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Lüders J, Sander C, Leonhard A, Schäfer I, Speerforck S, Schomerus G. [How Outpatient Psychotherapists Deal with Patients' Traumatic Experiences in Consideration of an Additional Qualification in Trauma Therapy]. PSYCHIATRISCHE PRAXIS 2023; 50:80-88. [PMID: 35287242 DOI: 10.1055/a-1773-7662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Investigation of the differences in dealing with traumatic experiences of patients between psychotherapists with and without further training in trauma therapy or partial qualification. METHODS Online survey of outpatient psychotherapists (N = 148) on possible obstacles in addressing traumatic experiences of patients and self-reported professional practice. RESULTS Further training in trauma therapy is associated with a higher level of competence in professional practice and fewer obstacles in addressing traumatic experiences. CONCLUSION A lower level of competence among psychotherapists without further training in trauma therapy speaks for the need for compulsory trainings. The expansion of low-threshold treatment offers for those affected by traumatic experiences and the dismantling of access barriers is urgently needed.
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Affiliation(s)
- Juliane Lüders
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Christian Sander
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Anya Leonhard
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Ingo Schäfer
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Sven Speerforck
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
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Dryden‐Mead T, Nelson B, Bendall S. "They may be confronting but they are good questions to be asking" young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program. Psychol Psychother 2022; 95:1090-1107. [PMID: 35942544 PMCID: PMC9804455 DOI: 10.1111/papt.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a history of inadequate enquiry about, and assessment of, trauma in young people within Early Psychosis services and even when screening does occur there is little known about how young people experience this process. AIMS This study aimed to explore young people's experiences of completing a trauma and PTSD screening tool when receiving a service in an Early Psychosis Program. METHOD Semi-structured interviews were conducted with 10 young people, aged 18-24 years, to explore their subjective experience of this process. Transcripts were analysed via interpretative phenomenological analysis. RESULTS Four super-ordinate themes were identified: (i) an emotional experience, (ii) the importance of the relationship with the clinician, (iii) an opportunity to reflect on past experiences, and (iv) the ability to be able to provide honest responses. Results from this study indicated that young people expected to be asked about their trauma experiences, acknowledged that this was challenging for them but found that this was made easier due to the relationship they had built with the clinician, the timing of the screening and also, possibly, by the written style format of the questionnaires. CONCLUSIONS Young people in this study accepted the need for screening for traumatic histories, and expected to be asked about their traumatic experiences, despite the possibility of a short-term increase in distress. The support offered by a trusted clinician, whom the young person had built a relationship with, appeared to be an important component to the willingness and the ability of the young person to complete the questionnaires. This reinforces the fact that screening for trauma in an early psychosis service can be conducted in a way that is safe and acceptable to young people.
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Affiliation(s)
- Tracey Dryden‐Mead
- Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
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3
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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 2022; 58:1076-1087. [PMID: 35094164 DOI: 10.1007/s10597-021-00916-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
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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Affiliation(s)
- Caitlin Neill
- School of Psychology, University of East London, Water Lane, London, E15 4LZ, UK
| | - John Read
- School of Psychology, University of East London, Water Lane, London, E15 4LZ, UK.
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4
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Lueders J, Sander C, Leonhard A, Schäfer I, Speerforck S, Schomerus G. Trauma assessment in outpatient psychotherapy and associations with psychotherapist's gender, own traumatic events, length of work experience, and theoretical orientation. Eur J Psychotraumatol 2022; 13:2029043. [PMID: 35251528 PMCID: PMC8890554 DOI: 10.1080/20008198.2022.2029043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Traumatic events are strongly associated with mental health problems. At present, traumatic events and trauma-specific needs are commonly underdetected in therapeutic settings. Many mental health professionals lack key competencies for trauma inquiry and treatment. OBJECTIVE In this study, we aimed to investigate the everyday practices of dealing with traumatic events in outpatient psychotherapy in Germany as well as the influence of the therapist's gender, own traumatic events, length of professional experience, and theoretical orientation. METHOD A total of 148 outpatient psychotherapists completed a purpose-designed online questionnaire. Therapists rated barriers and attitudes towards trauma assessment, possible requirements for enquiring about trauma, and practical aspects of trauma assessment. RESULTS Barriers reported in previous studies, e.g. fear of offending the patient or exacerbating their psychological state, could not be confirmed in our sample. Overall, participating therapists felt confident in engaging with traumatic events and considered enquiring about trauma important in all patients. Group differences were found for therapist's gender, own traumatic events, length of work experience, and theoretical orientation. CONCLUSIONS Our results suggest that trauma training lowers barriers and raises therapists' self-confidence in dealing with patients´ traumatic experiences. Therapists' characteristics effecting trauma assessment should be considered during training. Due to the increasing demand for psychotherapy, especially considering people with severe mental illness affected by traumatic events, trauma training should be obligatory for all mental health professionals.
