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New study aims to develop a trauma-informed model of primary and community mental health care

20 July 2020

Researchers at the University of Bristol’s Centre for Academic Primary Care are leading a study to inform the development of a UK-specific trauma-informed model of care that will help GPs and community mental health professionals care more sensitively for patients.

Trauma is widespread, harmful and costly. It occurs as a result of violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences. Most patients seeking mental health services have experienced trauma, with abuse most commonly having occurred in childhood. Patients can be re-traumatised in health care environments or in relationships with health care professionals that are not adapted to consider, recognise and respond sensitively to that trauma.

A trauma-informed model of care involves using a series of guiding principles when treating patients, including safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and cultural, historical and gender issues. It includes making service improvements, and training staff about the impact of trauma and ways of treating patients in a way that does not trigger their traumatic experiences.

The concept of trauma-informed care, developed in the US, has recently been implemented in the UK in the areas of criminal justice, homelessness, schools, and children and family services. However, there are few examples of trauma-informed practice in health care settings. NHS England has recommended developing the evidence base to demonstrate the value of trauma-informed health care approaches in the UK.

Using Cochrane methods, the study team will conduct a systematic review to establish the evidence base for the effectiveness of trauma-informed approaches in other countries and to identify successful models that could be adopted in the UK.

The systematic review will be complemented by a review of policy documents on trauma-informed health care. The team will bring the results together in an evidence synthesis to inform development of a UK-specific model of trauma-informed health care that can be used in general practice and community care. They will collaborate with healthcare professionals and patient and public involvement (PPI) groups, particularly seeking the advice of members of the public who have experienced trauma and have sought treatment from health care services.

Dr Natalia Lewis, Research Fellow at the Centre for Academic Primary Care, said: "Given the likely increase in trauma among the general population due to mental health impacts of the current coronavirus pandemic, the need for effective and understanding primary and community mental health care is more important than ever.

"Incorporating trauma-informed model of care principles into patients’ treatment will require organisational and cultural changes in health care delivery in the UK. These changes will need to focus on creating environments and relationships that promote recovery and prevent re-traumatisation.

"Once this first stage of reviewing the evidence is complete, we will develop a workable model for the UK, and apply for funding to test the feasibility and acceptability of the model in practice."

The TAP CARE (Trauma-informed approaches in primary care and community mental health care) study is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre.

Find out more about the study in the study protocol.

Patient and public involvement in the study

Members of the study’s PPI group have said that they chose to join the study because they want to use their treatment experiences to make improvements for other patients in the future, and from their experiences, prevent others from experiencing the same difficulties within the healthcare system. They have helped in a range of activities, including choosing the name of the project and reviewing this article. They have also expressed interest in how the project is completed in regard to the research process and believe this project will improve the health care system for all people including those who experience trauma.

Further information

About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

About the National Institute for Health Research
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

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