Remembering the forgotten population 

The date was 25 June 2007. Any hope of a golden summer ignited by the heatwave in April was gradually dwindling away. It was raining, again. That day, the equivalent of 20 Olympic swimming pools fell on Hull every second.
Dr Jennie Ormerod, a clinical psychologist with Humber Mental Health Teaching NHS Trust, was trying to get to work. It took three hours. 'When I got there, I found that no clients had been able to reach us. As more and more schools and businesses closed our boss sent us home. It wasn't easy… I passed abandoned cars floating down the street.
I eventually arrived home, to watch Tim Henman playing at a dry Wimbledon. It was quite surreal.'
Across the area 20,000 people were affected by the floods that day; of these 6300 people had to leave their homes with no prospect of returning before Christmas, and tragically, one man lost his life.
'I was fortunate enough not to have been that affected directly,' Ormerod says, 'but I became involved in discussions of how to support those that had. In the days that followed, people swapped stories of the floods and thrived on the drama of it all in what researchers describe as the 'heroic period'. This is followed by the 'disillusionment' period, in which the reality of the situation takes hold.'
Research shows that the effects of flooding on mental health are enduring. Tunstall's (1996) research found that the experience of having to move out of the home added to the health and stress effects of flooding, as did the length of time taken to get the house back to normal after the flood. 'For many people their homes are their sanctuary, they invest so much time, love and energy into them,' says Ormerod. 'My friend Hannah had spent months decorating her house for it all to be destroyed in the floods. For many, seeing their house stripped back to its breezeblocks in the months following the floods was devastating.'
Many studies have shown that the way in which a disaster is handled can be as distressing as the incident itself. Hull was dubbed the 'forgotten city' in the days after the floods, as complaints about the lack of funding to the area emerged. But what did Ormerod and her team do?
'Our Trust had previously adopted 'critical incident stress debriefing' (CISD) as a response to disasters. It was devised in the 1980s to assist people in dealing with the immediate psychological aftermath of disasters and was employed as early as 24–72 hours after the incident. But in the 1990s systematic reviews had indicated that at best CISD had no effect and at worst could actually be harmful. Damage may result from exposure to traumatic details, triggering of unwanted reactions and material, disruption of normal coping strategies and mishandled group processes. So the decline in the routine use of debriefing led to a dilemma – what should we do instead?'
The answer, in the initial aftermath, was to focus on the most pressing practical concerns. As the Red Cross state, 'Most disaster survivors are people who are temporarily disrupted by a severe stress, but can function capably under normal circumstances. Much of the mental health work at first will be to give concrete types of help.' But there was still a need to identify those who may be at risk. Norris (2005) found several factors that increase risk for psychological distress including psychiatric history, severe exposure and age. Recent models have been developed that reflect this including 'watchful waiting' (NICE, 2005), 'screen and treat' (Brewin, 2001) and 'psychological first aid model' (Freeman, 2001).
Ormerod says: 'If an individual's response does not appear to be resolving within a few months following the disaster or is causing particular distress or impact on functioning, then they may be referred through to mental health services for an assessment. An individual management plan could then be devised. Trauma-focused CBT delivered between one and six months after the incident has been found to be effective for people at risk of developing chronic PTSD, compared with being on a waiting list or receiving non-trauma focused intervention.'

