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Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England

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Abstract

This study aimed to ascertain how often staff in community mental health services (CMHSs) in England ask about adverse experiences in childhood and adulthood, including abuse and neglect, how often those experiences are known about and documented by staff, and how staff respond when such experiences are known about and documented. The files of 400 people using four CMHSs in England were reviewed. Only 13% of clinical records contained documentation of any adverse experiences. One percent showed clear evidence that clients had been asked about adversities. People with psychosis diagnoses were less likely to have adverse experiences documented in their file. Rates of responses to adversities of which staff were aware were high, with 90% of records indicating some appropriate support following disclosure. Future research endeavours are recommended, including on reasons for not routinely asking and on type of training needed. Recommendations are made in relation to policy change, staff training and guidelines to improve routine enquiry about adversities. Ultimately, a move to ‘trauma-informed’ services, already underway in some areas, is required for all mental health services.

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References

  • Agar, K., & Read, J. (2002). What happens when people disclose sexual or physical abuse to staff at a community mental health centre? International Journal of Mental Health Nursing, 11, 70–79.

    Article  PubMed  Google Scholar 

  • Agar, K., Read, J., & Bush, M. (2002). Identification of abuse histories in a community mental health centre: The need for policies and training. Journal of Mental Health, 11, 533–543.

    Article  Google Scholar 

  • Anda, R., Brown, D., Felitti, V., Bremner, J., Dube, D., & Giles, W. (2007). Adverse childhood experiences and prescribed psychotropic medications in adults. American Journal of Preventative Medicine, 32, 389–394.

    Article  Google Scholar 

  • Anda, R., Butchart, A., Felitti, V., & Brown, D. (2010). Building a framework for global surveillance of the public health implications of adverse childhood experiences. American Journal of Preventative Medicine, 39, 93–98.

    Article  Google Scholar 

  • Barnes, G., Emsley, R., Garety, P., & Hardy, A. (2021). Identifying victimisation profiles in people with psychosis and a history of childhood trauma: A latent class analysis. Psychosis: Psychological, Social and Integrative Approaches. https://doi.org/10.1080/17522439.2021.2009903

    Article  Google Scholar 

  • Bateman, J., Henderson, C., & Kezelman, C. (2013). Trauma-informed care and practice: Towards a cultural shift in policy reform across mental health and human services in Australia. Mental Health Coordinating Council.

    Google Scholar 

  • Bebbington, P., Jonas, S., Kuipers, E., King, M., Cooper, C., Brugha, T., & Jenkins, R. (2011). Childhood sexual abuse and psychosis: Data from a cross-sectional national psychiatric survey in England. British Journal of Psychiatry, 199, 29–37.

    Article  Google Scholar 

  • Bellis, M., Hughes, K., Leckenby, N., Perkins, C., & Lowey, H. (2014). National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England. BMC Medicine, 12, 72.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bentall, R., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., & Read, J. (2014). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49, 1011–1022.

    Article  PubMed  Google Scholar 

  • Bentall, R., & Varese, F. (2012). A level playing field? Are bio-genetic and psychosocial studies evaluated by the same standards? Psychosis: Psychological Social and Integrative Approaches, 4, 183–190.

    Article  Google Scholar 

  • Bernstein, D., & Fink, L. (1998). Childhood trauma questionnaire: A retrospective self-report manual. The Psychological Corporation.

    Google Scholar 

  • Boyda, D., McFeeters, D., & Shevlin, M. (2015). Intimate partner violence, sexual abuse, and the mediating role of loneliness on psychosis. Psychosis: Psychological Social and Integrative Approaches, 7, 1–13.

    Article  Google Scholar 

  • Briere, J., & Zaidi, L. (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146, 1602–1606.

    Article  CAS  PubMed  Google Scholar 

  • Brooker, C., Tocque, K., Brown, M., & Kennedy, A. (2016). Sexual violence and the Care Programme Approach. British Journal of Psychiatry, 209, 359–360.

    Article  Google Scholar 

  • Cavanagh, M., Read, J., & New, B. (2004). Sexual abuse inquiry and response: A New Zealand training Programme. New Zealand Journal of Psychology, 33, 137–144.

    Google Scholar 

  • Celic, C., & Odaci, H. (2020). Does child abuse have an impact on self-esteem, depression, anxiety and stress conditions of individuals? International Journal of Social Psychiatry, 66, 171–178.

