Reducing the impact of workplace trauma on acute mental health wards: The effectiveness of the Workplace Trauma Support intervention optimised to meet the needs of minoritised staff

Research question: What is the effectiveness and cost implications of the adapted Workplace Trauma Support intervention in acute mental health settings? Background: Staff working on mental health wards are regularly exposed to workplace trauma such as physical assault, restraining patients and witnessing self-harm. Our research has also found that staff from minoritised groups (40% of the NHS workforce) experience racism, homophobia and disability-related abuse and discrimination from patients or co-workers, adding to other workplace trauma. These experiences are frequent, cause high levels of distress for staff, and are often minimised or unacknowledged, leaving staff unsupported. Workplace trauma causes staff mental ill health, absences and turnover which impact on patient care and health service costs. Our team’s recent survey of Mental Health Trusts investigated support for staff following traumatic events. Only a small minority of Trusts in our survey described comprehensive approaches to reducing the impact of workplace trauma. One example was Workplace Trauma Support (WTS) developed within Lancashire and South Cumbria Foundation NHS Trust (LSCFT). The WTS intervention has been evaluated for acceptability across a range of different teams using surveys and interviews. However, research is needed to optimise WTS to overcome support barriers faced by staff from minoritised groups and test its effects in mental health wards in different NHS Trusts. Aims and objectives: 1) Co-adapt the WTS intervention to better meet needs of staff from minoritised groups. 2) Embed and implement the adapted WTS intervention across 30 wards within six NHS Trusts 3) Test the adapted WTS intervention effectiveness and estimate associated costs. 4) Understand the influence of contextual factors on our co-adapted intervention, explain discrepancies between expected and observed outcomes, and clarify causal mechanisms in our theory of change. Method: Within WP1 we will work with stakeholders to adapt the WTS intervention to ensure that it better meets the needs of minoritised staff. WP2 will focus on training and supervising staff across 30 mental health wards in the adapted WTS intervention. WP3 will be a quantitative evaluation of the adapted model using a controlled Interrupted Time Series design accompanied by a cost-consequences analyses to assess the economic impacts. We will assess staff outcomes in terms of burnout and wellbeing and patient perceptions of the ward environment. We will also collate routine NHS data on serious incidents, staff absenteeism and staff turnover on both the intervention wards and 30 matched control wards. WP4 will be a process evaluation, involving interviews with 25-30 staff and ward observations, to refine our theory of change and develop an understanding of intervention delivery, impact mechanisms and factors affecting effectiveness. WP5 will synthesise data across all the work packages to refine the theory of change designed to support the future use of our intervention in services. Timelines for delivery: 30 months. Anticipated impact and dissemination: An effective intervention to reduce the impact of workplace trauma within acute mental health staff that can be readily implemented across the NHS and meets the needs of all staff, including those from minoritised groups. We will disseminate findings widely to academics, clinicians, commissioners, patients, and carers, ensuring accessibility to all groups.