Author: Tiffany Lam, Consultant, NEF Consulting

Many people, including those who seek crisis support services, have experienced trauma. It may be more prevalent than we think. 1 in 3 adults in England have experienced trauma. And in the UK, 31% of young people have experienced trauma during childhood and 8% have experienced post-traumatic stress disorder (PTSD) by the age of 18.

Broadly speaking, trauma refers to experiences that are harmful or life threatening, and that have lasting negative impacts on one’s health and wellbeing. And according to the NHS, PTSD is an anxiety disorder caused by stressful, frightening or distressing events. People who have experienced trauma and PTSD are also likely to struggle with other mental health issues like depression.

Trauma disproportionately affects the marginalised

But trauma does not occur in a vacuum. It disproportionately affects marginalised groups of people. And research shows that experiences of trauma are inflected by gender, race and socioeconomic class. In particular, people with a lower socioeconomic status and people of racial and ethnic minorities are more likely to experience trauma. And emerging evidence demonstrates that racism contributes to and causes trauma and other mental illnesses that lead to poor health. The Women’s Mental Health Taskforce reported a greater prevalence of PTSD among women of black ethnic origin. Gender-based harassment and violence also elevates women’s exposure to trauma. Yet men may be more likely to put on a ‘tough guise’ and better mask trauma and PTSD to conform to masculinity norms.

All these complexities beg the questions: Does the crisis support sector understand how trauma is intertwined with systems of power, privilege and oppression? To what extent do the support and services that crisis support organisations provide reflect an understanding of the relationship between trauma and structural inequalities?

Research through our National Lottery-funded Help through Crisis (HtC) programme has found that many people, including those who seek HtC services, have experienced trauma. This can impact how they engage with and respond to crisis support services, such as the degree to which they feel safe within support services and trust service providers. To prioritise the safety of both people seeking support and those providing the support services, a trauma informed approach (TIA), or trauma informed care (TIC), in frontline crisis support could be crucial.

A trauma informed approach

A TIA reframes the question from “What’s wrong with you?” to “What happened to you?” It generally describes an approach that:

• Prioritises safety of both the service user and service provider;
• Realises the widespread impact of trauma and understands potential paths for recovery;
• Recognises the signs and symptoms of trauma in clients, families, staff, and others involved;
• Responds by fully integrating knowledge about trauma into policies, procedures, and practices;
• Seeks to actively resist re-traumatisation.

One of the key principles of a TIA is mindfulness of cultural, historical and gender contexts. This means acknowledging community-specific and historical trauma and its impacts, and tailoring services to be culturally sensitive and gender appropriate. It also means incorporating an intersectional perspective that acknowledges how various social categories of identity – age, race, socioeconomic status, immigration status, gender – interact to create different experiences of trauma. And how the interactions of these social categories occur within a larger context of power structures, like government policies, laws, public institutions and financial systems. They occur in the wake of historical traumas, like colonialism and imperialism, and in the backdrop of a complex interplay of other forms of oppression that create unequal social and economic outcomes, like patriarchy, racism and homophobia.

To adequately understand, heal and help others heal from trauma, we will need to have uncomfortable conversations and face uncomfortable realities about power, privilege and oppression. And we need to create trauma informed services that account for the systems and structures that lead to trauma, while simultaneously tackling these systems and structures themselves.