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Access alone is not enough: trauma-informed mental health care

October 10 is World Mental Health Day. This year’s theme, Access to Services: Mental Health in Emergencies and Catastrophes, recognises that mental health care can make all the difference to a person’s recovery. Fay Selvan, CEO of The Big Life Group, explores why we need to rethink how we deliver support and make trauma-informed care central to every service.

Access to mental health support is a universal challenge, and one that becomes even more critical when people are living through disaster, are experiencing trauma or have a history of trauma. But if access to services is inconsistent in everyday circumstances, it will inevitably fracture under the pressure of an emergency. The weaknesses that exist in our mental health systems day to day are always the ones most exposed during times of crisis. 

If we want to improve access in moments of emergency, we first must strengthen it in ordinary times. This involves making sure that the services that people are accessing are both acceptable and effective. In this vein, we should be encouraged to think about what “access” really means. It’s not only about how many people get seen, but whether the services available are what people truly need and are equipped to support safe, sustained recovery. 

This is particularly vital for people living with, or recovering from, trauma. 

Accessing services when you have been affected by/live with trauma 

There has been a surge in awareness of trauma in recent years. More people understand that the difficulties they are having may be rooted in adverse experiences. For some, this includes living through times of disaster or emergency. For others, the source of their trauma is less conspicuous. What’s key is that the impact of those experiences can be far-reaching, directly contributing to poor mental and physical health. Trauma can profoundly affect how and if someone seeks and accesses support.  

As collective awareness of trauma grows and demand for support increases, we need to ensure that our mental health systems and services are ready to respond. For people living with trauma, access isn’t just about getting an appointment; it’s about whether the support on offer feels safe, relevant, and capable of helping them heal.  

Our current mental health systems rely heavily on quantitative measures of success. Access is often defined by numbers: how many people are seen, how quickly, how efficiently. But for people living with trauma, the quality of the encounter matters far more than the quantity of appointments. Access that isn’t secure, culturally appropriate, or person-centred isn’t really access at all. Services that aren’t trauma-informed or culturally sensitive can leave people feeling unsafe, unseen, or even at risk of being retraumatised. 

What trauma-informed care really means 

As trauma becomes a more familiar term, there’s a danger of it being reduced to a ‘catch-all’ or buzzword; a phrase used so freely that it loses meaning. Similarly, there is also a risk that significant forms of trauma – such as trauma from persistent racial abuse- can be dismissed. 

But trauma-informed care is not a trend. It’s a fundamental and necessary shift in how we think about people and the systems that support them. It moves us away from society’s long-standing medical model that is focused on symptoms and diagnoses towards whole-person care, grounded in understanding, empathy and safety. 

A trauma-informed approach acknowledges that health and care teams need a full appreciation of someone’s life and experiences to provide effective support. It asks a different question: instead of “What’s wrong with you?”, it asks “What’s happened to you?” 

A trauma-informed approach acknowledges that health and care teams need a full appreciation of someone’s life and experiences to provide effective support. It asks a different question: instead of “What’s wrong with you?”, it asks “What’s happened to you?” 

This approach seeks to identify the widespread impact of someone’s trauma, enabling us to better understand the paths to recovery. To do this, care providers and organisations must be enabled to recognise the signs and symptoms of trauma in the people they support and their families and their staff; to integrate this knowledge into policies, procedures and practices; and, crucially, to actively avoid re-traumatisation. 

Re-traumatisation is still sadly an occurrence within current service provision. People are often required to retell and relive their traumatic experiences multiple times to multiple professionals to receive treatment or support. Even the environment in which people are met can be unsettling: with people having little control over who provides their care, where it happens, or when. 

A key component of trauma-informed care is recognising that people seeking support are already carrying deep distress, and that the way a service operates can either help or harm. It values the safety, security, autonomy and trust of the people it works with.  

People seeking support are already carrying deep distress, and that the way a service operates can either help or harm.

A missing national strategy 

There is growing interest in trauma-informed practice across the UK, with communities of practice emerging in health, social care and the voluntary sector. But there is no national strategy for trauma-informed care. Without central direction, practice risks remaining fragmented and inconsistent.  

At Big Life, we’ve been part of the national conversation so far, contributing to a community of practice with NHS leaders and others who are advocating for a joined-up approach. A recent briefing paper calls for the government to take the next step: to develop a national strategy, supported by legislation, so that trauma-informed practice isn’t just optional or localised, but embedded across the system. 

As an organisation, we have long advocated for services that take a whole-person approach. From early training on Adverse Childhood Experiences (ACEs) to our first trauma-informed audit in 2021, training partnerships with other trauma-informed providers, and the creation of a trauma-friendly charter for VCSE organisations, we continue to build on that foundation. 

Our work to become fully trauma-informed also recognises the emotional labour carried by staff and volunteers, many of whom bring their own experiences of trauma to their roles. Through compassion-focused approaches, reflective practice and staff support initiatives, we are embedding trauma-informed thinking throughout our culture. This extends beyond service delivery into the environments themselves – from the interior design of buildings and use of colour to access to green space and sensory surroundings. We want to ensure every aspect of care supports calm, dignity and recovery. 

One example of this is the HeaRRT initiative, which stands for Healing from Racism and Racial Trauma. It takes a non-clinical, community-based approach to supporting people from racialised communities affected by racial trauma. Traditional services can be highly prescribed, with limited flexibility to meet people where they are. HeaRRT instead focuses on creating genuine safety – not only in how support is offered, but also in how people’s information, identities and experiences are held. 

For many communities, particularly those who have experienced marginalisation, discrimination or harm within public systems, safety cannot be assumed. Healthcare settings themselves can evoke fear or mistrust. By working in community spaces and prioritising psychological and cultural safety, initiatives like HeaRRT begin to rebuild that trust, offering care that recognises trauma in all its forms, including those caused by racism and inequality. 

For many communities, particularly those who have experienced marginalisation, discrimination or harm within public systems, safety cannot be assumed. Healthcare settings themselves can evoke fear or mistrust.

Trauma-Informed Organisational Audit 

As well as being World Mental Health Day, today also marks the launch of our updated Trauma-Informed Organisational Audit, designed to assess how trauma-informed our organisation is. The audit combines both quantitative and qualitative measures and creates space for honest reflection and discussion across teams. 

Acting as a temperature check, it helps us understand where we sit on the continuum; from trauma-aware to trauma-sensitive, trauma-responsive and ultimately fully trauma-informed, while holding us accountable for progress. We want this audit to shape the design of services that are flexible, relational and rooted in compassion; services that recognise the full human story and respond with empathy. 

As World Mental Health Day reminds us, when we look at access to mental health services, we need to ask what access really means, and who our systems are truly working for. Where things are not working, we need to be bold enough to change them. 

Trauma-informed care gives us a clear framework for that change. It asks us to look beyond numbers and efficiency, and to build systems and services that heal. The work is complex, and progress takes time, but steady, consistent, incremental change is how transformation happens. By rethinking what “access” really means, we can create services people can genuinely trust, especially when they need them most. 

Earlier this year, Fay Selvan appeared on award-winning podcast The Wellbeing Rebellion, to discuss the state of public mental health support, mental health therapy access and efficiency

You can listen here:

Apple https://podcasts.apple.com/gb/podcast/the-wellbeing-rebellion/id1675517581?i=1000664669168

Spotify https://open.spotify.com/episode/11dJ6IfgQLJHGVs81tUq2y?si=b46a5ab3e5144080