From 2016 to 2019 the Winston Churchill Memorial Trust ran the Mental Health Fellowships programme, funding individuals to travel abroad to learn more about how community-based solutions are being created in response to some of today’s most pressing mental health challenges.
The Mental Health Foundation was the expert partner in this programme, helping to shape its aims, select the successful candidates from hundreds of applicants and provide mentoring to the successful Churchill Fellows. In total, 59 Fellows were chosen to investigate best practice in 17 countries and bring back new evidence and ideas to create positive change in their profession, practice and communities in the UK. This is one of four briefings that distil the key findings from this rich body of learning, and make recommendations for policy and practice in the UK. Each briefing focuses on an aspect of the Mental Health Fellowships’ overarching theme ‘community-based solutions’, and an overview of the learning from this Fellowship can be found in the programme’s summative briefing.
Scope
This briefing on Trauma and Adversity brings together learning from six Fellows’ research in the USA, Norway, Sweden, Bosnia & Herzegovina, Australia, New Zealand and Canada, that focuses on how community-based approaches are being used to effectively support people affected by trauma. The learning from this category is grouped into two main sections:
Section 1: Trauma-informed approaches
Introduces the emerging field of trauma informed care, provides a number of case studies and findings from two Fellows’ research, and details good practice in trauma-informed approaches for a range of public organisations, institutions and services.
Section 2: Supporting veterans living with trauma
Focuses on the mental health needs of military veterans, provides a number of case studies and key findings from four Fellows’ research, and introduces a range of non-traditional and more holistic approaches for supporting.
Why trauma and adversity?
In recent years, our understanding of trauma has grown exponentially in the UK, and there is both a greater awareness of its long-term effects on survivors and its prevalence in society1. It was recently estimated that 70% of the general population have been exposed, either directly or indirectly, to a traumatic event at some point in their lifetime2.
something that was once associated with particular groups (for example, veterans), is now a human experience that we consider to be far more widespread and affecting a much larger proportion of our society. It is becoming clear that trauma and adversity can, in fact, enter into our lives at any moment; whether it be through a broken early attachment to a primary caregiver, repeated peer bullying, or through bereavement or other types of loss (to name but a few).
This shift in understanding has been to an extent both led by and reflected in the redefining of ‘traumatic experience’ in clinical practice. The term Post Traumatic Stress Disorder (PTSD) - a diagnosis most closely associated with traumatic experience and associated with the lasting effects that trauma can cause (including flashbacks) - made its first appearance in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll) published by the American Psychiatric Association in 1980, and was closely connected with the legacy of the Vietnam War. This was preceded by earlier conflicts, including the two World Wars, giving birth to other terms such as shell shock, and war neurosis3. More recently, however, subsequent editions of the DSM have seen the criteria for PTSD modified to include traumatic situations that are not “outside the field of usual human experiences,” recognising that even everyday life events can create PTSD4.
Similarly, The Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the US Department of Health and Human Services, adopts a broad definition of a traumatic experience as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual wellbeing.”5 What is certain, is that in thinking about trauma and adversity, it is no longer an “us and them” debate, but a conversation about something which can affect us all.
The work of these Fellows is therefore well-timed and comes at a moment when we are continuing to develop our understanding of ‘trauma’ and re-thinking our approaches to effectively supporting those it affects. As the radical revolution of mental health services progresses - with a community-based care model largely replacing the acute and long-term care provided in in-patient settings - the Fellows’ findings provide innovative ideas for how we as individuals, families and communities can work together to look after one another, create an environment of safety, connection and healing, and ensure that everyone is able to enjoy their lives again following the trauma or adversity that life sometimes brings.