The psychological impact of major trauma is made clear in an audit carried out by Southampton General Hospital. Evidence showed that many major trauma victims suffer psychological as well as physical injuries, with over 40 per cent of major trauma patients suffering from anxiety and depression and almost a third experiencing psychosocial issues such as relationship or body image concerns. 

The results also highlight how easily major trauma can affect family dynamics and relationship roles and influence rehabilitation and discharge planning. Another study (from Oxford) of patients treated in the intensive care unit (ICU) found that over half reported significant symptoms of anxiety, depression or PTSD over the following two years; and those with depression were nearly 50 per cent more likely to die in that period than those without.

The findings in these studies are significant and demonstrate how imperative it is that we hold the psychological impact of major trauma in the same esteem as the physical impact. Physical rehabilitation is, of course, an integral part of the recovery process for major trauma survivors, but to focus on this solely is not enough – we must take a holistic approach to rehabilitation that encompasses mental wellbeing and social community care. 

A holistic approach 

To achieve a truly holistic approach to rehabilitation requires the right attitude and mindset from all parties involved in major trauma and personal injury recovery, including lawyers and insurers. Psychological rehabilitation must be prioritised by all from the outset. 

It is important from the outset for a solicitor to be mindful of the potential for psychological injury after a traumatic event. It is normal for a major trauma victim to experience intense fear for their lives and to suffer immediate shock of a traumatic event and their time in hospital. It is also normal to experience a range of emotions after the event and for a period of time thereafter, when undergoing treatment and rehabilitation and, perhaps, adjusting to a different life after a traumatic event. 

However, where the psychological impact is not settling down and becomes intrusive and starts affect day-to-day life and function, lawyers should act quickly to ensure their clients have access to psychological support.  
 
In this covid-19 era, we should expect an increase in the prevalence of psychological trauma – many victims will be isolated in hospital dealing with these emotions without the physical contact and support of their loved ones; or back at home unable to access rehabilitation which is impacting on their physical and psychological recovery. Imagine the anguish, fear and worry felt by a major trauma victim (and their loved ones) who has a life-changing injury and faces a long road to recovery ahead, without the support of those closest to them or without professional help?

Impact on quantum
 
So, how might the psychological impact of major trauma injuries affect the damages claim? A personal injury claim is meant to put an injured person back in the financial position they would have been, but for their accident. The claim compensates a major trauma victim for their injuries and any past and future financial losses. 

If there is a recognisable psychological injury such as PTSD, anxiety or depression, damages (compensation) can be claimed. The lawyer should ask their client to describe their psychological symptoms. If the symptoms are affecting their day-to-day life – work or education, relationships, ability to engage in rehabilitation treatment for physical injuries, then medical and any treatment records should be obtained and an expert psychiatrist should be instructed to provide a report diagnosing the psychological injury and advising on treatment and prospects of recovery.  

Funds should be requested from the defendant insurance company to pay for private psychological treatment and support. 

The amount recovered for psychological injury ranges from a few thousand pounds up to in the region of £100,000, depending on the nature, severity and impact of injury.  There may also be treatment costs (which can be costly in the private sector), so it is very important that psychological injury is not overlooked.
 
Interim payments
 
Funds should be requested from the defendant’s insurer treatment costs either via a Rehabilitation Code payment or interim payments. Rehabilitation Code funding is funding provided by a defendant insurance company to support the injured person’s rehabilitation and treatment costs while a compensation claim may be ongoing. 

It will be provided regardless of whether there is an agreement about fault for the injuries.  This means an interim payment can be requested once liability has been admitted or proven against the defendant; it’s more likely to made in cases where there is some dispute over liability.  

Throughout the pandemic, where insurers have made some noticeable savings, additional contributions to the rehabilitation and recovery of major trauma survivors would be a welcome respite to our overburdened NHS. This could come in the form of increasing the NHS injury cost recovery cap or tariffs that provide funding for the NHS to deliver vital care. 

It remains imperative that major trauma survivors have access to physical and psychological rehabilitation at this challenging time. With greater funding and emphasis behind a holistic approach to rehabilitation, we can vastly improve the lives of thousands of people recovering from major trauma injuries and their families.

Claire Roantree is a partner at Boyes Turner and a member of the Major Trauma Group boyesturner.com

Dr Ian McCurdie, consultant in rehabilitation medicine, also a member of the Major Trauma Group, assisted in the preparation of this article

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