Medical Fitness To Dive

Self-assessments, links to information about conditions and lists of diving medical doctors.

Am I medically fit to dive?

Where to access psychological therapy & support

Recommended options for post-traumatic stress, stress injury, anxiety or other mental health concerns due to diving trauma are similar to those for people who have had an accident / incident in any other area of life (e.g. road traffic incident, assault, severe illness). You may also want to consider how important it is to you that the healthcare professional understands scuba diving.

  • NHS

    In the UK psychological therapy is available via the NHS, accessed via your GP. If you have received care from a diving doctor (e.g. recompression therapy), and have signs/symptoms of PTSD or other mental health issues, the diving doctor may include this in the referral to your GP. Your GP then provides follow-up care & further referral to local mental health. To our knowledge, there are no specialist Diving Psychology services via NHS.

  • Health Insurance

    Private Health Insurers will often cover psychological therapy for post-traumatic stress and other mental health issues. You may need a formal diagnosis of PTSD to access therapy. You would need to check with your provider whether or not you are able to claim therapy sessions; and whether their providers have expertise in diving.

  • Self-Funding

    If self-funding is an option for you, access a therapist / psychologist in private practice. This option often opens more options to access a therapist of your choice. You can also access private therapy without a diagnosis (e.g. concerns that are specific to diving, prevention and improving skills). Therapy can be within practice or remote, online.

The decision to return to diving after a negative or distressing experience is highly personal.  What you decide will depend on a wide range of factors including the severity of the event, your role within it, loss or injury, relationships your opportunities, motivations, attitude to risk, personal values and many more.

Before returning to diving after an adverse event in diving, you first will need to consider whether you are medically fit to dive. If you were not injured in the event, or were a witness or rescuer, then there may be no impact on your medical fitness to dive. However, do also consider that anxiety and other mental health issues may be important in the decision about fitness to dive.  If you are not sure, use the link above and seek medical opinion.

If the outcome of the event was minor or you were not personally connected, it may be that you are diving again straightaway.  Perhaps you need a few days rest or, for more significant events a longer break.  This page covers a few things you may want to consider and look out for when returning to diving after an incident/accident.



The Nature of Unprocessed Trauma

Adverse diving experiences can impact subsequent dives

  • Wellbeing

    Going through a distressing experience can have multiple impacts on general health and wellbeing. For example, it may affect sleep, mood, energy levels and concentration. All of these things can affect our stress levels, decision-making, communication and ability to perform tasks.

  • Triggers

    One weird thing about trauma is that sometimes you feel ok until something "triggers" the unprocessed parts of the memory. When this happens, a person may become suddenly stressed by the threat, not think clearly and possibly lose control. If the adverse event happened underwater, it is possible that the triggers are underwater!

  • Avoidance

    Avoidance is a core feature of post-traumatic stress. Avoiding emotions, thoughts and sensations associated with a distressing memory can cause a blockage to learning and a resistance to doing important things. It also leads to disruption of communication and unwillingness to address concerns.

Making it work,

Or making it worse?

You have probably heard of the concept of facing fear, or "getting straight back on the horse".  Many divers, after having an incident that did not lead to physical harm, will turn to this approach.  If you are well, and physically fit to dive, and were not too overwhelmed by the event, .. this can work out ok.  

But sometimes it makes it worse.

This is because a person who has been through a difficult ordeal will have used a lot of energy and will still be in, or recovering from the "fight/flight" reaction.  It can also be an issue that the event happened underwater, so the brain and body may only react when in that same environment again.  

When we have not processed a threatening experience, then re-entering the same situation may lead to strong psychological and physiological reactions.  This can sometimes happen even when the diver was not harmed in the first incident, particularly if they were overwhelmed by the situation in some way.

A pattern I see regularly with divers who have had a bad experience, is that they return to diving and are triggered by something that links to the original incident.  They panic, or almost panic, and end the dive.  The brain registered that this was yet another threatening situation and learns that next time it happens, a similar reaction is needed.  Of course, this reaction can easily lead to panic, which is an unsafe state underwater.  The person is keen to dive, so they try again.  The same thing happens, often worse or even shallower.  The diver becomes increasingly anxious because each time this happens they are being "re-traumatised".  They may also engage in avoidance behaviours: actions they take to help feel better, but that do not really improve safety in the long term.  These behaviours feed into a cycle, and cement the message in the nervous system that the situation is threatening, and must trigger "fight/flight".  

Not only is this dangerous, the repetition can cause the issue to become more and more entrenched.  As a psychologist, if I see someone straight after a single-event trauma, there is a lot I can do.  On the other hand, if the pattern has become entrenched, it can often be more challenging to address, and many more appointments needed. 

This can often be avoided through simple measures, for example, having a rest, then starting with some very easy dives and gradually building up. (More tips below).  If it does begin to happen, get help to address the trauma, panic or anxiety before returning to diving. Panic episodes are a real concern and fall under medical fitness to dive, and could prevent diving in future.

Difficulty Returning To Diving

Mental blocks or Post-Traumatic Stress

I offer online therapy and coaching to divers to address mental blocks to diving, including specific skills.
Book a 15 minute call

You could be fine!

About Two-Thirds of people DO NOT develop symptoms of Post-Traumatic Stress (PTS)

It is hard to know what the rates of post-trauma conditions are in divers, research suggests 25 to 30% may show symptoms that meet criteria for PTS. 

It is normal to have some reactions for a while, such as bad dreams, lots of thoughts about the event, guilt etc.  This does not mean you are unwell.  It means your brain is processing what happened.  

People can and do heal naturally following traumatic events.  There is every possibility that you will be ok!  

SAFER DIVING

An option for divers who are keen to improve the safety of their future diving.

Things to consider

If you are returning to diving after a diving-related accident or incident, then here are a few things you may want to consider.

  • ADDRESS MENTAL HEALTH: If the adverse diving experience has led to mental health concerns (e.g. PTS, depression, anxiety etc) then address these. If the issue is affects psychological fitness to dive, it may need to be resolved or managed before returning to diving.

  • SCUBA SKILLS: Consider a skills refresher, or support from an instructor to work on diving skills. For example, if the incident arose because a leaking mask lead to panic, then work on mask skills. There may be skills that would help you to feel more confident.

  • COMMUNICATE WHAT YOU NEED: Perhaps this will be with your buddy, team or professional guides and can be in advance of the dive(s). It is up to you what you share and it may be helpful to let other know your needs and limits in advance. A professional guide will be able to take actions within their role, such as how they organise the dive and communicate with you.

  • BUILD-UP CONFIDENCE: Set-up the first few dives to make it highly likely that you will be able to have a positive experience and will not need to end the dive due to unwanted inner experiences (thoughts, emotions etc).

  • START EASY: A shallow dive, with a trusted buddy or guide without significant challenges. Start slow and gradually increase depth and challenge to your previous level (if desired). Consider pool dives and snorkelling, then very shallow dives. Slow is Fast.

  • PREVENT PANIC: If you return to diving and panic underwater, or nearly panic and end the dive due to anxiety, then this needs to be addressed. Continuing to dive while frequently reacting to triggers not only risks physical harm, it also risks re-traumatisation and more permanent psychological issues that affect future diving.

  • APPLY LESSONS: When a dive goes wrong, there is usually something to be learned. Whether that is a skill that needs more work, a situation to avoid or a procedure that needs to be changed. Make these changes for increased safety and to act on things that are within control.