Directiva Nº002-2010-CG/OEA

The negative effects of PTSD spilling onto social and family relations were mentioned by over a third of the family members who indicated having experienced family and friendship problems such as detached families, withdrawal from friends and avoidance

of social gatherings. The difficulties were linked to over exposure to emotional and psychologically straining situations such as mood swings, lack of trust, constant worry, fear and constant family conflicts, due to living with a member with PTSD.

Observable draw backs on families in terms of major domestic and household developments and general family life future planning were also reported as part of the experienced family problems. The above finding is in line with findings by Iniedu (2011:3), who assessed the impact of the veterans’ PTSD symptoms upon the wives, marriage and family lives among wives of Iraq and Afghanistan war veterans, and reported withdrawal and avoiding of other people, social interactions, crowds and gatherings as one of negative effects of PTSD on social relations.

Furthermore, increased impaired and unsatisfying social relationships, high marital and family violence leading to divorce and more demoralisation, social isolation, feelings of helplessness, anxiety and withdrawal were reported amongst the partners of Vietnam veterans with PTSD compared to partners of Vietnam veterans not diagnosed with PTSD and among families living with a member diagnosed with PTSD in the USA (Price et al 2014:7; Tull 2014:2). In addition, findings in studies by Iniedu (2011:3) and Ray et al (2011:15) documented similar data with regard to family members’ experiences of changing emotions due to living with a member diagnosed with PTSD.

Financial problems, largely as a result of having a family member with PTSD, included improper financial management; extensive medical bills and continuous exposure to debts, as indicated by close to a third of the family members. This specific social effect was most common in families separated from one another and working far apart in terms of job placement and in instances where medical funds got depleted. Financial problems brought about major drawbacks, which led to family members feeling stuck in the face of major family and household developments. Similarly, findings by Tull (2013:2) on families of the Vietnam military veterans reported financial strain, such as inadequate funds to cater for high medical bills, household needs and children’s educational funds due to financial mismanagement by the PTSD sufferer was experienced.

Findings of the current study showed that lack of constant support from the SAPS organisation to help manage living with a member diagnosed with PTSD was indicated as a major challenge by some of the family members. Studies conducted in the USA, on workers and families living with a member diagnosed with PTSD by Tull (2013:16) and

Reardon (2009:4) highlighted workers’ PTSD management guidelines for employers. The studies indicated the importance of providing support in the form of counseling to families to enable them to cope with stress reactions manifesting as a result of the burden of caring for a member living with PTSD (Tull 2013:6; Reardon 2009:4).

Studies conducted on the Metro police workers in the Gauteng Province by Kgalema (2002:16), in the Limpopo Province by Van Lelyveld (2008:14) and Madu et al 2006:216) and in the USA by Lynch (2007:5) noted the direct impact of living with a family member diagnosed with PTSD on families and emphasised the need for adequate support to be given to such families.

According to the current findings, the effects of living with a family member with PTSD impacted largely on the minority of the children and spouse’s performance at school and at work. Decreased school and work performance was mainly attributed to poor concentration caused by grave concern for the health and well-being of their parent and spouse. Findings from a study conducted by Tull (2013:1) on families with a member diagnosed with PTSD in the USA, pointed out that problems associated with PTSD such as substance use and unpredictable behavior patterns displayed by the PTSD sufferer may become too distressing for family members who will consequently show stress symptoms including decreased school and work performance, loss of interest and withdrawal. Similarly, findings in studies conducted among police workers and military veterans in the USA by Brown (2012:2), Boaz (2014:16), the National Centre for PTSD (2012:1) and the Department of veterans’ affairs (2011:59) observed that police workers’ children and spouses get mainly affected by changes in the PTSD sufferer’s behavior, in some cases the impact results in behavioral problems among the affected children.

