Trauma-informed approaches in healthcare: strategy and evidence

  • 24 October 2023

The implementation of trauma-informed approaches in UK healthcare requires policy commitment, leadership support and a solid evidence base. According to a recent study by researchers at the University of Bristol, these approaches can prevent re-traumatisation in services and improve experiences and outcomes for both patients and staff. The results of the study, funded by the National Institute for Health and Care Research Bristol Biomedical Research Centre (NIHR BRC), have been summarised for policy makers in a new PolicyBristol report.

Traumatic experiences resulting from childhood adversities, domestic abuse, violence, and social injustice can lead to mental and physical illnesses, homelessness, drug and alcohol use, and imprisonment. In England, nearly half of adults have experienced at least one childhood adversity, and up to 29 per cent of women and 13 per cent of men have experienced domestic abuse during their lifetime, costing the UK economy £14 billion annually.

A trauma-informed approach in healthcare recognises that any patient and healthcare staff member may have been affected by trauma. It involves organisational changes that incorporate knowledge about the prevalence and impacts of trauma into healthcare policies and practices. This approach aims to create safe environments, promote physical and emotional safety for all, and prevent re-traumatisation.

The TAPCARE study, supported by people with lived experience of trauma and healthcare professionals, conducted the first systematic review of trauma-informed organisational change programmes in adult primary care and community mental health care, as well as a review of UK policies. The study aimed to assess the effectiveness and acceptability of these approaches and to provide policy recommendations.

The study found that trauma-informed change can lead to improvements in some psychological, behavioural, and health outcomes for some patients and staff. However, it also highlighted the need for more research on potential harms, cost-effectiveness, and staff health.

The study concludes that the UK’s adoption of trauma-informed approaches has been fragmented, with Scotland and Wales showing more cohesive implementation and leadership. Enhanced coordination, government backing, and top-down support are seen as crucial elements for success.

Key policy recommendations:

  • allocating budgets and involving all staff groups and people with lived experience
  • providing ongoing training and support for all staff
  • creating safe physical and psychological environments for all patients and staff
  • evaluating trauma-informed programmes and initiatives to generate a UK evidence base
  • promoting top-down support from organisational, regional, and national leadership
  • supporting and joining local and national trauma-informed networks of professional and lived experience experts

Dr Natalia Lewis, Senior Research Fellow in Primary Care at the Centre for Academic Primary Care, University of Bristol, and author of the policy report, said:

“In the UK, the trauma-informed organisational change movement is driven from bottom-up by passionate trauma-informed experts who self-organise in local and national trauma-informed networks. These initiatives require top-down support from leadership within and across healthcare organisations, local authorities, the NHS, and national government.”

Read the policy report: Trauma-informed approaches in healthcare: piecemeal implementation needs UK-wide leadership, strategy and evidence by Natalia Lewis. Published by PolicyBristol. October 2023.

Visit the TAPCARE study website.