Psychological Support After Major Injuries: Do specialist trauma hospitals in England and Wales meet national standards for psychological care?

Psychological Support After Major Injuries: Do specialist trauma hospitals in England and Wales meet national standards for psychological care?

Imagine you have been involved in a car accident that has left you with multiple broken bones. You are in a specialist trauma hospital called a Major Trauma Centre (MTC). You start to experience flashbacks of the car crash, which causes you lots of worry and distress. You reach out for support for your mental health and are seen by a psychologist, who can support you emotionally whilst you recover.

What are Major Trauma Centres?

In England and Wales MTCs treat the most seriously injured patients, people who have had big accidents, fallen from heights or experience life-threatening injuries. Alongside physical injuries, there can also be emotional and psychological difficulties, such as anxiety or struggling to adjust. Guidelines and standards about what psychological care should look like come from the National Health Service (NHS), the National Institute for Care Excellence (NICE) and the Association of Clinical Psychologists UK (ACP-UK).

National guidelines outlined by NHS England, NICE and the ACP-UK state that:
• MTCs must offer access to clinical psychology
• Patients should receive proper mental health support from trained professionals
• Services should meet specific standards around staffing, training and patient care

However, previous studies have suggested not all MTCs have the same level of psychological resources.

What did the researchers do?

To see how well MTCs are meeting the guidelines, the researchers contacted all 29 MTCs in England and Wales to find out:
• Whether they had clinical psychology services
• How many psychologists worked there
• What kind of psychological support they provided
• Whether they believed they were meeting national standards

All 29 MTCs replied. Four MTCs reported having no psychology service at all. The remaining centres completed a detailed questionnaire about their staffing levels, the types of support offered and how well they thought they matched the national requirements.

What did the researchers find?

The seniority of staff was inconsistent across services, some were led by experienced consultant psychologists, while others with some newly qualified staff.

All services supported patients while they were in hospital. Over half of the services offered a service to support patients after being discharged. Only a third of services said they offered neuropsychology, something particularly important if a patient has suffered a head injury, and child trauma services were more likely to not have any service.

Many centres said they only saw up to 30% of all admitted trauma patients, meaning the majority may receive no psychology input. Most services offered support, such as staff training or emotional support for staff in the MTC and over half provided support to families.

Most centres rated themselves as not meeting or only partially meeting the guidelines set by NHS England, NICE and ACP-UK.

What does this mean?

Because psychological support varies between MTCs, many patients recovering from life-changing injuries are likely to not receive the mental health care national bodies say they should.

The biggest problems seem to be:
• Insufficient staffing
• Lack of capacity to see all patients
• Differences in service design
• Limited or no follow-up care after discharge
• Lack of support in child (paediatric) MTCs

The study also found that current national guidance on psychology provision in MTCs is too vague. Although guidelines say psychology should be available, they do not state what services should look like.

The researchers recommend that the minimum standards for psychology provision in MTCs, as stated in the NHS service contract, need to be clearly stated and detailed. This is referred to as a workforce model, with similar models used in other hospital specialities like intensive care. This would help to ensure all patients receive the same high-quality psychological care, no matter which hospital they go to.

Strengths and Limitations

Strengths
• All MTCs responded, giving a broad picture across England and Wales
• Detailed information was collected and compared to official standards
• The study highlights clear problems that need addressing

Limitations
• Some MTCs did not complete every detail of the questionnaire
• MTCs assessed themselves, which may not always be objective
• The study did not include feedback from patients or families.

Implications

This study shows that psychological care for trauma patients is unequal and inconsistent. The support a patient receives can depend simply on which hospital they happen to be taken to. National requirements exist, but many hospitals do not have the staff or systems to meet them.

In summary:

To the researcher’s knowledge, this is the first study to examine how well MTCs in England and Wales meet the psychological needs for people following a traumatic injury and how these services compare to national standards and guidelines. It is also the first study to receive responses from all MTCs. While many MTCs provide strong psychological support, this does vary a lot between hospitals, and more than half rating themselves as not meeting national requirements. To achieve fair and consistent care, a clear minimum standard is needed to ensure all patients receive equal and appropriate psychological care, no matter where they are treated.