Taking a trauma-informed approach to care for patients with mental illness

This month, Health Innovation South West hosted Finding a Way Forward: Trauma-Informed Care for Patients and Staff, an exploratory event on trauma-informed approaches to care. We brought together leaders, experts and people with lived experience across mental health, maternity and neonatal care, and cancer screening, sparking real conversations and determining threads of commonality to drive meaningful change in trauma-informed practice.  

Here, Marie-Joelle West, Portfolio Director at Health Innovation South West and a speaker at the event, describes a personalised approach providing access to primary care for vulnerable people being trialled in coastal North Devon.  

“They said over 10 years ago I had psychosis right, and they put me on olanzapine and it calmed me down. Then they said, turn round, you haven’t got psychosis, you can’t have tablets anymore and my emotions are running everywhere – and I told him after so many years I do need those tablets or something else, but no one seemed to listen and I ended up in a trouble.”  

John, aged 44, Ilfracombe 

For John (name changed for anonymity), seeking health care doesn’t feel easy. John has multiple mental health challenges, feels isolated and suicidal, and lives with chronic obstructive pulmonary disease (COPD) in Ilfracombe, a coastal town in the top 10% most deprived areas in England that has a 15-year difference in life expectancy compared to the most affluent parts of Devon. 

After his experiences, John feels too anxious to see a GP. He isn’t alone. Evidence informing the Core20PLUS5 approach indicates that COPD is the third biggest cause of this life-expectancy gap, with the rate of premature mortality due to respiratory disease at least twice in deprived areas. Moreover, the prevalence of Severe Mental Illness (SMI) within the most deprived areas is triple that within the least deprived areas.  

Mental health issues can affect the ability of vulnerable and homeless individuals to seek care, as can negative experiences of healthcare in the past. This can lead to delayed diagnoses of severe illnesses such as cancer, where mortality rates are twice as high in areas of high deprivation.  

Improving access to health care in rural North Devon for people like John, who face multiple issues including substance abuse, homelessness, and who find it particularly challenging to seek healthcare via the traditional routes, is a challenge for our local health and care system.  

At Health Innovation South West we have been supporting One Northern Devon and Dr Sarah William, a GP at Combe Coastal Practice in Ilfracombe, to test an innovative new primary care outreach model to improve access to routine healthcare assessments, including cancer testing, for residents at high risk of ill health and premature death, including those with severe mental illness. 

The outreach model has been tested in Belle’s Place, a community hub on the seafront where over 200 locals with higher-than-average health needs are provided with a safe and nurturing place to eat a meal, socialise and feel cared for.  

Twice a month, Dr Williams has delivered unstructured, drop-in sessions, addressing any health concerns and providing interventions for long-term conditions, including an innovative quantitative faecal immunochemical test (FIT) to guide referral for colorectal cancer.  

Importantly, these sessions are promoted by trusted community connectors and coordinated with the provision of other services including mental health, housing and literacy services.  

Here, John and his peers feel safe, understood, and cared for. They feel respected, trusted, and not stigmatised, which enables them to build a rapport with a healthcare professional – something they haven’t experienced previously. 

As a result of our pilot, over 50 of the most vulnerable people have received personalised healthcare. Dr William has been able to identify serious conditions, treat them accordingly, and refer at least 11 people to other services such as drug and alcohol rehabilitation.  

Individuals attending Belle’s Place have been offered improved health outcomes and earlier identification and management of colorectal cancer, other cancers and chronic diseases such as hypertension, diabetes and COPD.  

What’s more, John has felt supported and respected at the hub. He feels less isolated and anxious, and has been able to access clinical care with a sense of personhood without stigma. After visiting the surgery, John remarked that the GP didn’t focus solely on his pills, but rather listened to him and linked him to other services.  

This work, which was initiated by NHS England’s national Innovation for Healthcare Inequalities Programme, is helping us to understand the barriers and enablers for people at high risk of health inequalities to access routine healthcare.   

To support more people like John in the South West and further afield, we have developed a set of recommendations for health and care systems in other deprived – and potentially coastal and rural – areas looking to adapt, adopt and spread this personalised and trauma-informed model of care. Research and innovation in these areas is crucial, and we hope our increased understanding will inform a sustainable way of commissioning and providing care in rural and coastal regions up and down the country.  

If you are a healthcare professional and are interested in exploring our set of recommendations, please contact Marie-Joelle West at [email protected].  

Health Innovation South West will be continuing to explore trauma-informed work in the South West. If you are a system or team looking to discuss or invest in this work please contact Programme Manager Emily van Vliet ([email protected]).