Despite the evidence – why are we still not creating more trauma informed mental health services?

Abstract

Purpose -Despite evidence that exposure to traumatic events can be an important antecedent to a range of serious and chronic mental health problems -it appears that within the British National Health Service at least, this is still not fully understood nor acted upon. This paper aims to examine this evidence and asks why these findings have not been fully implemented in terms of updating practice.Design/methodology/approach -A literature search was undertaken alongside relevant British DH policy. This resulted in a subsequent policy analysis.Findings -Although there have recently been changes in recommendation in clinical practice (e.g. CPA guidance) and policy (No Health without Mental Health) it appears that although some knowledge in this area has been changed into policy, its implementation remains ''patchy''.Practical implications -This short paper outlines some of the evidence, examines current issues and highlights a possible pathway which might be of value in addressing this.Originality/value -This short paper highlights traumatic exposure as an important antecedent to a range of mental health issues and highlights ways in which this may be assessed and, where relevant, addressed.

Are mental health services getting better at responding to abuse, assault and neglect?

“…The barriers to asking about abuse have received a small amount of research attention , but the barriers to responding therapeutically following disclosures remain, apart from a misguided belief in some staff that psychosis is unrelated to adverse life events , unidentified.…”

“…Two recent qualitative studies in London, focussed specifically on domestic violence, have found that both service users and professionals believe that the medical diagnostic and treatment approach can be a barrier to inquiry and that service users experience mixed responses from staff following disclosure .…”

Comorbidity between PTSD and Anxiety and Depression: Implications for IAPT Services

“…Supervisors (who are trained in detecting PTSD) can ask the supervisee appropriate questions that will ensure that the impact of trauma is less likely to be missed. The introduction of a screening tool for PTSD and an increased emphasis on trauma/PTSD in supervision will create a trauma-informed service, which is widely recognized as being of value in the US [18] and likely to be benefi cial in all mental health services.…”

The PCL as a brief screen for posttraumatic stress disorder within schizophrenia

“…Longden et al, 2012;Steel et al, 2005) and in the development of trauma-focused treatments for this population (Frueh et al, 2009;van den Berg et al, 2015). Epidemiological findings and therapeutic developments have contributed to recent calls for more trauma-informed mental health services (Rose et al, 2012), including the routine assessment of trauma history and current symptoms of posttraumatic stress. There is, therefore, a need for a brief screening instrument to identify those requiring trauma focussed interventions.…”