Survivors of Trauma & Abuse

• In a 2014 UK study on Adverse Childhood Experiences (ACEs), 47% of people experienced at least one ACE with 9% of the population having 4+ ACES
• ACEs can lead to health-damaging behaviours as well as poor health and social outcomes in adulthood
• Relationship between number of ACEs experienced by a child increases and risk of poor outcomes
• Risks of alcohol use, smoking, drug use, violence and mental illness outcomes were increased in individuals with any level of ACEs. Risks of high BMI, heart disease and respiratory disease were increased in individuals with ≥2 ACEs, and risks of type 2 diabetes, cancer and stroke in those with ≥4 ACEs only.
• ACEs create a huge financial burden – From a recent study, the total estimated annual ACE-attributable cost, across England and Wales was £42.8 billion, equivalent to 2.6% of the total GVA in England and Wales and representing approximately £1800 per household per annum

Lugalia-Hollen, M. Everything Matters: The Power of Addressing Adverse Childhood Experiences (ACEs). (2015). https://www.kzoo.edu/praxis/the-power-of-aces/

• One in five adults aged 18 to 74 years experienced at least one form of child abuse, whether emotional abuse, physical abuse, sexual abuse, or witnessing domestic violence or abuse, before the age of 16 years (CSEW)
• An estimated 1 in 100 adults aged 18 to 74 years experienced physical neglect before the age of 16 years
• One in seven (14.2%) children and young people under the age of 18 will have lived with domestic violence at some point in their childhood
• 7.5% of our population have experienced sexual abuse before the age of 18, and that 20% of women and 4% of men have experienced some type of sexual assault since the aged of 16.
• Over 90% of sexually abused children were abused by someone they knew (Radford, 2011)

Creating ACE-informed places 2021 by Wave Trust and the Association of Directors of Public Health describes risk factors that can lead to ACEs (right). The Trust recommends we: 

• Realise the widespread impact of trauma and understand potential paths for recovery 

• Recognise the signs and symptoms of trauma in clients, families, staff and others involved with the system 

• Respond by fully integrating knowledge about trauma into policies, procedures and practices; 

Seek to actively resist re-traumatisation of both service users and staff

Trauma can have lifelong impacts on relationships, physical and mental health. The Iriss Trust highlights:

• Not all children who have adverse experiences will be traumatised every child is unique and their responses to the same adversity will differ.
• Trauma can affect brain development. Many traumatised children function at an earlier developmental level than their chronological age suggests.
• Traumatised children may struggle to develop regulatory skills needed for learning and social relationships.
• Some children react powerfully to sensory triggers related to their trauma by becoming hyperaroused or dissociating. 

The All Party Parliamentary Group on Adoption and Permanence has highlighted: 

• All adopted children have experienced the trauma of separation from their birth family, and most have endured additional adverse childhood experiences. 
• Placement changes, and changes of social worker, exacerbate a looked after child’s trauma. 
• Every adopted child should feel safe, secure and supported, know what to expect and experience consistent love.

• The World Mental Health Survey Consortium reports that over 70% of adults have reported a traumatic event since the age of 18; 30% of those have been exposed to four or more traumatic events in their adult life – at least 20% of those will go on to develop PTSD as a result (N.B. this doesn’t take into account childhood trauma).
• Just under 40% of people involved in road accidents in the UK, develop PTSD as a result. 
• 1 in 8 individuals in our UK armed forces have been seen in military healthcare for a mental health related reason. 
• People who suffer and survive critical illnesses are at significant risk of developing PTSD.
• Based on national prevalence figures, it is estimated that, 232 women in SNEE experienced PTSD in the perinatal period (2017/18)
• In the year ending 2019, 1.6 million women experienced domestic abuse in the UK, and every year, 1 in 3 victims of domestic abuse are men, equating to over 750,000 men every year. It will affect 1 in 4 women and 1 in 6 men in their lifetime 
• Domestic abuse has more repeat victims than any other crime (on average there will have been 35 assaults before a victim calls the police) and it is the single most quoted reason for becoming homeless (Shelter, 2002)
• The CSEW estimated that 60% of victims of violence were male, and 1 in 5 victims of ‘Honour Based Abuse’ (where the victim is LGBT – 63% male, or where they have mental capacity concerns – 55% male)
• A study showed that about one in four persons that reported DVA against them to the police were male. National crime surveys suggest that only about 10% of male victims tell the police

