Major trauma refers to serious injuries that can be life-threatening or significantly life-altering, often resulting from events such as road traffic accidents, violence, or sports (Thompson et al., 2019). Since 2012, survival has increased by 19% in the UK due to the establishment of major trauma centers (MTCs) that enhance acute care (Balfe et al., 2025; Moran et al., 2018).
However, many survivors face long-term psychological challenges, such as acute stress disorder (ASD), with an estimated rate of 23–45% (American Psychiatric Association, 2013; Wiseman et al., 2013). Conditions such as post-traumatic stress disorder (PTSD) (Joseph et al., 2020), depression, and anxiety are prevalent among these individuals (Weik, 2025), and psychological distress can hinder physical recovery and rehabilitation (Katsampa, 2021).
Studies indicate significant gaps in psychological care for trauma survivors, highlighting the need for a more integrated approach to addressing physical and emotional health concerns (e.g., Olive et al., 2023).
The objectives of the present study (Balfe et al., 2025) were:
- Explore the experiences of leading trauma therapists interacting with psychology services
- Identify strengths and areas for improvement.
While the NHS mandates psychological support in major trauma centres, implementation lacks clarity and consistency.
methods
Seven physicians from Southmead Hospital in Bristol were interviewed about their experiences with the psychology service within major trauma care. Purposive sampling was used to ensure that participants were closely involved with the service, allowing them to provide valuable insight into its impact on patient recovery. The study focused on gathering perspectives from multidisciplinary trauma practitioners rather than external professionals to gain a deeper understanding of the service:
- 3 Senior Physiotherapists and Leading Trauma Practitioners
- 1 Speech Therapist and Major Trauma Practitioner
- 2 Consultant in Rehabilitation Medicine
- 1 Consultant Plastic Surgeon
The interviews were conducted in person or online between April and May 2023. Physicians provided informed consent and were assured that their responses would be recorded anonymously. Semi-structured interviews explored perceptions of the psychology service, its importance and potential areas for improvement without being restricted to a rigid framework.
Recorded conversations were transcribed and analyzed for recurring themes using NVivo 12 software, yielding actionable findings that could guide service development. This exploratory approach allowed the researchers to capture the genuine perspectives of practitioners, ensuring that themes emerged organically from the data rather than being imposed by pre-existing theories (Braun and Clarke, 2006; 2013).
Result
Five themes were identified through thematic analysis, three of which included subthemes.
Theme 1: The need for specialist psychology for major trauma patients
The prevalence of psychological issues in major trauma patients indicated the need for integrated specialist psychological support. Furthermore, practitioners highlighted the deep psychological impact of life-altering trauma, particularly the challenges of coping with injury, disability, and trauma-related experiences. The psychology service was widely seen as addressing an apparent unmet need in both inpatient and long-term care.
Ever since the psychology service started and the impact it has been having on patients over the years, you can see how much it was needed.
(Francois)
Theme 2: Psychological involvement facilitates patients’ recovery
The subthemes identified focused on service user treatment engagement and the holistic care provided to people who have experienced life-altering trauma. Clinicians described psychological input as improving patients’ acceptability and engagement with treatment, particularly in the acute stages. For example:
(The psychologist) came and saw him in the ward, and (…) in a few hours, this patient’s attitude completely changed (…) he completely complied with everything.
(Peter)
Better engagement was associated with better recovery outcomes, while psychological support was considered essential in providing biopsychosocial care rather than focusing solely on physical recovery.
It’s not just about their physical needs or their discharge needs or their rehabilitation needs… In fact, a big part of being a major trauma patient is your psychological and emotional needs.
(Charlotte)
Theme 3: Psychologists have an important role in assisting physicians
Two subthemes were identified in relation to the emotional and professional support given to other staff members in the service. Clinicians highlighted the emotional impact of trauma work and the importance of including psychologists in the team. Accessible, team-based support was particularly appreciated. Psychologists were also credited with strengthening physicians’ skills and confidence.
It can be very difficult for us emotionally to deal with it day after day, with terrible things happening to people all the time.
(Anne)
Theme 4: Need for service expansion
Two subthemes were identified in relation to service expansion: services being under-resourced and new ideas for service development. While access to acute settings was appreciated by participants, staffing pressures were acknowledged. Therefore expansion was strongly advocated:
Any less clinical psychology would be a terrible thing, so more please, more.
(Peter)
Practitioners also identified shortcomings in provision, particularly for families.
His family must be going through hell (…) but (…) we don’t have the funds to support that family on an ongoing basis.