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Affiliation(s)
- Juliane Lueders
- Department of Psychiatry and Psychotherapy, University Medical Centre Leipzig, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University Medical Centre Leipzig, Leipzig, Germany
| | - Anya Leonhard
- Department of Psychiatry and Psychotherapy, University Medical Centre Leipzig, Leipzig, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University Medical Centre Leipzig, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medical Centre Leipzig, Leipzig, Germany
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5
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Mitchell S, Shannon C, Mulholland C, Hanna D. Reaching consensus on the principles of trauma-informed care in early intervention psychosis services: A Delphi study. Early Interv Psychiatry 2021; 15:1369-1375. [PMID: 33169532 PMCID: PMC8451918 DOI: 10.1111/eip.13068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
AIM The current study sought to conceptualize and reach consensus on the principles of trauma-informed care in early intervention psychosis services. METHODS A three-phase Delphi method was employed in this study. Experts included researchers, service providers and Experts by Experience in the area of early intervention in psychosis. In the initial qualitative phase, an expert panel (n = 57) shared their views on the constituents of trauma-informed care in early intervention psychosis services. Thematic analysis led to the generation of statement items. The expert panel was asked to rate the extent to which each statement item was an essential principle of trauma-informed care, leading to consensus of endorsed principles. RESULTS Qualitative analysis of the first phase data led to the identification of 185 distinct statements which were compiled into an online questionnaire for the panel to rate in Phase 2. The Phase 2 questionnaire was completed by 42 experts, with the endorsement of seven principles. In Phase 3, the panel were invited to re-rate 24 statements. This phase was completed by 39 panel members, with the acceptance of a further nine principles. Consensus was achieved resulting in the endorsement of 16 essential principles of trauma-informed care. CONCLUSIONS The study offers novel understanding of the conceptualisation of trauma-informed care in early intervention services and suggests principles which are widely agreed by experts in the field. The recommendations may inform the adoption of consistently delivered trauma-informed care in early interventions in psychosis and facilitate the evaluation and development of services.
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Affiliation(s)
- Sinéad Mitchell
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Ciaran Shannon
- STEP Team, Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - Ciaran Mulholland
- STEP Team, Northern Health and Social Care Trust, Antrim, Northern Ireland.,School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Donncha Hanna
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
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Nagar M, Nakash O, Westen D. Unpacking childhood experiences of abuse: Can clinicians identify their patients' History of Abuse? J Trauma Dissociation 2020; 21:396-408. [PMID: 31973658 DOI: 10.1080/15299732.2020.1719264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emotional, physical and sexual abuse, have been consistently linked to mental health problems in adults. Previous research found that mental health providers rarely ask their patients about their childhood experiences of abuse. No study to date has examined the convergence of clinicians' and patients' reports of childhood abuse. The current study applied a multi-method, multi-informant approach to explore the concordance between patients' reports of childhood experiences of abuse and clinicians' identification of their patients' history of abuse. Assessment of an independent interviewer was included. A convenience sample of clinicians (N = 80) and their patients (N = 170) in mental health clinics in care-as-usual settings participated in the study. To assess the history of abuse clinicians and patients completed the Clinical Data Form, patients additionally completed the Childhood Trauma Questionnaire. Independent interviewer completed the Familial Experiences Interview. Findings show that across all informants, exposure to emotional abuse was most prevalent, followed by physical abuse and least prevalent was sexual abuse. Additionally, clinicians reported lower prevalence of physical and sexual abuse among their patients as compared with the patient and independent interviewer's reports. Moderate to strong correlations were observed between clinicians, patients and independent interviewer reports of emotional, physical and sexual childhood abuse. Moreover, the severity of the patient's history of abuse was related to greater accuracy in clinicians' reports. Clinicians are advised to collect explicit information regarding childhood abuse through interviews or valid measures. Clinicians should pay special attention when assessing patients with moderate severity of childhood abuse since they are frequently under-identified.
