Counselling is widely recommended - but in reality it can be impossible to find when you are in a crisis. Angela Neustatter reports
ROB WHARTON was finishing work on Saturday afternoon, locking up the office where he worked. He was attacked from behind by two men who beat him around the head and knocked him face down to the ground, tied his wrists and ankles with wire then bound his eyes, nose and mouth with sticky tape before ransacking the place for money. If a passer-by had not found him hours later, he would certainly have died.

That was almost three years ago but the nightmares, the panic attacks, the constant terror if he is out that someone is coming up behind, are what Rob has lived with since the attack. He went to his GP who did little until it was clear that Rob was becoming more distressed - at which point he was referred to a community psychiatric nurse. She was not qualified to give the help he needed. The psychologist he could have seen, trained in trauma work, had a three-month waiting list. Rob's GP bought in a psychotherapist for 12 sessions, but just as this appeared to be making some difference the sessions came to an end and Rob was told there was no trust-fund money for further treatment. It was then that Rob tried to kill himself with an overdose.

He is not alone. Paul Ride, the Englishman recently released after the trauma of spending months in an Iraqi prison, recognised that he urgently needed help. He rang the Traumatic Stress Clinic at the Middlesex Hospital. They could only offer him an appointment weeks ahead. Ride attempted suicide.

After Brenda Geransar's 18-year-old daughter Roxanne was killed by a drunken driver she too turned to the Middlesex for help. There was a three month wait - an eternity for someone suffering the vivid flashbacks, nightmares, panic attacks, the sense of guilt and despair which are the classic symptoms in a trauma victim. Brenda could not face going on and left a note saying: ``Better a dead wife than a mad one'' before she threw herself under a Tube train and died.

If any of these people had suffered their traumas in a large-scale disaster they would have been offered instant treatment designed to ``debrief'' them - help them work through their experience and make some sense of the chaos and anguish they were feeling. There would have been long-term counselling and any other care considered necessary. But if you are an individual suffering equal devastation but alone, do not assume there will be help for you.

Despite Home Secretary Michael Howard's insistence on the importance of caring for victims, there is little sign of the resources to provide the help they need. This is even though the professionals in the field report that they are unable to cope with the greatly increasing demand from victims of crime and accidents whose lives are wrecked by what has happened to them.There are just a handful of clinics around the country specialising in the care of victims of trauma.

Trauma is generally diagnosed by the state of the patient, rather than the event which triggers it, as people react very differently to similar experiences. A traumatised person suffers symptoms which can include flashbacks, time distortion, loss of emotional control, a heightened sense of danger, sorrow and guilt and psychosomatic symptoms. Although an increasing number of GPs know the danger of Post Traumatic Stress Disorder - which occurs if a trauma is not treated quickly - there are far too few suitable clinics or practitioners to which they can refer. The Middlesex Hospital in London has one of the best known clinics; they aim to do critical debriefings within a week of an accident and give treatment for established Post Traumatic Stress Disorder within a month. But their waiting list has, as Mrs Geransar found out, been up to three months long. Dr James Thompson, joint head of the clinic, says: ``If we had the resources we would offer emergency treatment, that is within 24 hours, because it's generally agreed this is the most effective. My colleagues and I would very much like to be able to offer more than we do. We take people who have experienced a major threat to life and whom the new health service is willing to pay for. But there are certainly fund-holding GPs who will not fund a patient's request to be treated by us, people who we believe need help badly.''

Professor John Gunn runs the highly-respected Victim Clinic at the Maudsley Hospital in London where waiting lists stretch into the new year. The government funding they were given to set up runs out in April, after which the treatment they have been offering free will have to be paid for by fund-holders. Professor Gunn fears many local health authorities do not consider victim treatment a priority. He puts it bluntly: ``There is not a lot of help for the poor old victim at the bottom of the heap.''

Roderick Ormer, head of the Psychological Service in Lincoln, who runs a clinic specialising in Post Traumatic Stress Disorder says he has to turn away three patients in ten. The Cullen Centre in Edinburgh, where 70 per cent of patients are victims of crime, takes people who have not been helped immediately after the trauma and are suffering abnormal reactions some months later. They now have a waiting list of six months.

The Victim Support organisation receives government funding, but it relies on volunteers to see victims at its 376 centres around the country. It provides immediate help free to anyone, and sees more than a million people a year. ``We refer victims to trauma clinics when we can,'' explains spokesperson Helen Peggs, ``but there are nowhere near enough people doing that work and we are not able to offer specialised treatment. We see the degree of pain and anguish which crime and accidents cause. It is heartbreaking to think these victims may not be helped properly.'' Practitioners talk emphatically of the difference that specialised care can make to a victim. Lynn Brown, Senior Fellow in Sociology at Liverpool University carried out some research for the Home Office in 1990, looking at the impact of murder on 100 victims' families - people known as ``secondary victims''. She says: ``We found that if somebody was helped fairly quickly to get a sense of control over life then deep traumatic stress doesn't seem to happen to the same degree as if they are left to cope alone.'' Psychologist Lori Beth Bisbey has also researched patients with diagnosed Post Traumatic Stress Disorder. ``We used several measures, but all the people who had had treatment came out far better than those who had not been helped. Intrusive imagery, nightmares, panic attacks, and depressive symptoms were relieved.''

A government-commissioned report reviewing psycho-social services in England and Wales, submitted to the Department of Health in 1993, recommended that localised Post Traumatic Stress Disorder clinics should be set up around the UK. Nice idea, agrees Doug Morris, who with his wife Wendy has set up the Trauma Aftercare Trust. But for the time being counsellors trained in treating victims are urgently needed.

Doug Morris knew lots of people returning from the Gulf War and, having suffered from PTSD himself after working as a troubleshooter in the Far East, he recognised their problems. He and Wendy decided they would try to help, and put up most of the money themselves to set up first a helpline, then a training group for trauma work. ``We set up TAT 18 months ago to train people, using a proper qualification through an established body, with the aim of setting up a national network to which doctors can refer patients,'' he explains. He knows how desperate people can become and points to 15 attempted and five actual suicides by people who couldn't get help quickly enough. Morris is appalled at the way services so often exclude secondary victims even though they may have seen the most horrifying things or lost a member of their family. He says: ``Witnessing an event makes you a primary victim just as if it happened to you. You become dysfunctional, relationships break down, there may be awful feelings of guilt and rage at what happened. People urgently need help to work through all this but bad counselling from untrained people or those who take the 'least said soonest mended' approach can be positively harmful.''

But that may be the fate of the increasing number of victims of crime and accident if their trauma is not taken seriously enough. Inner anguish does not show up like broken limbs, nor does it have the obvious urgency of treatment for cancer or heart disease. But Post Traumatic Stress Disorder may consign people to many years of being trapped re-living the horror of what happened. Vivienne Wharton, the wife of Robert, says: ``He just shrivelled up after the attack. He's lost his heart and soul and I've lost a husband.''

Organisations for victims:

Assist: Aid Support and Self-Help in Surviving Trauma, 38 Southfield Road, Rugby CV22 5NJ. Tel: 0788 535677

Samm: Support After Murder and Manslaughter, set up by Victim Support at the same address: Cranmer House, 39 Brixton Road, London SW9 6DZ. Tel: 0171 735 3838

Trauma Aftercare Trust, Buttfields, The Farthings, Withington, Glos GL54 4DF. Tel: 0242 890306