Anyone who has tried to get treatment or support through the NHS for mental health issues related to trauma knows just how much of an uphill struggle it is. My dad, who actually works within NHS mental health services has given me plenty of insight over the years into just how much the sector is struggling to meet demand, and that ultimately many of those working within it are often powerless to do the very thing that drew them to the job in the first place, help people.
Even so, there have been many occasions over the last few years that, in spite of knowing just how strained NHS mental health is, have sent me into a spiral of anger, frustration, hopelessness and desperation over just how impossible it feels to access help for trauma, especially complex trauma, through the NHS.
The current picture of mental health support for complex trauma
Owing to the lack of resources within the NHS, many areas in the country fall back on local charitable organisations to provide a ‘trauma pathway’. Survivors Trust is a national organisation for survivors of sexual violence and abuse that includes a series of specialist member organisations in their remit, who provide the on the ground, one-to-one and group support.
Like many charitable organisations, the specialist member organisations of Survivors Trust – the one most local to me being Survivors Network – are becoming increasingly overwhelmed by demand for their services.
Unfortunately, this system has resulted in many people who experience complex trauma unable to access any help through the NHS but also unable to access any immediate help through organisations such as Survivors Network. The last time I heard about the waiting list for therapy through Survivors Network, the minimum wait was two years.
So, what is the answer?
Really there is no simple answer, Assessment and Treatment Services (ATS) are too overwhelmed by the people they already treat to open their doors to those who might fit the criteria for complex post-traumatic stress disorder (C-PTSD), self-referral wellbeing services are overwhelmed by the sheer number of new and returning cases for depression and generalised anxiety to be able to accommodate those experiencing the effects of trauma; and so we see this gap.
In late summer of this year, feeling that the psychotherapy I had been paying for (luckily I was paying concession due to being on Universal Credit when I started the therapy) wasn’t actively changing enough in my life, to justify that outgoing every month, I got back in touch with my GP practice, to try again with ATS in the hopes I would be assessed and could be put on a waiting list for some specialist trauma therapy.
Unfortunately, that didn’t quite go as I had hoped. However, I was notified by my GP practice that they were going to be offering places on a ‘holistic complex trauma programme’. This programme, the first of its kind in the country, would attempt to identify and ‘treat’ the physical symptoms of trauma through various interventions: from acupuncture to green social prescribing exercises like foraging, in the hopes that this would in turn, alleviate the psychological symptoms of trauma, not entirely, but enough so that they’re easier to manage.
What trauma does to the body
When we experience or witness something stressful, the two branches of our nervous system – the sympathetic and parasympathetic – are activated to help you respond to the stressor and then to deal with the stress in the aftermath.
If for example, you witness a car crash, your sympathetic nervous system will turn on, release adrenaline, tell your body to do whatever in that scenario makes sense to keep you alive, so think of the stress/trauma responses of: fight, flight, freeze, flop and fawn.
After you have cognitively and consciously assessed the danger your parasympathetic nervous system comes into play, this is the side of your nervous system that sends messages around your body to calm down, to slow your breathing again, relax your muscles etc.
This mechanism works perfectly for short-term danger/stressors. However, for a traumatic experience that you are unable to escape, or process unconsciously, through these two nervous systems, the danger or stressor might be perceived as so unsurmountable that our parasympathetic nervous system (the one that helps us to calm down) simply doesn’t do what it’s supposed to – thus leaving you in a hypervigilant, stressed, fight, flight, freeze, flop or fawn state.
What is the long lasting impact of this nervous system dysregulation?
A trauma or stress response actually activates an immune response in the body, this often manifests through inflammation, because the body is reacting as if there is something that it needs to attack or force out. Under this state of immune response, inflammation can become chronic, your immune system goes into overdrive and substances called ‘inflammatory cytokines’ continue to multiply unchecked.
All of this can lead to various physiological problems such as cardiovascular diseases, pulmonary diseases, dermatological problems, bowel problems, musculoskeletal complications and autoimmune diseases.
- See also: 'Repairing wounded lives: trauma and the promise of psychoanalytic treatment'
- See also: 'No return to the workplaces of the old status quo, the new normal is trauma-informed'
- See also: 'How nature has grounded me in the here and now during trauma recovery'
Back to the holistic complex trauma programme
Before beginning the interventions that have been selected as part of the trauma programme, myself and everyone else on the programme had to attend four psychoeducation sessions on the theory and thinking behind treating trauma holistically, and to help us choose the right interventions for us.
Week 1 & 2
In week one we identified what psychological trauma is and what a stress response is. We also discussed how a trauma cycle is ‘finished’, for this we analysed the responses of certain animals when they are attacked, and what happens when they run to safety, often what is observed is that they shake to ‘release’ the energy stored in that initial sympathetic response.
We explored how trauma means that we get ‘stuck’ in the stress response, and how that can lead to maladaptive coping mechanisms such as dissociation as well as physiological symptoms such as inflammation in the body. Finally, we explored some different coping mechanisms such as controlled breathing.
We discussed the gut and bowels. There is a growing body of research that is revealing just how important gut health is to mental health and trauma disorders are tightly linked with the gut. To explore this, we discussed the part that nutrition might play in holistically treating the physiological effects of trauma. As a group we identified the importance of vitamin B/B12 foods that can help to regulate some of the psychological and physiological effects of trauma such as exhaustion, as well as the important role of a balanced and active gut biome.
Finally we discussed how dysregulation of cortisol can impact our hormone levels which all exist in a never-ending feedback loop, where one hormone system is impacted, others follow.
Week 3 & 4
We discussed the benefit of movement, both in exercise form but also in a general way. Often when we are triggered or stressed, especially if your trauma is related to feeling powerless, we go into ‘freeze’ or ‘flop’ and rarely think of moving. We discussed how fighting that urge to stay still, can actually help us to ‘finish’ the stress cycle.
Finally, we explored the idea of toxicity both in the physical sense and in an interpersonal sense. Following on from this we identified positive, healthy ways of ‘banishing’ toxicity and of out letting the negative effects of it. Here, we discussed boundaries, safely expressing emotion, journaling, creative outlets and breathing exercises.
After the four psychoeducation sessions, which were all finished by early December, we were breaking for around a month, then meeting up in January to begin our interventions, with a better idea of the kind of interventions, treatments, and social prescribing experiences we believe would best suit us.
This is an entirely new way, especially within the NHS, to treat trauma. Without the framework of talking therapy, those of us within this programme are being encouraged to understand and perceive the symptoms we experience every day, through a different lens.
I will be continuing to document my experiences on this journey, here in our blog section, and of the potential benefits of each of the interventions I will be taking part in or have personally chosen. As I mentioned earlier, this is the first of its kind in the UK, and although those running the programme, nor myself would ever suggest this kind of treatment should replace traditional talking therapies or medication, it could be that this holistic treatment becomes a very necessary tool in how we understand and treat trauma moving forward.
The interventions, treatments and social prescribing practices I will be taking part in:
- trauma informed yoga
- TRE (trauma releasing exercise)
- foraging in nature
- equine assisted therapy