Why do we need to engage more with patient trauma?
The pressure on healthcare systems driven by traumatic experience is on the rise, and trauma is a major driver for poor mental and physical health throughout life – yet our healthcare systems aren’t engaging with it enough. How can we do better?
1 in 3 adults in England report having experienced at least one traumatic event in their lives, which involved exposure to risk of serious harm or death .
Many of those who experience traumatic life events don't have a clinical diagnosis of post-traumatic stress disorder (PTSD) but have nevertheless been affected by complex trauma. This can impact everything from their mental and physical health to their behaviours and the way they engage with medical services.
Our consultant Mikoto Nakajima discusses trauma informed practice and how a more thoughtful approach to engaging with those with lived experience of trauma can benefit the individual and can also have major benefits at system level for NHS organisations.
How does trauma impact mental and physical health?
The prominence of traumatic experiences is well-known within specific populations like military veterans and in the realm of mental health. However, research highlights that it is a substantial driver underlying a much wider range of behaviours and outcomes across health and social care.
Studies show that 85% of people with multiple complex health and social needs have experienced trauma from one or multiple Adverse Childhood Experiences. Meanwhile exposure to trauma is also known to lead to an increase in the risk of engaging in harmful behaviours such as tobacco and substance use, high-risk sexual behaviours, poor mental health, obesity, heart disease, respiratory disease, and cancer.
The impact of trauma is likely to become even more acute following the COVID-19 pandemic. Current models of trauma focus on the impact of past experiences, so our understanding of how the pandemic contributed to trauma is still limited. Nevertheless, recent studies have already found that COVID-19 can be considered a traumatic stressor event which elicit PTSD-like responses and can worsen other mental health problems.
How does trauma impact the way that we engage with healthcare services?
The pressure on systems from conditions strongly attributed to traumatic experiences is on the rise in recent years. When examining particularly complex diagnoses such as eating disorders which have very high comorbidity rates with PTSD, the UK has seen an 84% increase in hospital admissions for the mental health condition in the past 5 years.
Similarly, many healthcare systems across the country are grappling with high intensity attendances of A&E. The PSC’s primary research with the British Red Cross reported that approximately 370,000 people attended A&E more than five times in 2015, resulting in a total of 2.6 million attendances by this cohort alone. Many of these attendees sustained their behaviour for multiple years and had a complex mix of physical and mental health issues with underlying traumatic experiences and life events.
These behaviours and outcomes are not only detrimental to the wellbeing of each individual but also result in distressing experiences for frontline staff and high-cost interventions for the system.
What is a trauma-informed approach, and what benefits can we expect?
Given the scale of traumatic experiences across service users in the care system, we need to take on an approach to interacting with individuals in a psychologically, emotionally, and physically safe manner to avoid retriggering any trauma and exacerbating it. This is true for any process that involves engagement with individuals who have lived experience of trauma.
Trauma-informed practices are designed to achieve this aim. It is a strength-based approach seeking to account for and respond to the impact of trauma on people’s lives, aiming to empower individuals to re-establish control of their lives at every point of engagement. The practice involves principles of self-awareness, trust and empathy.
Benefits for individuals are evident. A thoughtful approach can avoid re-traumatisation and help to build belief that the ongoing costs of trauma can be overcome even when revisiting these experiences. Several studies exploring the effectiveness of these approaches found reductions in symptoms related to trauma alongside improvements in physical health and coping skills.
Embedding trauma-informed approaches consistently can lead to benefits at a system-level as well. Some evidence suggests that it could lead to reduction in the use of methods involving seclusion and restraints. Individuals also tend to stay in treatment and reduce in their length of inpatient stays. These outcomes can also positively impact staff, where burnout and turnovers could be reduced.
Why is this important for co-production, and our work at The PSC?
Healthcare systems are passionate about delivering transformation using principles of co-production at the core. Co-production ensures that people, family members, carers, organisations and commissioners work together in an equal way, sharing influence, skills and experience to design and deliver services. This is especially important when thinking about individuals with complex needs, often including a mixture of socioeconomic, physical health and mental health problems; of which the population is growing.
Co-production usually comes to life through direct engagement with people with lived experience of receiving care for their complex needs. Although people carry out these engagements with the best intentions, they can unfortunately cause unintended harm on vulnerable individuals through re-traumatisation. Many will be forced to remember or relive a past trauma in intense sensory detail when sharing their experiences, posing risk of even further psychological and emotional damage. It is therefore crucial to design these engagements with trauma-informed methods to prevent these outcomes but empower individuals in the process.
Taking on trauma-informed practice is important for our work at The PSC, especially those that aim to reduce health inequalities. As we continue to dive into complex problems in the health and social sectors, we are mindful of ways we can maximise positive impact for each individual and system that we encounter – including both service users and providers.
In our next article, we’ll dive into the application of trauma-informed practices and what they look like in real life.
Author: Mikoto Nakajima, The PSC Transformation team
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