Complex trauma in adult mental health services: Prevalence and the role of therapeutic support workers.

Ryan, Zoe (2026) Complex trauma in adult mental health services: Prevalence and the role of therapeutic support workers. Doctoral thesis, University of East Anglia.

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Abstract

Background Childhood abuse and neglect are strongly associated with adverse mental health outcomes across the lifespan. Adults accessing specialist mental health services are likely to have elevated rates of childhood trauma exposure; however, variability in assessment practices and workforce preparation may limit services’ ability to respond consistently in trauma-informed ways. This thesis portfolio aimed to examine the prevalence of interpersonal childhood trauma within adult mental health services and to explore the experiences of support workers working with these individuals in these services.

Method The portfolio comprises of a systematic review and an empirical qualitative study. The systematic review synthesises and appraises the findings from 38 studies reporting the prevalence of childhood abuse and neglect among adults accessing specialist mental health services using a random effects meta-analysis. The empirical study utilises a qualitative approach to explore therapeutic support workers’ experiences of delivering care to individuals with a history of complex trauma within adult mental health services. Thirteen support workers were interviewed from various services and thematic analysis was utilised to analyse the data.

Results The systematic review identified high rates of childhood abuse and neglect among adults in specialist mental health services, with a pooled prevalence estimate of 66% of individuals accessing these services having experienced some form of childhood abuse or neglect. However, prevalence estimates varied substantially across studies due to methodological differences, including sampling approaches and trauma assessment measures. Overall study quality was mixed, with high heterogeneity limiting direct comparison across findings. The empirical study identified five themes relating to the relational and emotional demands of support work in this context, challenges in role clarity and boundaries, and variability in the availability of training, supervision, and support. Support workers described frequently encountering trauma-related material without consistently receiving structured training or protected clinical supervision.

Conclusion This portfolio highlights the pervasive presence of childhood abuse and neglect within adult mental health services and the implications of high levels of complex trauma for clinical practice and service design. Findings support the need for routine and sensitive trauma assessment, clearer role definition for support workers, structured supervision standards, and workforce training in trauma-informed principles. Taken together, the studies contribute to the broader field of clinical psychology by linking prevalence-level evidence with workforce experience and by emphasising the importance of organisational approaches to trauma-informed care.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	09 Nov 2026 11:25
Last Modified:	09 Nov 2026 11:25
URI:	https://ueaeprints.uea.ac.uk/id/eprint/105014
DOI:

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