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People in secure psychiatric services experience high levels of exposure to early psychological trauma, are often diagnosed with severe mental illness (SMI) and have increased risk for obesity. Developmental trauma, SMI and obesity are associated with poor physical health outcomes and early death. This study aimed to assess the predictive power of Adverse Childhood Experiences (ACEs), self-harm and psychiatric diagnosis for secure inpatient weight gain and obesity. Data for 248 Welsh patients accommodated in low, medium, and high secure hospitals throughout England and Wales was analyzed. Patient admission bodyweight (in kilograms), bodyweight at the time of audit, and patient BMI at the time of audit was collected. Sex, psychiatric diagnosis, length of current admission, number of ACEs, and frequency of self-harm were also examined. Patients gained significant amounts of weight between admission until the time of the audit (median period = 1 – 2 years) and showed high levels of obesity. Self-harm frequency significantly predicted weight difference. Number of ACEs and diagnosis of schizophrenia significantly predicted patient BMI at the time of audit. The study findings indicate that psychological trauma and the nature of mental illness are important factors driving weight gain and excess morbidity in this vulnerable group. [ABSTRACT FROM AUTHOR]

Therapeutic relationships between children and staff across the Children and Young People Secure Estate (CYPSE) is an under-researched area. The aim of this research is to explore the research question, 'what are the key elements of the development and maintenance of effective therapeutic relationships?' Qualitative semi-structured interviews and a focus group were conducted with children in Young Offender Institutions, Secure Training Centers and Secure Children's Homes in England between February–November 2019 (N = 28 children; 25 interviews, 1 focus group). Framework analysis and grounded theory methodology were applied to the data, and 13 themes were generated. The facilitating properties of good communication, understanding, reciprocal respect, trust, and a sense of fairness in these relationships are highlighted. Positive relationships may be facilitated through the formulation process. The varied experiences of children are considered, highlighting the need for knowledge sharing and training staff in effective helping skills. [ABSTRACT FROM AUTHOR]

Accessibility Summary: What is known on the subject?: A significant number of people with mental health diagnoses have also experienced some form of trauma.In 2008, it was recommended that MHTs in England provide training to MHPs to support them in how to ask their service users about trauma and abuse.It has been identified that staff are not consistently enquiring about trauma and abuse in mental health services. What the paper adds to existing knowledge?: A description of how many MHTs in England are providing training for staff to ensure that they enquire about trauma and abuse.The current gaps in the resources available for mental health practitioners and staff. What are the implications for practice?: Much more work and development of trauma‐informed care and accessibility of training is needed for MHPs working in MHTs.Most MHTs still need to take the first step of implementing training in trauma‐informed care. This should involve ways to ask about trauma and abuse and advice on how to respond to any disclosures made. Introduction: Trauma, abuse and adversities are extremely prevalent for those who access secondary mental health services. Health policy guidance recommends that mental health professionals (MHPs) should routinely enquire about trauma and abuse. Staff training is required to adopt trauma‐informed approaches, as research has identified a clear gap in practice. This study provides a baseline measure of the current provision of trauma‐informed training in English mental health trusts (MHTs). Question: What trauma‐informed training is currently available for MHPs in England? Method: A freedom of information request was submitted to 52 MHTs in England to explore the current training available for MHPs in trauma‐informed care, routine enquiry into abuse and responding to disclosures. Results: The results showed 70% of respondents reported no available training in trauma‐informed care. Discussion: Many MHTs in England do not provide any trauma‐informed training (despite existing recommendations from 2008). Does this contribute to the re‐traumatisation of patients? Implications for Practice: MHTs in England require a responsible and active approach to training MHPs in sensitive routine enquiry into trauma and abuse as a first step to becoming trauma responsive. [ABSTRACT FROM AUTHOR]

Background: One in five women in the UK are survivors of rape and sexual assault, and four in five women will give birth. This implies that a substantial number of women experience rape and sexual assault before pregnancy. We highlight and explore the voices and lived experiences of survivors during pregnancy and birth, to better understand the relationship between sexual violence, biomedicine, and pregnancy and to inform maternity care practice. Methods: This qualitative research took an intersectional feminist approach. We conducted in-depth individual interviews in England with fourteen women who self-identified as survivors of rape or sexual assault, and who had experienced pregnancy and birth after the assault. We conducted open line-by-line coding of the interview transcripts, and identified key themes and sub-themes inductively. Results: Three themes help summarise the narratives: control, safety and trauma. Maintaining a sense of control was important to survivors but they often reported objectification by healthcare staff and lack of consent or choice about healthcare decisions. Participants' preferences for giving birth were often motivated by their desire to feel in control and avoid triggering traumatic memories of the sexual assault. Survivors felt safer when they trusted staff. Many participants said it was important for staff to know they were survivors but none were asked about this. Pregnancy and birth experiences were triggering when they mirrored the assault, for instance if the woman was prevented from moving. Many of our participants reported having unmet mental health care needs before, during or after pregnancy. Conclusions: Survivors of sexual violence have specific maternity care needs. For our participants, these needs were often not met, leading to negative or traumatic experiences of pregnancy and birth. Systemic biases and poor birth experience jeopardise both psychological and physical safety. Funding for maternity and mental health services must be improved, so that they meet minimum staffing and care standards. Maternity services should urgently introduce trauma-informed models of care. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic enveloped the globe there was a parallel increase in the incidence of domestic abuse (DA). This has been ascribed to the restrictions in movement and growing tensions during lockdown periods. The Domestic Abuse Act covering England and Wales was about to be passed prior to the COVID-19 outbreak, but progress halted as attention focused on managing infection control and treatment nationally. The unfolding DA 'shadow pandemic' led to pressure groups lobbying for specific changes to the Act which, in its revised form, became law in April 2021. This article sets out the changes in definition, statutory response and prevention of DA and relates these to nursing practice. Health education and promotion theory is considered and linked to nursing practice with those who are both victims/survivors and perpetrators of DA. [ABSTRACT FROM AUTHOR]

Background: There is an intricate relationship between the mind and the body in experiences of health and wellbeing. This can result in complexity of both symptom presentation and experience. Although the contribution of life trauma to illness experience is well described, this is not always fully recognised or addressed in healthcare encounters. Negotiating effective and acceptable trauma-informed conversations can be difficult for clinicians and patients., Aim: To explore the experience of primary care practitioners caring for women through a trauma-informed care lens., Design and Setting: Qualitative study in the general practice setting of England, with reflections from representatives of a group with lived experience of trauma., Method: This was a secondary thematic analysis of 46 qualitative interviews conducted online/by telephone to explore primary care practitioners' experiences of supporting women's health needs in general practice, alongside consultation with representatives of a lived-experience group to contextualise the findings., Results: Four themes were constructed: 'you prioritise physical symptoms because you don't want to miss something'; you do not want to alienate people by saying the wrong thing; the system needs to support trauma-informed care; and delivering trauma-informed care takes work that can have an impact on practitioners., Conclusion: Primary care practitioners are aware of the difficulties in discussing the interface between trauma and illness with patients, and request support and guidance in how to negotiate this supportively. Lack of support for practitioners moves the focus of trauma-informed care from a whole-systems approach towards individual clinician-patient interactions., (© The Authors.)