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Affiliation(s)
- Maayan Nagar
- School for Social Work, Smith College, Northampton, MA, USA
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, MA, USA.,Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA, USA
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7
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Childhood adversity and trauma: experiences of professionals trained to routinely enquire about childhood adversity. Heliyon 2019; 5:e01900. [PMID: 31372522 PMCID: PMC6658729 DOI: 10.1016/j.heliyon.2019.e01900] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/20/2019] [Accepted: 05/31/2019] [Indexed: 11/21/2022] Open
Abstract
Research indicates that adverse childhood experiences play a causal role in the development of poor health and social outcomes in adulthood. Despite this, research suggests that such experiences go undetected since spontaneous disclosure is unlikely, and practitioners are unlikely to ask. A project was developed in which practitioners were trained to routinely enquire about adversity in their daily practice. Four pilot services took part that worked directly and indirectly with children and young people, many of whom were exposed to multiple adverse experiences. The aim of this study was to construct an understanding of the experiences of these practitioners. Seven interviews were conducted, and the data was analysed using thematic analysis. The emerging themes were: change in knowledge, perception and practice; the emotional impact of hearing and responding to disclosures; confidence in asking and responding appropriately; making sense of the impact for clients; how and when to ask. Findings indicate that participants' change toward more adverse-experience-informed formulations of clients' difficulties ensure commitment to routine enquiry and changes in referral patterns and therapeutic practice. Suggestions are made with regard to the practicalities of routine enquiry and how services can best support practitioners who are embedding this skill into their practice.
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8
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Carr ER, Hamlett N, Hillbrand M. When Sexual Trauma Survivors with Severe Psychiatric Disabilities Experience Institutional Care. J Trauma Dissociation 2019; 20:179-196. [PMID: 30095379 DOI: 10.1080/15299732.2018.1502716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Individuals with severe psychiatric disabilities face many challenges from their experience of mental health problems, but also from disenfranchisement, marginalization, and stigmatization from a sociocultural experience. Those who are sexual trauma survivors also have unique challenges and intersecting experiences, which are not historically well understood, acknowledged, or treated in U.S. systems of care. Both in historic and modern mental health systems there have been methods thought of as interventions that have been or are currently reported as traumatizing to those who experience them. This article highlights the specific challenges, needs, and organizational shifts that U.S. systems of care need to be aware of and embark upon in order to provide treatment that is more efficacious with and cognizant of the experiences of those who are sexual trauma survivors. Furthermore, new paradigms for providing mental health treatment are offered in the context of providing trauma-informed as well as trauma treatment to those who are sexual trauma survivors and experience severe psychiatric disabilities.
