Do trauma survivors miss out on valuable treatment?
Hundreds of thousands of people every year in the UK suffer from the severe stress reaction, post-traumatic stress disorder (PTSD).
But Dr Jennifer Wild of the Institute of Psychiatry at King's College London says in this week's Scrubbing Up that they are not getting the help they need.
I'm treating Paul, a young man who was stabbed in London in 2001. Terrifying memories of the attack replay over and over in his mind. He can't concentrate, feels scared, and has been unable to leave his house.
He has post-traumatic stress disorder (PTSD) and has been suffering for 10 years. But it is only now that he's getting treatment.
Sadly this is a common story for trauma survivors.
They wait years before getting the help they need because they're ashamed they're coping so badly and many don't even know that their symptoms can be treated.
But that's not the only problem. GPs don't know enough about what PTSD is and how it should be treated.
An estimated 1.5% of England's adult population suffer from PTSD. That's over 700,000 people and research shows that much less than half this number will go to their GPs for help.
'Nothing to fix the source'
Even when sufferers pluck up the courage to talk to their doctor, surveys show that many GPs are not very familiar with PTSD or the best way to treat it.
Many, like the man I'm treating, are given drugs for depression or insomnia.
That's because some of the symptoms of PTSD overlap with depression and some symptoms, like sleep problems, may appear to be the source of the problem.
But drugs for depression are less effective than talking therapies for PTSD, like cognitive-behavioural therapy. They also have unpleasant side effects.
Sleeping tablets are addictive and are only a patch on one of the symptoms, doing nothing to resolve the source of the suffering.
When GPs hear their patients talking about sleep problems or feeling low, they should also ask if the patient has been through a traumatic event. Then they need to ask about the classic symptoms of PTSD.
Is the patient having unwanted memories of what happened, nightmares, or flashbacks? Are they avoiding reminders, such as talking about what happened or activities, such as driving, that may remind them of what happened?
People who have suffered through a trauma and are suffering with PTSD can get cognitive behavioural therapy, one of the leading treatments for PTSD, through the Improving Access to Psychological Therapies Programme (IAPT). They can self-refer or go to their GP and ask to be referred to a local IAPT service or to one of the UK's specialist trauma clinics.
But there are other ways to get treatment. Many clinical research centres offer treatment as part of ongoing audit or research development programmes and patients can usually get access to this treatment within weeks.
So to redress the balance between the number of people suffering from PTSD and the numbers getting treatment, patients and GPs need to be aware of the symptoms that make up the PTSD diagnosis, understand that some symptoms may overlap with depression, and to be aware of the treatments that are available.