Introduction
Children and adolescents may experience a multitude of, or prolonged exposure to, potentially traumatic and highly stressful events. Whilst some events may directly threaten a child's wellbeing (such as abuse and neglect), dysfunction within the household can undermine their sense of safety and attachment. These adverse childhood experiences (ACEs) are known to correlate with poor mental health outcomes and increase risk of self-harm and suicidality, particularly in those with complex mental health needs (CMHN). Despite the research available, healthcare provider knowledge about childhood adversity is lacking, with service users rarely asked about trauma from their early years during primary care assessments.
Aim
To explore the recording of ACEs in mental health records of service users with CMHN. We also aimed to learn more about the clinical profile of service users with CMHN, including prevalence of self-harm and suicidal behaviours, and their care pathways.
Method
Quantitative data was collected through an in-depth analysis of 76 service user records. A retrospective cohort design was employed to assess service user pathways to current placement, along with their demographics, family history, clinical profiles, and risk profiles.
Results
Almost half of the cohort reported more than one ACE, with two and three ACEs most commonly reported. Eleven service users reported four or more ACEs, which is considered a high level of trauma exposure. For each number of ACEs reported, suicide history was more frequent. In total, 64% of the cohort reported a suicidal history. This data was found within notes made by psychologists, psychiatrists and other mental health professionals as a result of assessments, discussions and therapy notes; however, this information is not routinely collected and there is no coding for such data to be captured.
Conclusion
Our research found that data on childhood adversity and other social determinants of mental distress are not systematically recorded, potentially obstructing access to trauma-informed care. Childhood trauma stories tend to be buried in survivors' medical notes and are not easily accessible to professionals. This could be detrimental to building a therapeutic relationship that facilitates recovery. It is imperative that practitioners and researchers alike can recognise the risk factors for childhood adversity in order to support their prevention and thus reduce their consequences, such as risk of suicide.