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Affiliation(s)
- Erika R Carr
- a Yale School of Medicine/CMHC , New Haven , Connecticut , USA
| | - Nakia Hamlett
- b Psychology Department , Connecticut College , New London , Connecticut , USA
| | - Marc Hillbrand
- a Yale School of Medicine/CMHC , New Haven , Connecticut , USA
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9
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Read J, Harper D, Tucker I, Kennedy A. How do mental health services respond when child abuse or neglect become known? A literature review. Int J Ment Health Nurs 2018; 27:1606-1617. [PMID: 29873169 DOI: 10.1111/inm.12498] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
Child abuse and neglect are strongly associated with many subsequent mental health problems. This review summarizes the research on how adult mental health services respond when child abuse or neglect become known. MEDLINE, PsycINFO, and Scopus were searched for studies with rates of responding in various ways to child abuse and neglect by mental health professionals. Thirteen studies were identified: seven case note reviews, three surveys of staff, and three sets of interviews with service users. Rates of inclusion of abuse or neglect in treatment plans ranged from 12% to 44%. Rates of referral to abuse-related therapy ranged from 8% to 23%. Rates were lower for neglect than for abuse and were also lower for men and people with a diagnosis of psychosis. Two per cent or less of all cases were referred to legal authorities. The studies varied in focus and methodology, but all indicated inadequate clinical practice. The rates of abused or neglected people referred for therapy are actually lower than indicated by this review because most users of adult mental health services are not asked about abuse or neglect in the first place. The barriers to good practice, and the need for trauma-informed services, are discussed.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
| | - David Harper
- School of Psychology, University of East London, London, UK
| | - Ian Tucker
- School of Psychology, University of East London, London, UK
| | - Angela Kennedy
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
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10
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Sweeney A, Filson B, Kennedy A, Collinson L, Gillard S. A paradigm shift: relationships in trauma-informed mental health services. BJPSYCH ADVANCES 2018; 24:319-333. [PMID: 30174829 PMCID: PMC6088388 DOI: 10.1192/bja.2018.29] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.
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Affiliation(s)
- Angela Sweeney
- Trauma survivor and researcher. She has worked in mental health research since 2001, and has a particular interest in perinatal mental health and trauma-informed approaches (TIA). Her current research is aimed at understanding and improving assessment processes for talking therapies
| | - Beth Filson
- US-based writer and trainer in TIA. She works with diverse groups to integrate TIA in policy and practice. She also contributes to the development of Intentional Peer Support and peer support alternatives to the psychiatric system. Her early experience of multiple hospital admissions informs her work
| | - Angela Kennedy
- Clinical psychologist who has worked in the NHS since 1990. She is trauma informed care lead for a large Mental Health Trust and is mental health lead for the North of England Clinical Network. Her focus is applying clinical knowledge to system-wide change, including compassion-focused cultures and leadership
| | - Lucie Collinson
- Public health specialty registrar on the London training scheme and NIHR Academic Clinical Fellow at the London School of Hygiene and Tropical Medicine. She has worked as a doctor in the NHS and overseas and has experience in health services research
| | - Steve Gillard
- Reader in social and community mental health. His current research focuses on the increasing role played by people with lived experience in producing the services that they use - the development of more distributed forms of mental health practice
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Read J, Harper D, Tucker I, Kennedy A. Do adult mental health services identify child abuse and neglect? A systematic review. Int J Ment Health Nurs 2018; 27:7-19. [PMID: 28815844 DOI: 10.1111/inm.12369] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/26/2022]
Abstract
Child abuse and neglect play a causal role in many mental health problems. Knowing whether users of mental health services were abused or neglected as children could be considered essential for developing comprehensive formulations and effective treatment plans. In the present study we report the findings of a systematic review, using independent searches of three databases designed to discover how often mental health staff find out whether their clients were abused or neglected as children. Twenty-one relevant studies were identified. Most people who use mental health services are never asked about child abuse or neglect. The majority of cases of child abuse or neglect are not identified by mental health services. Only 28% of abuse or neglect cases identified by researchers are found in the clients' files: emotional abuse, 44%; physical abuse, 33%; sexual abuse, 30%; emotional neglect, 17%; and physical neglect, 10%. Between 0% and 22% of mental health service users report being asked about child abuse. Men and people diagnosed with psychotic disorders are asked less than other people. Male staff ask less often than female staff. Some improvement over time was found. Policies compelling routine enquiry, training, and trauma-informed services are required.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
| | - David Harper
- School of Psychology, University of East London, London, UK
| | - Ian Tucker
- School of Psychology, University of East London, London, UK
| | - Angela Kennedy
- Tees, Esk and Wear Valleys National Health Service Foundation Trust, Darlington, UK
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12
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Sampson M, Read J. Are mental health staff getting better at asking about abuse and neglect? Int J Ment Health Nurs 2017; 26:95-104. [PMID: 27600259 DOI: 10.1111/inm.12237] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as 'schizophrenia', tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.
