Do Mental Health Professionals in the UK Ask about Experiences of Adversity and Respond Appropriately?

This study ascertained the extent to which mental health professionals working in adult community mental health services directly ask clients about adverse experiences, how often they are aware of those experiences, and how well they respond when such experiences do become known. The clinical records of 400 adult clients using four London community mental health teams were reviewed, using similar methodology to previous studies so as to enable comparisons. The results suggest that routine enquiry about adverse experiences is not taking place, despite this being NHS policy. Identification of adversities was poor. Only 13% of clinical records contained documentation of one or more forms of adverse experience. Only 1% showed clear evidence that service users had been asked about adversities by a clinician. This study included adverse experiences not previously studied, and documentation rates of these within clinical records was also low. The clinical records of female clients contained a higher total number of adverse experiences than males. People with a diagnosis indicative of psychosis were significantly less likely to have adverse experiences documented in their file. There was significant variation in documentation of adversities between the four services. Overall rates of response to known adversities were high, with 90.4% of clinical records containing documentation that the service user was offered some type of relevant support following disclosure of an adverse experience. There were no significant differences in the number of appropriate responses provided by mental health professionals in relation to age, diagnosis, community mental health team location or gender. Theoretical and conceptual knowledge relating to why some mental health professionals do not routinely ask about adverse experiences is discussed. Recommendations are proposed regarding the need for policies, staff training and guidelines to improve routine enquiry and responses to disclosures of adversity. Future research endeavours are recommended, linked to some of the methodological limitations of this study. Implications for both mental health services and broader societal factors are discussed.