    Article  Google Scholar 

  • Chandan, J., Gokhale, K., Bradbury-Jones, C., Nirantharakumar, K., Bandyopadhyay, S., & Taylor, J. (2020). Exploration of trends in the incidence and prevalence of childhood maltreatment and domestic abuse recording in UK primary care. British Medical Journal Open, 2020(10), e036949. https://doi.org/10.1136/bmjopen-2020-036949

    Article  Google Scholar 

  • Cho, Y., Kim, D., & Kim, S-H. (2021). Prevalence and clinical correlates of childhood trauma among inpatients diagnosed with bipolar disorder: A matched comparison with schizophrenia. Psychological, Social and Integrative Approaches, 13, 13–23.

    Google Scholar 

  • Couper, S., & Mackie, P. (2016). ‘Polishing the diamonds.’ Addressing adverse childhood experiences in Scotland. Glasgow: Scottish Public Health Network.

    Google Scholar 

  • Coyle, L., Hanna, D., Dyer, K., Read, J., Curran, D., & Shannon, C. (2019). Does trauma-related training have a relationship with, or impact on, mental health professionals’ frequency of asking about, or detection of, trauma history? A systematic literature review. Psychological Trauma: Theory, Research, Practice, and Policy, 11, 802–809.

    Article  Google Scholar 

  • Cunningham, T., Shannon, C., Crothers, I., et al. (2016). Enquiring about traumatic experiences in psychosis: A case note and self-report comparison. Psychosis: Psychological Social and Integrative Approaches, 8, 301–310.

    Article  Google Scholar 

  • Currier, G., Barthauer, L., Begier, E., & Bruce, M. (1996). Training and experience of psychiatric residents in identifying domestic violence. Psychiatric Services, 47, 529–530.

    Article  CAS  PubMed  Google Scholar 

  • Darves-Bornoz, J., Lemperiere, T., Degiovanni, A., & Gaillard, P. (1995). Sexual victimization in women with schizophrenia and bipolar disorder. Social Psychiatry and Psychiatric Epidemiology, 30, 78–84.

    Article  CAS  PubMed  Google Scholar 

  • Davies, E., O’Leary, E., & Read, J. (2017). Child abuse in England and Wales 2003–2013: Newspaper reporting versus reality. Journalism, 8, 754–771.

    Article  Google Scholar 

  • Day, A., Thurlow, K., & Woolliscroft, J. (2003). Working with childhood sexual abuse: A survey of mental health professionals. Child Abuse and Neglect, 27, 191–198.

    Article  PubMed  Google Scholar 

  • Department of Health. (2008). Re-focussing the Care Programme Approach: Policy and positive practice guidance. Department of Health.

    Google Scholar 

  • Department of Health. (2015). Policy Research Programme. Implementing and sustaining routine enquiry about violence and abuse in mental health services: Guidance for trust managers. London: DHPRP.

    Google Scholar 

  • Eilenberg, J., Fullilove, M., Goldman, R., & Mellman, L. (1996). Quality and use of trauma histories obtained from psychiatric outpatients through mandated inquiry. Psychiatric Services, 47, 165–169.

    Article  CAS  PubMed  Google Scholar 

  • Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., & Edwards, V. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14, 245–258.

    Article  CAS  Google Scholar 

  • Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2014). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 329, 329–333.

    Article  Google Scholar 

  • Fisher, H., Craig, T., Fearon, P., et al. (2011). Reliablity and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophrenia Bulletin, 37, 546–553.

    Article  PubMed  Google Scholar 

  • Goodwin, J., Attias, R., McCarty, T., Chandler, S., & Romanik, R. (1988). Reporting by adult psychiatric patients of childhood sexual abuse. American Journal of Psychiatry, 145, 1183–1184.

    Article  CAS  PubMed  Google Scholar 

  • Greenberg, N., Brooks, S., & Dunn, R. (2015). Latest developments in post-traumatic stress disorder: Diagnosis and treatment. British Medical Journal, 114, 147–155.

    Google Scholar 

  • Guha, A., Luebbers, S., Papalia, N., & Ogloff, J. (2019). A follow-up study of mental health service utilisation in a cohort of 2433 sexually abused Australian children utilising five years of medical data. Child Abuse & Neglect, 90, 174–184.

    Article  Google Scholar 

  • Hepworth, I., & McGowan, L. (2013). Do mental health professionals enquire about childhood sexual abuse during routine mental health assessment in acute mental health settings? A substantive literature review. Journal of Psychiatric and Mental Health Nursing, 20, 473–483.

    Article  CAS  PubMed  Google Scholar 

  • Jacobson, A., & Richardson, B. (1987). Assault experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry. American Journal of Psychiatry, 144, 508–513.