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Affiliation(s)
- Maria Sampson
- Taylor Centre, Auckland District Health Board, Auckland, New Zealand
| | - John Read
- School of Psychology, University of East London, Stratford Campus, London, UK
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13
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Berry K, Varese F, Bucci S. Cognitive Attachment Model of Voices: Evidence Base and Future Implications. Front Psychiatry 2017; 8:111. [PMID: 28713292 PMCID: PMC5491615 DOI: 10.3389/fpsyt.2017.00111] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/08/2017] [Indexed: 01/26/2023] Open
Abstract
There is a robust association between hearing voices and exposure to traumatic events. Identifying mediating mechanisms for this relationship is key to theories of voice hearing and the development of therapies for distressing voices. This paper outlines the Cognitive Attachment model of Voices (CAV), a theoretical model to understand the relationship between earlier interpersonal trauma and distressing voice hearing. The model builds on attachment theory and well-established cognitive models of voices and argues that attachment and dissociative processes are key psychological mechanisms that explain how trauma influences voice hearing. Following the presentation of the model, the paper will review the current state of evidence regarding the proposed mechanisms of vulnerability to voice hearing and maintenance of voice-related distress. This review will include evidence from studies supporting associations between dissociation and voices, followed by details of our own research supporting the role of dissociation in mediating the relationship between trauma and voices and evidence supporting the role of adult attachment in influencing beliefs and relationships that voice hearers can develop with voices. The paper concludes by outlining the key questions that future research needs to address to fully test the model and the clinical implications that arise from the work.
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Affiliation(s)
- Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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14
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Pilton M, Bucci S, McManus J, Hayward M, Emsley R, Berry K. Does insecure attachment mediate the relationship between trauma and voice-hearing in psychosis? Psychiatry Res 2016; 246:776-782. [PMID: 27817908 DOI: 10.1016/j.psychres.2016.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/25/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
This study extends existing research and theoretical developments by exploring the potential mediating role of insecure attachment within the relationship between trauma and voice-hearing. Fifty-five voice hearers with a psychosis-related diagnosis completed comprehensive assessments of childhood trauma, adult attachment, voice-related severity and distress, beliefs about voices and relationships with voices. Anxious attachment was significantly associated with the voice-hearing dimensions examined. More sophisticated analysis showed that anxious attachment mediated the relationship between childhood sexual and emotional abuse and voice-related severity and distress, voice-malevolence, voice-omnipotence, voice-resistance and hearer-dependence. Anxious attachment also mediated the relationship between childhood physical neglect and voice-related severity and distress and hearer-dependence. Furthermore, consistent with previous research, the relationship between anxious attachment and voice-related distress was mediated by voice-malevolence, voice-omnipotence and voice-resistance. We propose a model whereby anxious attachment mediates the well-established relationship between trauma and voice-hearing. In turn, negative beliefs about voices may mediate the association between anxious attachment and voice-related distress. Findings presented here highlight the need to assess and formulate the impact of attachment patterns upon the voice-hearing experience in psychosis and the potential to alleviate voice-related distress by fostering secure attachments to therapists or significant others.
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Affiliation(s)
- Marie Pilton
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Sandra Bucci
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - James McManus
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Mark Hayward
- School of Psychology, University of Sussex, United Kingdom; Department of Research and Development, Sussex Partnership NHS Foundation Trust, United Kingdom
| | - Richard Emsley
- Institute of Population and Health, University of Manchester, United Kingdom
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom.
