Search results

The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.

The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.

There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.

This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.

An emerging evidence base, and increased awareness of the effects of trauma on the body, advocates a sensory-based approach to treatment with posttraumatic stress and complex trauma survivors. This paper aims to identify, analyse and summarise the empirical evidence for the sensory-based interventions, which occupational therapists are using in the treatment of adult and adolescent trauma survivors.

An integrative review of the literature was undertaken. Both empirical and conceptual papers were included. An inductive approach and constant comparative method were used to understand and synthesise the research.

The literature search yielded 18 papers describing the types of sensory-based interventions used, sensory processing (SP) patterns and the context and evidence for sensory-based occupational therapy practice with trauma survivors. Nine of the studies were empirical and nine were conceptual and review papers. Themes identified included: atypical SP patterns; type of sensory-based intervention used with trauma survivors; and transdisciplinary treatment programmes can reduce the symptoms of trauma.

Sensory-based interventions with adult and adolescent trauma survivors are emerging as promising areas of practice and research in the literature. Although empirical data is limited, the sensory needs of the body in processing trauma experiences is becoming more recognised and are supported by the atypical SP patterns identified in survivors. A sensory-based, transdisciplinary approach to treatment has the potential to be effective in treating the trauma survivor.

With a skill base in sensory integration and occupational analysis, occupational therapists have much to offer the field of trauma studies. This review begins to address the gap in the literature, recommending more rigorous controlled outcome research with larger sample sizes, person-centred studies focussing on the trauma survivor’s perspective and continuing professional development and mentorship for occupational therapists working with this population.

In South Africa, the majority of the population struggles to access care and support for mental health challenges. Drawing on challenges faced by asylum seekers and refugees in the urban margins of Johannesburg, this paper aims to explore the relationship between migration and mental health through a lens of heightened vulnerability, precarious urban spaces and unmet basic needs.

Remote interviews were conducted with respondents working in the mental health-care sector (public and private) and with migrant communities in Johannesburg. Respondents were identified via purposive sampling and interviews were conducted in English. Key findings were identified using thematic analysis.

Effective responses to asylum seekers and refugees facing mental health challenges are based on an understanding of context, of crisis and of the need to meet basic needs such as paying rent, finding employment and providing for families. These “daily stressors” not only compound “extreme traumatisation” but are a form of trauma in and of itself.

This paper shows how alternative responses determined by an understanding of context, of crisis and of the need to meet basic needs provide critical and potentially far-reaching interventions. Locating trauma in the unmet needs, precarious urban spaces and marginalisation opens up space to further question the ways that migration and mental health shape and reshape one another.

Based on an extensive literature review, this chapter outlines key developments in global health and research during the last century with focus on the emergence of violence and child maltreatment as international public health priorities. Violence has been known to humans for millennia, but only in the late 1990s was it recognised as a global public health issue. Every year, an estimated 1 billion children are exposed to trauma, loss, abuse and neglect. Child maltreatment takes a social and economic toll on countries. Research initiated in 1985 found child maltreatment to be associated with increased disease, disability and premature death in adult survivors. The global availability of data on child maltreatment is, however, sporadic with low validity and reliability. Few global experts have consulted and involved the survivors of child maltreatment, as the experts by experience, in their attempts to provide a more comprehensive picture of reality. Youth and adult survivors of child maltreatment are often traumatised by the experience, and it is important to use trauma-informed approaches to prevent re-traumatisation. Participatory and inclusive research on child maltreatment is only in its infancy. There is a need for more inclusive research, designed by survivors for survivors, hereby strengthening local capacity building and informing policymakers from the bottom up. This chapter reviews lessons learnt and provides recommendations for how to enhance the participation and inclusion of the experts by experience in research on child maltreatment.

This study aims to examine the emotional and cognitive responses of frontline homelessness service support staff to the highly insecure attachment styles (AS) exhibited by people experiencing multiple exclusion homelessness (MEH), that is, a combination of homelessness and other forms of deep social exclusion.

Focus groups were conducted with frontline staff (N = 19) in four homelessness support services in Scotland. Hypothetical case vignettes depicting four insecure AS (enmeshed, fearful, withdrawn and angry-dismissive) were used to facilitate discussions. Data is analysed thematically.

