17 March 2022

Researchers from the University of East London (UEL) analysed the medical records of 400 anonymised people using four  London community mental health services (CMHS). The study revealed that:

  • Only 13 per cent (52/400) of clinical records contained documentation of any adverse experiences such as abuse or neglect.
  • Only one per cent (4/400) showed clear evidence that patients had been asked about adversities.

The paper titled 'Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England,' published in Community Mental Health Journal, was conducted by Dr Caitlin Neill as part of her doctorate for Clinical Psychology at UEL, and supervised by Dr John Read, Professor of Clinical Psychology at UEL.

It aimed to find out how often CMHSs in England ask about adverse experiences in childhood and adulthood, including abuse and neglect. They also analysed how often those experiences are documented by staff, and how staff responded to these cases when they are identified. 

The researchers audited individual patient records which covered, mental health history and presenting situation. The study showed that despite it being NHS policy that mental health services request this information, there is a lack of evidence of questions being asked about childhood and adulthood adversity - including abuse or neglect.

 "The low number of adversities documented in clinical records is concerning," said Dr Neill.

Adverse childhood experiences have been linked to many psychiatric conditions and individuals who experience them are more likely to be admitted to a psychiatric hospital; self-harm; die by suicide; or have greater severity of symptoms.

"It is vital that these services ensure they ask questions about adversity and document them clearly to improve patient care," she continued.  

A positive outcome highlighted in the study was that clinicians respond appropriately in cases where adversity is recorded.

For example, 75 per cent out of the 52 documented cases of adversity, showed that clinicians had included this in formulation plans - which identified the causes of issues and treatments for patients.  

"Mental health staff must ensure clients are asked about the full range of past and current adversities explored in this study, and whether these are related to their current problems," said Dr Neill.

"Training programmes need to address both asking and responding, as well as the need for careful and consistent documentation," she concluded.

Read the full paper: Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England, in the Community Mental Health Journal.

Related topics