    Google Scholar 

  • Johnstone, L., Boyle, M., Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D., & Read, J. (2018). The Power Threat Meaning Framework. Leicester: British Psychological Society.

    Google Scholar 

  • Karatzias, Y., Shevlin, M., Pitcairn, J., Thomson, L., Mahoney, A., & Hyland, P. (2019). Childhood adversity and psychosis in detained inpatients from medium to high secured units: Results from the Scottish census survey. Child Abuse & Neglect, 96, 104094.

    Article  Google Scholar 

  • Kessler, R., McLaughlin, K., Green, J., Gruber, M. J., Sampson, N. A., & Zaslavsky, A. M. (2010). Childhood adversities and adult psychopathology in the WHO world mental health surveys. British Journal of Psychiatry, 197, 378–385.

    Article  Google Scholar 

  • Lee, A., Coles, J., Lee, S., & Kulkarni, J. (2012). Primary healthcare practitioners’ screening practices and attitudes towards women survivors of child abuse. Mental Health in Family Medicine, 9, 181–189.

    PubMed  PubMed Central  Google Scholar 

  • Lipschitz, D., Kaplan, M., Sorkenn, J., Faedda, G., Chorney, P., & Asnis, G. M. (1996). Prevalence and characteristics of physical and sexual abuse among psychiatric out-patients. Psychiatric Services, 47, 189–191.

    Article  CAS  PubMed  Google Scholar 

  • Lotzin, A., Buth, S., Sehner, S., et al. (2018). ‘Learning how to ask’ - Effectiveness of a training for trauma inquiry and response in substance use disorder healthcare professionals. Psychological Trauma: Theory, Research, Practice and Policy, 10, 229–238.

    Article  Google Scholar 

  • Mansfield, Y., Meehan, T., Forward, R., & Richardson-Clarke, F. (2016). Asking the question: Childhood sexual abuse in adults with mental illness. Australian Social Work. https://doi.org/10.1080/0312407X.2016.1213873

    Article  Google Scholar 

  • McLaughlin, K., Green, J., Gruber, M., Sampson, N., Zaslavsky, A., & Kessler, R. (2010). Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey replication II: Associations with persistence of DSM-IV disorders. Archives of General Psychiatry, 67, 124–132.

    Article  PubMed  PubMed Central  Google Scholar 

  • McNeish, D., & Scott, S. (2008). Meeting the Needs of Survivors of Abuse: Overview of Evaluation Findings (p. 2008). DMSS Research and Consultancy.

    Google Scholar 

  • Muskett, C. (2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23, 51–59.

    Article  PubMed  Google Scholar 

  • Nagar, M., Nakash, O., & Westen, D. (2019). Unpacking childhood experiences of abuse: Can clinicians identify their patients’ history of abuse? Journal of Trauma & Dissociation, 21, 396–408.

    Article  Google Scholar 

  • Nixon, B., & Quinlan, E. (2021). Asking the hard questions: Psychologists’ discomfort with inquiring about sexual abuse histories. Violence against Women. https://doi.org/10.1177/10778012211014558

    Article  PubMed  Google Scholar 

  • Oram, S., Khalifeh, H., & Howard, L. (2016). Violence against women and mental health. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(16)30261-9

    Article  PubMed  Google Scholar 

  • Prytherch, H., Cooke, A., & Marsh, I. (2020). Coercion or collaboration: Service-user experiences of risk management in hospital and a trauma-informed crisis house. Psychosis: Psychological. Social and Integrative Approaches, 13, 93–104.

    Google Scholar 

  • Read, J. (1998). Child abuse and severity of disturbance among adult psychiatric in-patients. Child Abuse & Neglect, 22, 359–368.

    Article  CAS  Google Scholar 

  • Read, J., Agar, K., Argyle, N., & Aderhold, V. (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy: Theory Research and Practice, 76, 1–22.

    Article  Google Scholar 

  • Read, J., Dillon, J., & Lampshire, D. (2014). How much evidence is required for a paradigm shift in mental health? Acta Psychiatrica Scandinavica, 129, 477–478.

    Article  CAS  PubMed  Google Scholar 

  • Read, J., & Fraser, A. (1998a). Abuse histories of psychiatric inpatients: To ask or not to ask? Psychiatric Services, 49, 355–359.

    Article  CAS  PubMed  Google Scholar 

  • Read, J., & Fraser, A. (1998b). Staff response to abuse histories of psychiatric inpatients. Australian and New Zealand Journal of Psychiatry, 32, 206–213.

    Article  CAS  PubMed  Google Scholar 

  • Read, J., Hammersley, P., & Rudegeair, T. (2007). Why, when and how to ask about child abuse. Advances in Psychiatric Treatment, 13, 101–110.