In terms of the WTM, the above findings on the health and social effects of living with a member diagnosed with PTSD point to the component of telling/ retelling the traumatic story and normalising the traumatic symptoms. The two components of the model emphasise the need and importance of catharsis through giving a detailed description of family members’ traumatic symptoms and experiences and discussing them into detail, normalising the reactions and educating the families on other symptoms which may ensue (Eagle 1998:139). These components call for awareness and acknowledgement of the traumatic impact brought about by rendering care to a loved one living with PTSD spilling on to family relations. Family members serve as a support structure for the

worker diagnosed with PTSD. Therefore, rendering trauma support through integrated family counseling, empowering families on post-traumatic stress symptoms, their effect and providing information on the normality of experiencing symptoms, such as family conflicts, negative stress and withdrawal symptoms, is vital.

Furthermore, with these two components of the WTM, family members shall be assisted to realise that talking about trauma is a supportive occupational health intervention tool, as they allow for historical trauma memories to be managed. Bringing the traumatic experiences, thoughts and effects to the surface is helpful in modifying irrational and distorted thoughts normally experienced by trauma survivors and their caregivers (Eagle 1998:139). Therefore, these will in turn assist families to manage living with a member diagnosed with PTSD.

6.12 FAMILY MEMBERS’ COPING WITH THE EFFECTS OF LIVING WITH A MEMBER DIAGNOSED WITH PTSD

The use of support from immediate and extended families and friends was reported to have helped over half of the participants to manage the effects of living with a member diagnosed with PTSD. This included talking to each other and learning more about the health condition, sharing household responsibilities and assisting the member with PTSD with the correct taking of medication. Similarly, the use of social support in managing living with a family member with PTSD was documented by the US Department of Veterans Affairs (2014:2), Boaz (2014:15) and Tull (2014:2) in studies conducted among families living with a member diagnosed with PTSD in the USA. The need for family members to learn more about the health condition, the symptoms, treatment and symptom triggers was reported by Tull (2013:4) as vital in the management of PTSD.

The study findings also showed that few of the families coped by trying to be strong and avoiding conversations with the PTSD sufferer (parent/ spouse/ child sibling). On the contrary, Lynch (2007:60) confirmed that the use of the avoidance strategy delays trauma recovery, and is not beneficial in dealing with trauma and PTSD.

Practicing religion, specifically attending church and praying together to establish and maintain family support was also reported by most participants. Findings from studies conducted on families with a member diagnosed with PTSD in the USA noted that the families coped by understanding their loved ones’ traumatic symptoms and impact on

behavior. In addition, obtaining professional help as a family and exercising relaxation techniques, such as listening to music, praying and reading, assisted families to cope with PTSD (Tull 2013:4; Ruzek 2012:1).

The study findings on coping with the health and social effects of living with a family member diagnosed with PTSD is closely concomitant with the WTM’s component of promoting mastery of traumatic symptoms, which advocates for active implementation of adequate and effective coping strategies among individuals exposed to and directly affected by trauma and PTSD. Mastering traumatic symptoms is aimed at enabling continuation with responsibilities of daily living and the re-establishment of previous levels of coping among families affected by living with a member diagnosed with PTSD (Eagle 1998:142). Education among family members on how to best render care and support to their loved one is fundamental. Generating effective coping mechanisms among families caring and supporting a worker with PTSD is also essential.

In addition, awareness and empowerment on how families can manage their own traumatic responses to the situation is important. Thus, educating them on effective and non-effective coping strategies is crucial in order to support and assist on coping with a member diagnosed with PTSD. The positive health and wellness of family members contributes positively to the wellness of the worker diagnosed with PTSD and ultimately promotes PTSD management and best job performance. Thus, a healthy and well employee is highly likely to do their best at work and contribute positively to the achievement of set organisational objectives.

6.13 FAMILY MEMBERS’ OPINIONS AND RECOMMENDATIONS FOR THE MANAGEMENT OF LIVING WITH A MEMBER DIAGNOSED WITH PTSD

Current findings showed that a large proportion of family members viewed the provision of combined family counselling sessions, home and hospital visits as critical for management of the effects of living with a member diagnosed with PTSD. Similarly findings from studies conducted by Tull (2013:20) and Boaz (2014:18) on families with a member diagnosed with PTSD emphasised the importance of taking part in couples counselling and therapy, which enhances communication and counter feelings of isolation, mistrust, loss of control and withdrawal within families in an effort to improve coping with PTSD.