The needs of children
One particularly vulnerable group were children – 91 schools were affected, and a small school recovery group was established after the floods to assess the likely impact on school performance. In addition, Humber Mental Health Trust funded two clinical psychologists for six months, to cater for additional mental health need in children and families.
One of those psychologists, Dr Sarah Eaton, says: 'Our initial concern had been that the flooding and the chaotic aftermath may have left many children traumatised – that they would be terrified of the rain, experiencing regular nightmares, sleeping badly and unable to concentrate in class when it rained. Although a proportion of children reacted like this over the first few weeks, which is perfectly normal, this didn't seem to continue for the majority of children. The issue that was having the biggest impact was the damage and disruption caused to families' homes and lives. Flooding removed important resources from some families' lives: family and friends if people had to move; space for children to play out; warm living conditions; equipment to cook, and other such resources that help to keep our lives relatively good.'
Eaton has used a mixture of qualitative and quantitative methods to ascertain the nature and extent of the problems, and to identify characteristics of families who appear more vulnerable to experiencing negative outcomes, such as family conflict or depression. Factors emerged, such as having limited access to activities away from the home if flood damaged; experiencing repeated flooding; being flooded at both work and home; continued communications with insurers, builders, council, etc; being isolated; being elderly; having children; and limited financial resources.
Dr Eaton felt it was important to highlight that there are a lot of families who were flooded who have managed to piece things back together, and who have coped and are coping functionally. However, there are those who have still yet to return to their homes, or who are living in poor conditions, and it is important that these families are thought about and appropriately supported. In line with this, a teaching professional told Dr Eaton: 'I think although some children have bounced back, some children have become really fearful… about the future and about how well their parents have coped.' Dr Eaton commented: 'I hope our research can inform the type of support required to prepare and support people – not only services, but also communities. We've fed our preliminary findings into systems such as the government Pitt Review Board, the Red Cross and the local authority. We're trying to help shift the focus away from the flooding event and to identifying, understanding and helping support families to most effectively re-establish their lives.'
'This post has required my colleague and me to work in a number of different ways: including consultative, quantitative and qualitative research, group work, metal health promotion, through to individual therapy and assessment. It is to the credit of the services involved that they had the foresight to provide posts with such flexibility to respond to an unpredictable need, of a poor city, following mass long-term displacement of this population.'

Resilient and prepared?
Jennie Ormerod says there is still a great deal of anxiety in Hull at the prospect of a repeat event, but she is keen to emphasise the positives to come out of the flooding. 'Resilience is probably the most common observation after all disaster. The spirit of togetherness that exists in Hull brought people closer together following the floods, and the Independent Review Body praised the resilience and underlying strengths of
the communities.'
As for the psychological community as a whole, Ormerod says: 'In the aftermath of the floods I contacted several colleagues in other trauma services to ask their advice on current responses to disaster. One joked that they had a plan in place but no disasters to try it out on, but surely better to be prepared than be caught unawares when disaster strikes?'

References
Brewin, C.R. (2001). A cognitive neuroscience account of post-traumatic stress disorder and its treatment. Behaviour Research and Therapy, 39, 373–393.
Freeman, C., Flitcroft, A. & Weeple, P. (2001). Psychological first aid. Edinburgh: The Rivers Centre.
National Institute for Clinical Excellence (2005). Guidelines for treating post-traumatic stress disorder. London: Department of Health.
Norris, F.H., Murphy, A.D., Baker, C.K. & Perilla, J.L. (2004). Postdisaster PTSD over four waves of a panel study of Mexico's 1999 Flood. Journal of Traumatic Stress. 17, 283–292.
Tunstall, S.M., Tapsell, S.M., Green, C. et al. (2005). The health effects of flooding. Journal of Water and Health, 4, 365–380.

Life as an occupational psychologist

Gene Johnson reflects on his route to becoming an occupational psychologist, and the issues facing the profession

I am Chair of the Society's Division of Occupational Psychology (DOP). My 'day job' is EMEA (Europe, Middle East and Africa) Learning and Development Manager at Dell.

Why psychology?
'Did you choose psychology or did psychology make you this way?' is a question I ask myself and other people. Given that, I can't be definitive about why I became involved in psychology.
I originally majored in political sciences and wanted to change to history, but didn't like the amount of memorisation involved. I have greater strengths in understanding ideas and evaluating them. My view is that if a professional is well-trained, they don't have to memorise everything. They should know where to find a piece of information or a theory. And, as I'll stress, they should have the ability to evaluate it: a frame of reference is essential.
Having studied psychology and I/O psychology at undergraduate level, I took my PhD at Tulane University, New Orleans.
My master's was on intrinsic motivation theory. My PhD researched the effectiveness of structured interviewing using a medical school as the research base. This was quite early in the trend towards more structured interviewing. I was able to develop training in the technique at the time and structured interviewing is proving a really valuable replacement for the old-style informal conversation that used to be a main basis for recruitment and promotion.