(Anne)
Theme 5: Importance of integration of psychologists within the multidisciplinary team
Clinicians have described psychologists as “An important feature in itself” and a well-organized part of the trauma team. Their embeddings supported collaborative care,”“It feels like it’s team-based care” And positive working relationships reinforced this integration.
Incorporating psychology within core trauma care reshapes recovery at every level, impacting patient engagement, emotional adjustment, team functioning, and overall quality and consistency of care.
conclusion
To our knowledge, this is the first evaluation to examine the role of specialist psychologists in an NHS major trauma center from the perspective of frontline clinicians. The findings indicate that psychological services are helpful in trauma care for patients who have experienced life-altering injuries. Clinicians reported that psychology enhances patient engagement, emotional adjustment, holistic care, and team dynamics.
Involvement of psychologists was associated with better recovery trajectories, increased therapist confidence, and a stronger multidisciplinary culture.
Strengths and limitations
A key strength of this qualitative evaluation is that it is the first to examine the contribution of specialist psychologists within an NHS Major Trauma Center from the perspective of frontline practitioners. The qualitative design enabled in-depth exploration of both anticipated and less anticipated findings, including the importance of the role of psychologists in supporting patients with major trauma alongside physicians.
However, perspectives were limited to key trauma physicians and did not include wider service partners or patients. Since the data were generated within a single center, contextual effects may affect transferability. Although the interviews were confidential, participants were aware that the evaluations pertained to their coworkers, which may have shaped responses.
Gathering insights from professionals in trauma care provides valuable, practice-informed perspectives on psychological services within major trauma settings.
Implications for practice
The findings emphasize the importance of including psychosocial support as a fundamental aspect of major trauma services. The authors recommend implementing regular, formal group psychological support sessions for physicians and providing more frequent psychological training to a broader range of staff. They also suggest increasing staffing capacity, enhancing family support services, strengthening psychological input into rehabilitation, conducting regular psychometric screening and creating an exemplary model for other NHS major trauma centres.
Beyond these formal recommendations, the findings point to several broader considerations for practice. Most importantly, ensuring that the psychologist is physically present during ward rounds and multidisciplinary discussions is important to facilitate informal consultation and build relational trust. Therefore, services should prioritize allocating protected time for this embedded work rather than relying solely on a referral-based model for psychology input.
Second, psychosocial support in workforce planning should be recognized as a systemic resource that strengthens team resilience and reduces emotional burden, not just as an intervention directed at patients.
Integrating trauma-informed principles throughout the service may lead to a cultural shift towards a holistic, biopsychosocial approach to care in major trauma services.
Statement of Interests
Anna Weick has no conflicting interests to declare. Anna Weick acknowledges the use of AI to assist in the revision of text to increase clarity and accuracy. This tool helps in grammar checking and rewriting long sentences to increase the overall quality of the blog.
edited by
Dr. Daffney Katsampa.
Link
primary paper
Alice Balfe, Megan Powell, Mattia Monastra, Joanna Latham (2025). Perspectives on the newly developed UK major trauma and plastic psychology service: a qualitative service evaluation.. Injury112619.
Other references
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition)
Joseph, N.M., Benedick, A., Flanagan, C.D., Breslin, M.A., Simpson, M., Ragon, C., … and Vallier, H.A. (2020). Prevalence of post-traumatic stress disorder in acute stroke patients. OTA International, 3(1), E056.
Katsampa, D. (2021, June 10). Life after injury: Physical, psychological, and social impacts. Psychic elf.
Moran, C.G., Leckie, F., Boumra, O., Lawrence, T., Edwards, A., Woodford, M., … and Coates, T.J. (2018). Changing system-major trauma patients and their outcomes in the NHS (England) 2008–17. EClinicalMedicine, 213-21.
NHS England. NHS Standard Contract for Major Stroke Service (All Ages).
Olive, P., Hives, L., Wilson, N., Ashton, A., O’Brien, M.C., Mercer, G., … and Harris, C. (2023). Psychological and psychosocial aspects of major trauma care in the United Kingdom: a comprehensive review of primary research. trauma, 25(4), 338-347.
Thompson, L., Hill, M., McMeekin, P., and Shaw, G. (2019). Defining major trauma: A pre-hospital perspective using focus groups.. British Paramedic Journal, 4(3), 16-23.
Weik, A. (2025, August 8). Not just PTSD: Reframing trauma as a public health issue. Psychic elf.
Wiseman, T., Foster, K., and Curtis, K. (2013). Mental health after traumatic physical injury: An integrative literature review. Injury, 44(11), 1383-1390.