• Having a long-term condition that risks your life and limits your freedom makes depression and anxiety more likely. 
• The effects of illness, successive hospital admissions, A&E visits and intrusive treatments (for example routine dialysis) can also be traumatic and increase risk. 
• Getting a transplant can also have consequences: guilt at benefiting from someone else’s sacrifice, fearing infection and immune rejection, limiting your world to stay safe. 
• For some people, poor mental health may have been a part of their life before they became unwell. For many people with a mental illness their physical health is overlooked and neglected by health services until it reaches crisis point. 
• The consequences of poor mental health among people with kidney disease are serious and potentially life-threatening. 
• Poor mental health makes it less likely people will adhere to treatment plans. Not taking regular life-preserving medication or dialysis has immediate and serious implications.

“Once you’re a kidney patient, you are a kidney patient for life… Every time you are admitted or have a procedure you go into that carrying all the trauma from previous procedures. Trauma that has had time to grow and solidify in your head. Then you are made to feel like you are overreacting. This often leads to you feeling even worse. Shame, self-doubt and criticism all mix in with the trauma and make de-escalating your reaction harder and harder. Is it any wonder those with long term health conditions are more likely to have a mental illness? I think all too often the medical professionals hugely underestimate the burden that we carry and minimise the psychological effects of this burden.” (Sarah Green) 

Recommendations include

• Ensuring all staff in kidney disease services have the necessary knowledge and skill, and the right supervision, to look after patients’ mental and physical health 
• Securing access to psychological and physical rehabilitation therapies delivered by professionals who understand the specific circumstances of people living with kidney disease. 
• Making kidney disease services fully trauma-informed, for example by creating clinical environments that promote wellbeing and a sense of safety

• One in seven (14.2%) children and young people under the age of 18 will have lived with domestic violence at some point in their childhood.
• 61.7% of women in refuge in 2017 had children aged under 18 with them. [Women’s Aid]

Domestic abuse can end in death. The  Femicide Census 2019 found that of the over 1400 women killed by men in the previous 10 years, almost 900 were killed by a man currently or previously in an intimate relationship with them.

Men are also victims of death caused by current or former intimate partner. Data shows that between 2009-2020 for every two men killed, there were 13 women. 

Short term impacts: 

• Younger children: anxiety, tummy-aches, difficulty sleeping, enuresis, temper tantrums, behaving much younger. 

• Older children: Either outward expressions of distress – aggression, disobedience, copying the adults’ behaviour, truancy, alcohol or drugs. Or becoming withdrawn, anxious, depressed, vague physical symptoms, eating disorder, or self harm. 

• Any age: symptoms of PTSD – nightmares, flashbacks, jumpy, headaches, physical pains. Difficulty concentrating at school, or school refusal

Long term impacts in adulthood: 

• More likely to become involved in a violent and abusive relationship themselves. Copying learned behaviours of their parents – being violent, or tolerating violence.
• Many try not to make the same mistakes as their parents, but may still feel anxious and depressed, and find it difficult to get on with other people.

The Impact on Children of a Caregiver’s Trauma

• Caregivers living with trauma may impact on the physical development of the unborn child, and once born, insecure attachments can impact the child’s emotional development.
• When the child reaches adulthood they may be more prone to mental health difficulties, and may struggle with their own relationships.
• Breaking the cycle will have a positive impact on current and future generations.

• How we develop 2022 – Healthy Suffolk
• https://napac.org.uk/key-facts-figures/
• Impact on children and young people – Women’s Aid (womensaid.org.uk)
• Can Do Healthcare – Thinking Differently Together About Trauma Informed Care (sneeics.org.uk)
• Domestic Abuse Statistics | lwa.org.uk : LWA
• Public health profiles – OHID (phe.org.uk)
• Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys | BMJ Open

Survivors in Transition – Survivors in Transition support anyone over the age of 18 who has experienced sexual abuse in childhood.

CARA Centre For Action On Rape And Abuse – CARA is a registered charity working with adults of all genders, young people and children from across mid and north Essex.

Lighthouse – Lighthouse is a Suffolk based charity that supports women, young people and children who are affected by domestic abuse.