Findings in the present study indicated that a majority of participants viewed the provision of life skills empowerment programmes for all families affected by living with a worker diagnosed with PTSD as fundamental in the management of the effects thereof. Similarly, findings in studies conducted by DeAngelis (2008:44) and Boaz (2014:18) among families living with a member diagnosed with PTSD in the USA documented that teaching families stress management techniques and providing psycho-education about the condition, such as symptoms, course, triggers and its treatment, is essential. In addition, education on effective communication, problem solving and anger management skills to the families is a critical strategy that mental health practitioners can use to help PTSD clients and their families deal with the effects of PTSD (DeAngelis 2008:44; Boaz 2014:18) . Further findings among families living with a member diagnosed with PTSD in the USA, conducted by Tull (2013:1), emphasised learning about the symptoms of PTSD and understanding their influence on behaviour as the first step toward living with and helping a loved one with PTSD.

In the same breath, transferring workers diagnosed with PTSD nearer to families was also reported by a few of the families as an essential strategy to assist in managing the effects thereof. Findings from Tull’s (2012:24) studies on families with a member diagnosed with PTSD pointed that the family is the most critical support system and further reported the importance of rendering constant and immediate family support to the member diagnosed with PTSD. Being there, understanding PTSD symptoms and triggers of the symptoms, and changing routines based on the member’s symptoms requires family members to always be available. Thus, transferring workers nearer to families will enable the provision of necessary immediate family support for workers with PTSD.

In the current study, a minority of family members pointed out the need for workers with PTSD to be provided with adequate medical assistance as well as the extension of study bursaries to all families living with a member diagnosed with PTSD. Findings in a study conducted in the USA by Reardon (2009:3), which examined how organisations can render support to combat veterans diagnosed with PTSD, emphasised the importance of employers making an assessment of how best to adjust and accommodate these workers and their families, further highlighting that rendering simple and inexpensive workplace and family support can assist such workers and families to achieve life fulfilment and recovery from the health condition. Such support

can also contribute positively towards the attainment of organisational goals and objectives (Reardon 2009:3).

In the WTM, the above findings on family members’ opinions and recommendations for PTSD management relates to the two components of the model: promotion of mastery of traumatic symptoms and facilitating the creation of meaning. These components promote the establishment and maintenance of the use of a variety of support systems, including family and friends, the organisation, psycho-education on experienced stress and trauma reactions (Eagle 1998:142). In addition, the emphasis and focus is on the trauma survivor’s belief system in creating hope and meaning, at the same time being aware of the impact of trauma and PTSD in his life. The latter is important to unleash the capability to lead a manageable and positive life (Eagle 1998:143). Through integrated family trauma counseling, using the WTM, family members will be using and benefiting from the support rendered by the SAPS organisation to help manage the effect of living with a worker diagnosed with PTSD. The SAPS workers’ immediate family members experience direct effects of living with a worker with PTSD, therefore, taking their recommendations into consideration will bring about a sense of being cared for and supported by the SAPS organisation. The support will also serve as a positive reinforcement to continue caring and sustaining their loved ones living with PTSD. Therefore, feelings of self-confidence, belongingness and attainment of greater optimism are highly likely to ensue among the SAPS workers’ family members.

6.14 CONCLUSION

This chapter provided a detailed discussion of the findings on work and non-work- related traumatic incidents leading to a possible PTSD development. Information on how PTSD and living with a family member diagnosed with PTSD impacted on the health and social being of the SAPS workers and their immediate family members was also documented. Available occupational health and wellness support programmes as well as coping mechanisms used by participants and family members were also pointed out in this chapter.

The next chapter presents the contributions, conclusions and limitations of the current study. Recommendations developed on the basis of the findings of the current study are also presented in the next chapter.

CHAPTER 7

SUMMARY, CONCLUSIONS, RECOMMENDATIONS, CONTRIBUTIONS

AND LIMITATIONS OF THE STUDY

7.1 INTRODUCTION

This chapter presents the summary of the study with the major findings. The conclusions drawn from the main research findings and the contributions of the current study are also discussed. The recommendationsgathered from the key findings of the study and its limitations are also presented in this chapter.

7.2 SUMMARY OF THE STUDY FINDINGS