    Article  Google Scholar 

  • Read, J., Sampson, M., & Critchley, C. (2016). Are mental health services getting better at responding to abuse, assault and neglect? Acta Psychiatrica Scandinavica, 134, 287–294.

    Article  CAS  PubMed  Google Scholar 

  • Read, J., Harper, D., Tucker, I., & Kennedy, A. (2018a). Do adult mental health services identify child abuse and neglect? A systematic review. International Journal of Mental Health Nursing, 27, 7–19.

    Article  PubMed  Google Scholar 

  • Read, J., Harper, D., Tucker, I., & Kennedy, A. (2018b). How do mental health services respond when child abuse or neglect become known? A literature review. International Journal of Mental Health Nursing, 27, 1606–1617.

    Article  PubMed  Google Scholar 

  • Read, J., & Mayne, R. (2017). Understanding the long-term effects of childhood adversities: Beyond diagnosis and abuse. Journal of Child and Adolescent Trauma, 10, 289–297.

    Article  Google Scholar 

  • Read, J., McGregor, K., Coggan, C., & Thomas, D. (2006). Mental health services and sexual abuse: The need for staff training. Journal of Trauma and Dissociation, 7, 33–50.

    Article  PubMed  Google Scholar 

  • Rossiter, A., Byrne, F., Wota, A., Nisar, Z., Ofuafor, T., & Murray, I. (2015). Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma. Child Abuse and Neglect, 44, 36–45.

    Article  PubMed  Google Scholar 

  • Sampson, M., & Read, J. (2017). Are mental health staff getting better at asking about abuse and neglect? International Journal of Mental Health Nursing, 26, 95–104.

    Article  PubMed  Google Scholar 

  • Scott, S., Williams, J., McNaughton Nicholls, C. McManus, D., Brown, A., Harvey, S., Lovett, J. (2015). What survivors of violence and abuse say about mental health services: Responding effectively to violence and abuse: Briefing, 4. Retrieved from http://natcen.ac.uk/our-research/research/responding-effectively-to-long-term-consequences-of-violence-and-abuse-(reva)/.

  • Sellick, K., Rose, D., & Harms, L. (2020). Hearing voices, sexual abuse and service system responses. Psychosis: Psychological Social and Integrative Approaches, 12, 11–22.

    Article  Google Scholar 

  • Social Care Institute for Excellence (SCIE, 2015). At a glance 69: Adult safeguarding: Types and indicators of abuse. Retrieved October, 3, 2017, from https://www.scie.org.uk/publications/ataglance/69-adults-safeguarding-types-and-indicators-of-abuse.asp.

  • Sweeney, A., Clement, S., Filson, B., & Kennedy, A. (2016). Trauma-informed mental healthcare in the UK: What is it and how can we further its development? Mental Health Review, 21, 174–192.

    Article  Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care and alternatives to seclusion and restraint. Washington, DC: SAMHSA.

    Google Scholar 

  • Toner, J., Daiches, A., & Larkin, W. (2013). Asking about trauma: The experiences of psychological therapists in early intervention services. Psychosis: Psychological Social and Integrative Approaches, 5, 175–186.

    Article  Google Scholar 

  • Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., & Bentall, R. (2012). Childhood trauma increases the risk of psychosis: A meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661–671.

    Article  PubMed  PubMed Central  Google Scholar 

  • Visser, M., Boonstra, N., de Bont, P., van der Vleugel, B., & van den Berg, D. (2021). The effects of a specialized staff training on trauma-sensitivity in professionals working with patients with a psychotic disorder: A pilot study. Psychosis: Psychological, Social and Integrative Approaches. https://doi.org/10.1080/17522439.2021.1994635

    Article  Google Scholar 

  • Walters, S., Hogg, L., & Gillmore, C. (2015). Evaluation of a tailored training programme to improve the assessment and treatment of trauma in an Early Intervention in Psychosis service. Psychosis: Psychological Social and Integrative Approaches, 8, 226–237.

    Article  Google Scholar 

  • World Health Organisation. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.

    Google Scholar 

  • Wurr, C., & Partridge, I. (1996). The prevalence of a history of childhood sexual abuse in an acute adult inpatient population. Child Abuse & Neglect, 20, 867–872.

    Article  CAS  Google Scholar 

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  1. School of Psychology, University of East London, Water Lane, London, E15 4LZ, UK

    Caitlin Neill & John Read

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Neill, C., Read, J. Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England. Community Ment Health J 58, 1076–1087 (2022). https://doi.org/10.1007/s10597-021-00916-4

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