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Read J, Sampson M, Critchley C. Are mental health services getting better at responding to abuse, assault and neglect? Acta Psychiatr Scand 2016; 134:287-94. [PMID: 26852371 DOI: 10.1111/acps.12552] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether staff responses to abuse disclosures had improved since the introduction of a trauma policy and training programme. METHOD The files of 250 clients attending four New Zealand mental health centres were audited. RESULTS There was a significant improvement, compared to an audit prior to the introduction of the policy and training, in the proportion of abuse cases included in formulations, and, to a lesser extent, in treatment plans. There was no significant improvement in the proportion referred for relevant treatment, which remained at less than 25% across abuse categories. The proportion of neglect disclosures responded to was significantly lower than for abuse cases. Fifty percent of the files in which abuse/neglect was recorded noted whether the client had been asked about previous disclosure, and 22% noted whether the client thought there was any connection between the abuse/neglect and their current problems. Less than 1% of cases were reported to legal authorities. People diagnosed with a psychotic disorder were significantly less likely to be responded to appropriately. CONCLUSION Future training may need to focus on responding well to neglect and people diagnosed with psychosis, on making treatment referrals, and on initiating discussions about reporting to authorities.
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Affiliation(s)
- J Read
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Vic., Australia.
| | - M Sampson
- Clinical Psychologist, Taylor Centre, Auckland District Health Board, Auckland, New Zealand
| | - C Critchley
- Department of Statistics, Data Sciences and Epidemiology, Swinburne University of Technology, Melbourne, Vic, Australia
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Xiao CL, Gavrilidis E, Lee S, Kulkarni J. Do mental health clinicians elicit a history of previous trauma in female psychiatric inpatients? J Ment Health 2016; 25:359-365. [DOI: 10.3109/09638237.2016.1139074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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17
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Walters S, Hogg L, Gillmore C. Evaluation of a tailored training programme to improve the assessment and treatment of trauma in an Early Intervention in Psychosis (EIP) service. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2016. [DOI: 10.1080/17522439.2015.1131324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Rossiter A, Byrne F, Wota AP, Nisar Z, Ofuafor T, Murray I, Byrne C, Hallahan B. Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma. CHILD ABUSE & NEGLECT 2015; 44:36-45. [PMID: 25636522 DOI: 10.1016/j.chiabu.2015.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/30/2014] [Accepted: 01/02/2015] [Indexed: 06/04/2023]
Abstract
Despite an increased awareness regarding the prevalence and impact of childhood trauma, especially childhood sexual abuse (CSA), few studies examine the clinical reporting of such childhood experiences. This study compared the prevalence of childhood trauma recorded in individual's clinical notes to those ascertained with a structured validated questionnaire, examined which forms of childhood trauma were less likely to be reported to the treating mental health team and established which demographic or clinical factors were associated with reporting of childhood trauma. The prevalence of childhood trauma was ascertained using both the Childhood Trauma Questionnaire (CTQ) and a lifetime retrospective clinical note review in 129 individuals attending a general adult mental health service. Individuals were evaluated for the presence of mental health disorders, impulsivity, symptom severity and disability. Using the CTQ, childhood trauma was noted in 77% of individuals and recorded in 38% of individual's clinical notes (p<0.001). The greatest differences between CTQ reporting and clinical note documentation were noted for emotional neglect (62% versus 13.2%), physical neglect (48.1% versus 5.4%) and CSA (24.8% versus 8.5%). Childhood trauma was associated with increased psychopathology and greater symptom severity, and was particularly prevalent for individuals with personality disorders. This study demonstrated high rates of childhood trauma amongst adults attending a general adult mental health service. Furthermore, we demonstrated high rates of either non-enquiry from mental health professionals and/or high rates of non-documentation of childhood trauma by mental health professionals. Given the disparity between reporting of childhood trauma in clinical notes and findings with the CTQ, the use of a standardised questionnaire for the assessment of childhood trauma should be considered when performing a comprehensive mental health history.
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Affiliation(s)
- Amy Rossiter
- Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland
| | - Fintan Byrne
- Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland; Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - Anna Paulina Wota
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Zafar Nisar
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Thomas Ofuafor
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Ivan Murray
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Charles Byrne
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Brian Hallahan
- Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland; Department of Psychiatry, University Hospital Galway, Galway, Ireland
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