Service users with AS characterised by high anxiety (enmeshed or fearful) often evoked feelings of compassion in staff. Their openness to accepting help led to more effective interactions between staff and service users. However, the high ambivalence and at times overdependence associated with these AS placed staff at risk of study-related stress and exhaustion. Avoidant service users (withdrawn or angry-dismissive) evoked feelings of frustration in staff. Their high need for self-reliance and defensive attitudes were experienced as hostile and dismissing. This often led to job dissatisfaction and acted as a barrier to staff engagement, leaving this group more likely to “fall through the net” of support.

Existing literature describes challenges that support staff encounter when attempting to engage with people experiencing MEH, but provides little insight into the causes or consequences of “difficult” interactions. This study suggests that an attachment-informed approach to care can promote more constructive engagement between staff and service users in the homelessness sector.

There is a high prevalence of trauma among mental health clients, with risk of re-traumatisation when admitted to a Department of Psychiatry (DoP) (Kimberg and Wheeler, 2019). The COVID-19 pandemic poses challenges to therapy service operations in DoPs, with infection control measures impacting opportunities for therapeutic and social engagement. A trauma-informed care (TIC) lens was used when adapting services in Tallaght University Hospital DoP in response to COVID-19.

An interdisciplinary approach was taken to adapt therapy services during early stages of the pandemic. Changes were informed by TIC principles to minimise re-traumatisation while maintaining high-quality services. Changes included expansion of the therapeutic activity programme, changes to groups, addition of COVID-19-specific groups and increased awareness of communication support needs.

The early response to the pandemic, combined with the focus on TIC, resulted in continued, effective therapy services and positive client feedback. With clients’ involvement in their care enhanced, Individual Care Planning goals were achieved through group interventions.

The COVID-19 pandemic brought unprecedented changes to mental health services. This paper highlights a response to unique challenges brought by COVID-19 on a DoP.

This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.

This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).

Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.

This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.

The COVID-19 pandemic has impacted the functioning of education systems in a multitude of ways. In Ireland schools closed on March 12th and remained closed for the remainder of the academic year. During this time educators engaged with students, families and colleagues in new and diverse ways. The purpose of this study was to explore educators' experiences during the closures, particularly regarding the impact of the pandemic on the wellbeing of students, school staff and wider school communities.

A series of one-to-one interviews, lasting approximately one hour, were conducted in July 2020 with 15 education professionals online via Zoom or Microsoft Teams. Participants occupied various roles (classroom teacher, school leader, special educational needs coordinator, etc.) and worked in a diverse range of communities in Ireland. Qualitative data from interviews were transcribed and emergent themes identified through an inductive followed by deductive analytic approach.

The interviews highlighted the central role that schools play in supporting their local communities and the value teachers place on their relationships with students and families. Many teachers and school leaders found themselves grappling with new identities and professional boundaries as they worked to support, care for and connect with the students and families they serve. There was considerable concern expressed regarding the plight of vulnerable or marginalised students for whom the school ordinarily offered a place of safety and security.

The findings reveal how COVID-19 has exacerbated pre-existing inequalities and the central role of schools in promoting the health and wellbeing of all its members.

This integrative literature review aims to explore themes within higher education that may be applicable to leadership education including: descriptions of trauma, trauma-informed practices and trauma-informed practitioners.

Integrative, systematic literature review.

The results suggest that trauma and trauma-informed practices may have a place in leadership education pedagogy.

There is no work being done in trauma informed practice in leadership education. This study provides future direction for both research and practice.

How should researchers navigate and interpret the moral emotions evoked in them in research on trauma? In this reflective essay, the authors discuss their experience as researchers on moral injury (MI) in veterans and police personnel in the Netherlands. Stories of MI usually do not allow for a clear-cut categorization of the affected person as a victim or perpetrator. This ambivalence, in fact, is explicitly part of the concept of MI. It means however that researchers face complicated psychological, ethical and methodological challenges during research on MI.

The authors contemplate these challenges by describing two empirical cases demonstrating the particular moral challenges that emerge in MI research. Drawing from literature on qualitative research and emotions, the authors distil different perspectives on the role of moral emotions in research.

Reflecting on the ambivalent and difficult emotions the authors experienced as researchers when listening to personal accounts of moral injury, the authors offer insights into the necessity and delicacy of navigating between the methodological potential and the ethical and psychological risks of such emotions.

This study is relevant for all researchers examining trauma, in particular when the research is surrounded by complex ethical questions. While the issue of managing emotions in research on trauma is challenging in itself, it is further complicated when the stories related by respondents challenge the researcher's own moral beliefs and values.