Complex Trauma Survivors' Experiences of Services and Support for Mental Health: A Qualitative Thematic Synthesis

In exploring survivors' experiences of the wide range of services across settings that they sought for mental health support, this review synthesises experiences, facilitators and barriers encountered to help-seeking in adult survivors of complex trauma. We searched multiple databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, EMBASE, Applied Social Sciences Index, Web of Science, and PROQUEST. In total, 23,129 records were retrieved and screened, out of which 108 records were eligible for inclusion. Following a narrative synthesis, seven themes representing facilitators and barriers to seeking help were identified at individual, organisational and societal levels: internal and external stigma, peer support, staff attitude, service flexibility, therapeutic relationship, skills and training. Our synthesis resulted in a conceptual model with three interconnected overarching themes: feeling safe, embarking on a journey, and achieving connectedness, all of which contribute to the development of post-traumatic self. Offering a comprehensive understanding of the obstacles involved in seeking support for complex trauma is essential. A large number of studies highlighted a need for greater public awareness to reduce stigma, trauma-informed training for staff in statutory and non-statutory settings, peer support, funding and better links between services to offer a more holistic approach. Political and practical interventions could help improve accessing support, hence further research to redress this balance is therefore warranted.