Working
I initially worked in the US Internal Revenue Service before moving to the US Office of Personnel Management.
I then moved country and sector to become a lecturer at the University of Auckland, New Zealand. I set up my own consultancy and created an externship programme to match students to employers.
My involvement with Cranfield's International Strategic HRM survey led to a sabbatical at Cranfield, after which I worked at Ford's Unit on People and Management Skills in the UK.
So, I've worked in government, academia, consulting and corporate life. They all have their different challenges.
The transitions can be difficult, particularly from consulting to corporate life and from academic to consulting work. During these sorts of changes you'll get questioned closely about whether you have the right mindset, approach and particular sorts of knowledge for the area you want to move into.
I think it's important to have this sort of range as an occupational psychologist now: you need academic skills to give credibility, an evidence base for your interventions (I'll return to this) and experience
of real-world problems. You need to think like a scientist-practitioner. In addition, career structures mean you'll likely not stay in one sector for life; you need adaptable skills.
Working in a consultancy may narrow you down – most commonly you 'earn your stripes' by specialising in one area to the exclusion of others, such as assessment centres or leadership training. Alternatively, although only rarely, you may have to be a jack of all trades – and too busy for self-reflection, keeping up with other people's research or, as I believe we should do, embedding research into practical situations.
While many bigger firms in the USA will hire someone with the job title Occupational Psychologist, it's much less common here where trained psychologists will tend to be hired as an HR person, a coach or a trainer.
I think a great way to help broaden experience and set up one's career with an appropriate science-practice orientation is the internship. Some of the big firms have them, but they're not that common. It's something we're trying to give more structure to and emphasis on in the DOP; we're doing this through our Employer-Academic Forum, which is one of the initiatives I've set for my year as Chair. The internship can help get one's foot in the door, as well as help with chartership logbook entries.

An international dimension
I've worked in three countries: the USA, New Zealand and the UK. There are differences in the way occupational psychology is practised, although I think this is less to do with distinct cultures than of critical mass.
The US simply has more psychologists: there is probably a greater awareness of occupational psychology, and it has very developed infrastructures. That's why SIOP (The Society for Industrial and Organizational Psychology: Division 14 of the American Psychological Association) runs the most useful conference I go to.
International occupational psychologists go to SIOP to deliver and take part in a programme of rigorous papers and symposia. I'd like to see us upgrade equivalent events in the UK.
In terms of training, the breadth and depth in US graduate programmes are really enviable. My master's course was long enough to give a rich understanding of the subject and do genuine research. I'm not convinced that a one-year master's really gives time for good research design: to learn to be a genuine scientist-practitioner.

Present issues
My job at Dell reflects current issues in our profession. It's international and part of it involves running a team of management development trainers across the EMEA region. The training topics are typical of a large corporate: communications, management, cross-cultural and remote leadership, as well as the corporate induction programme. I also liaise between the central team and some of the business units, such as emerging markets where we look at business areas we can impact using psychological principles.
But a lot of time is spent on the identification, development and coaching of talent: the issue that dominates the HR and business press at the moment.

The future
The last point is a key one for occupational psychologists and the Division. We need to integrate research into practice. Psychology is an applied science – with a bit of art about it!
So we need to back up our interventions with evidence and theory. We shouldn't be frightened of bringing psychology into the conversation with science. That's why critical intelligence is so important. We need to ask questions like: Why did or didn't that intervention work? Which intervention has the best evidence–base for real success? If we don't introduce our specialist knowledge and stringent thinking, why should anyone want to use us?
We need to create more time for practitioners to keep up to date with new ideas.
In 10 years' time, I'd like to see more larger firms in the UK using teams of people with the job title Occupational Psychologist. In my view, we probably need a longer, more in-depth postgraduate training programme. The focus of my year as Chair of the Division is on the science-practitioner model and how every aspect of the profession – from training to practice – can strengthen that model.