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New research suggests treatment for psychological injury following road traffic accidents can be cost-effective, which spells good news for motor insurers, write Dr Manda Holmshaw and Pippa Smith

In May this year Post reported that total motor claims costs are predicted to reach £10.9bn by 2012, despite improvements in safety and the total number of accidents reducing from 222,000 in 2002 to 189,000 in 2006 (8 May 2008, p4).

Anecdotal feedback from the insurance sector also suggests there is an increase in claims for psychological injury due to road traffic accidents. One factor influencing this could be heightened public awareness of psychological treatment. So a key question motor insurers would undoubtedly like answered is whether such mental health conditions resulting from RTAs can be treated cost-effectively.

Psychological problems consequent to RTAs include post-traumatic stress disorder, travel phobia, depression, anxiety and chronic pain - and more than one of these conditions may be present. Conditions can also be persistent, causing long-term difficulties including delayed return to work or even loss of a job, thus increasing the damages claimed.

To substantiate this, a longitudinal study of 1148 RTA casualties at Oxford Radcliffe Hospital's accident and emergency department identified a high incidence of psychological problems that persisted over time, despite there being only minor or no physical injuries.

The outcomes were published by Mayou and Bryant in 2001 and 2002, within the British Journal of Psychiatry and Psychological Medicine respectively.

The research found at three months post-accident, 36% of individuals had psychological disorders. After one year this figure had fallen to 32%, but three years following the RTA the problems reported remained prevalent - at 26%.

Efficacy of treatment

In terms of what psychological treatment is effective for PTSD after a single traumatic event, guidelines published by the National Institute for Health and Clinical Excellence in March 2005 recommend between eight and 12 sessions of either cognitive behaviour therapy or eye movement desensitisation and reprocessing. Nice advises against generic counselling (Post, 26 October 2006, p27).

Until now, no large sample research has been carried out specifically on personal injury claimants who were involved in an RTA. But the results of a new study have just been produced. These stem from assessing and treating 1179 consecutive motor PI claimants, referred with possible psychological problems resulting from an RTA. The aim of this research was two-fold: to analyse the efficacy of evidenced-based psychological intervention and assess if Nice guidelines are supported for PTSD in RTA claimants; and to identify the factors that may impact the success of treatment.

Treatment sample

Of the 1179-strong claimant sample, one-fifth received a full psychological assessment only, while 65% (763) of the full sample went on to treatment. Of those, 692 completed the treatment recommended.

The treatment sessions consisted of CBT, EMDR or a combination of both. Outcomes were measured subjectively by the therapist and client as well as objectively using industry standard psychometric scores.

Despite the variation in the sample in terms of severity and complexity of conditions, treatment for four out of every five patients was successful or showed much improvement and required 12 or fewer treatment sessions.

Across the group, on average nine sessions of treatment were required. This is comfortably within the Nice recommendations of eight to 12 sessions of treatment for psychological problems resulting from a single traumatic event.

Influencing factors

When it came to identifying what factors affect treatment outcomes, age was one indicator: children under 16 and claimants over 60 needed fewer sessions than younger adults. EMDR was particularly successful with children.

Socio-economic status and gender did not affect treatment outcome; but the greater the lag time from the date of accident to referral, the more sessions were required for successful treatment outcome. Referrals within three to six months of the date of the index accident were generally more cost-effective.

A change in claimant employment status from pre-accident to post-accident predicts poorer treatment outcomes. Coping with the change in employment status, as well as the accident, may be the reason for this.

There was a strong indication in the sample that claimants who fail to attend more than two treatment sessions, without legitimate cause, will have potentially poorer outcomes.

The upshot is that psychological trauma following an RTA can be treated cost-effectively and the latest research supports Nice's guidelines for treatment of PTSD when applied to RTA claimants. Secondly, the results highlight the importance of a psychological assessment a short time prior to commencement of treatment.

Natural human resilience means not everyone requires psychological treatment after an RTA. For example, 17.5% of the total research sample was found to be well at assessment and required no further treatment. In some cases, dated medico-legal assessments legitimately recommended psychological treatment but due to the protracted period between this assessment and referral, natural healing took place. So embarking on treatment at this stage - without re-assessment - could be an expensive and inappropriate endeavour.

The research also confirms that early referral reduces both human and financial cost: trauma-induced behaviours become more intractable over time and harder to change, increasing cost.

PI claims costs in the motor sector may be on the increase but psychological trauma need not be an expensive rehabilitation cost for the claims handler.

Dr Manda Holmshaw is a consultant clinical psychologist and clinical director of Moving Minds, which carried out the research, and Pippa Smith, an occupational psychologist, is its business relationship manager.

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