Don't force Thai cave boys to talk about it, says British psychiatrist adviser

When the 12 young members of the Wild Boars football team emerged from the snaking caverns of Tham Luang, northern Thailand, the first concern was over their physical condition.

The boys, aged between 11 and 17, had been trapped with their 25-year-old coach underground for 18 days by monsoon rains, before they were sedated and led to safety in a dramatic rescue by specialist divers.

But as she watched the events unfold, Rebecca Sheriff, a British psychiatrist specialising in childhood mental health, knew the psychological effects of their ordeal could be more long-lasting. “There was almost a public response which was ‘Oh my goodness, these kids are going to be messed up, something has to be done’, and I was nervous that the services and the powers that be would take that on," she said.

"They knew that debriefing is not the thing to do but weren’t quite sure how to go about all the things they needed to do."

Ms Sheriff, who trained at Balliol College in Oxford and who holds dual British and Australian citizenship, now lives with her family in Bangkok where she provides clinical supervision to doctors at the King Chulalongkorn Memorial Hospital. When the boys first emerged from the cave, she volunteered her services to the deputy mental health minister.

Ms Sheriff advised a policy of "watchful waiting": find out about vulnerabilities and allow the traumatised boys to rely on their established social networks.

Rebecca Sheriff

“When bad things happen, people say ‘oh, you should talk things through’, almost like it’s this Freudian idea that psychological pus gets discharged if we talk about it,” she said.

“But actually we know from research that that is one of the most harmful things you can do because it runs the risk of re-traumatising them. For some people it will be helpful to talk, but what we have found from military studies is that you are better off talking to your friends, your family and your normal support networks than to a psychiatrist or health-care professional - why would you want to talk to some stranger?”

The boys were kept in a carefully controlled hospital environment, with their loved ones allowed to see them through protective glass. The children were also protected from media intrusion, with a managed press conference arranged a week after the boys emerged. “The kids were taking a lot of comfort from each other, obviously having been through it together and having been football team-mates and having that camaraderie," said Ms Sheriff.

She said reassuring the parents was another crucial step in the process. “Research in Australia on the traumatic after-effects of bushfires has shown that one of the biggest predictors of children not coping well with trauma is having parents who have not coped well," she said.

“There’s a natural and normal response which is that if your child has been through a trauma to protect them, but what was found there was that if the parent continues to be anxious and over-protective, and almost restrict that child from having a normal adolescence, then you have a more severe long-term mental health effect, not just post-traumatic stress disorder (PTSD), but depression and anxiety as well.

"So a lot of the watchful waiting is about reassurance, making sure people know services are there if they need them.”

The group were released from hospital after a week and have recently returned to school, after all but one of them spent nine days in a Buddhist monastery, a tradition for Thai males who experience adversity. Three young players and the coach, Ekapol Chanthawong, have also since been granted Thai citizenship, having previously been stateless.

Throughout their time in the cave the coach tried to get the boys to use meditation in an attempt to remain calm and use less oxygen, which Ms Sheriff said was a positive distraction. “A lot of the techniques from meditation are similar to mindfulness and hypnosis,” she says, “so you wonder if it’s actually pretty protective”.

Of the 13 people and their families involved, Sheriff said it was likely only one or two could require professional treatment in future.

Reflecting on the cave rescue, Ms Sheriff had nothing but praise for the way the Thai authorities grappled with the unprecedented problem. “There was a lot to admire about how amazingly the Thais coordinated a huge international effort to get the kids out of the cave and of people offering up their help. The way the Thai authorities weren’t overwhelmed and were able to coordinate a response was incredibly positive.”

Of her own involvement, she was happy just to be available. “You’ve got to take your pride out of it,” she said. “Offer what you think might be helpful, see what they take up and walk away.”