Major trauma refers to severe injuries that can be life-threatening or significantly life-altering, often resulting from incidents such as road traffic accidents, violence, or sports (Thompson et al., 2019). Since 2012, survivorship in the UK has increased by 19% due to the establishment of Major Trauma Centres (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 incidence rates estimated at 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 (Veic, 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 address both physical and emotional health concerns (e.g., Olive et al., 2023).
The aims of the current study (Balfe et al., 2025) were to:
- Explore the experiences of major trauma clinicians interacting with the psychology service
- Identify strengths and areas for improvement.
While the NHS mandates psychological support in Major Trauma Centres, the implementation lacks clarity and consistency.
Methods
Seven clinicians from Southmead Hospital in Bristol were interviewed about their experiences with the psychology service within major trauma care. Purposive sampling was used to ensure participants were closely involved with the service, allowing them to provide valuable insights on its impact on patient recovery. The study focused on gathering perspectives from multidisciplinary trauma clinicians rather than external professionals to gain a deeper understanding of the service:
- 3 Senior Physiotherapist and Major Trauma Practitioners
- 1 Speech Therapist and Major Trauma Practitioner
- 2 Consultants in Rehabilitation Medicine
- 1 Consultant Plastic Surgeon
Interviews were conducted between April and May 2023, either in-person or online. Clinicians provided informed consent and were assured their responses would be recorded anonymously. The semi-structured interviews explored perceptions of the psychology service, its importance, and potential areas for improvement without being confined to a rigid framework.
The recorded conversations were transcribed and analysed for recurring themes using NVivo 12 software, leading to actionable findings that could guide service development. This exploratory approach allowed researchers to capture the genuine perspectives of clinicians, ensuring the themes emerged organically from the data rather than being imposed by pre-existing theories (Braun & Clarke, 2006; 2013).
Results
Five themes were identified through thematic analysis, with subthemes included in three of the themes.
Theme 1: Necessity of Specialist Psychology for Major Trauma Patients
The prevalence of psychological issues in major trauma patients indicated a need for integrated specialist psychological support. In addition, clinicians highlighted the profound psychological impact of life-changing trauma, particularly the challenges of adjusting to injury, disability, and trauma-related experiences. The psychology service was widely seen as addressing a clear unmet need across both inpatient and longer-term care.
Since the psychology service has started and you see the kind of impact it has been having on patients over the last few years, you can see how much there was a need for it.
(Francois)
Theme 2: Psychological Involvement Facilitates Patients’ Recovery
Subthemes that were identified focused on service user treatment engagement and the holistic care provided to people experiencing life-changing trauma. Clinicians described psychological input as improving patients’ acceptance and engagement with treatment, particularly in acute stages. For example:
[The psychologist] came up and saw him on the ward, and in […] a couple of hours, completely turned this patient’s attitude around […] he complied with absolutely everything.
(Peter)
Improved engagement was associated with better recovery outcomes, while psychological support was seen as essential to delivering biopsychosocial care rather than focusing solely on physical recovery.
It’s not just about their physical needs or their discharge needs or their rehab needs… actually, a huge part of being a major trauma patient is your psychological and emotional needs.
(Charlotte)
Theme 3: Psychologists Have an Important Role in Supporting Clinicians
Two subthemes were identified in relation to the emotional and professional support offered to other staff members in the service. Clinicians highlighted the emotional toll of trauma work and the value of having psychologists embedded within the team. Accessible, team-based support was especially appreciated. Psychologists were also credited with strengthening clinicians’ skills and confidence.
It can be quite difficult emotionally for us to deal with day in, day out when you’ve got horrible stuff happening to people all the time.
(Anne)
Theme 4: Requirement for Service Expansion
Two subthemes were identified in relation to service expansion: service being under-resourced and new ideas for service development. While accessibility in acute settings was praised by participants, staffing pressures were acknowledged. Expansion was therefore strongly advocated:
Any less clinical psychology would be a terrible thing, so more please, more.
(Peter)
Clinicians also identified gaps in provision, particularly for families.
Their family will be going through hell […] but […] we’re [not] funded to support that family on an ongoing basis.
(Anne)
Theme 5: Importance of Psychologists’ Integration within a Multidisciplinary Team
Clinicians described psychologists as “an important speciality in its own right” and a well-integrated part of the trauma team. Their embedment supported collaborative care, “feels like it is team-based care” and positive working relationships reinforced this integration.
Embedding psychology within major trauma care reshapes recovery at every level, influencing patient engagement, emotional adjustment, team functioning, and the overall quality and sustainability of care.
Conclusions
To our knowledge, this is the first evaluation examining the role of specialist psychologists in an NHS Major Trauma Centre from the perspective of frontline clinicians. The findings indicate that psychological services are helpful to trauma care for patients who have experienced life-altering injuries. Clinicians reported that psychology enhances patient engagement, emotional adjustment, holistic care, and team dynamics.
Psychologists’ involvement was linked to improved recovery trajectories, increased clinician 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 Centre from the perspectives of frontline clinicians. The qualitative design enabled in-depth exploration of both anticipated and less foreseen findings, including the significance of psychologists’ role in supporting clinicians as well as patients with major traumas.
However, perspectives were limited to major trauma clinicians and did not include wider service partners or patients. As data were generated within a single centre, contextual influences may affect transferability. Although interviews were anonymised, participants were aware that the evaluation related to their colleagues, which may have shaped responses.
Collecting insights from professionals in trauma care offers valuable, practice-informed perspectives on psychological services within major trauma settings.
Implications for practice
The findings emphasise the importance of incorporating psychological support as a fundamental aspect of major trauma services. The authors recommend implementing regular, formalised group psychological support sessions for clinicians 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 in rehabilitation, conducting routine psychometric screenings, and creating a replicable model for other NHS Major Trauma Centres.
Beyond these formal recommendations, the findings point to several wider considerations for practice. Foremost, ensuring that psychologists are physically present during ward rounds and multidisciplinary discussions is crucial for facilitating informal consultations and building relational trust. Therefore, services should prioritise allocating protected time for this embedded work instead of relying solely on referral-based models for psychology input.
Second, psychological support should be recognised in workforce planning as a systemic resource that strengthens team resilience and reduces emotional burden, and not merely as an intervention directed at patients.
Integrating trauma-informed principles across the service may create a cultural shift toward a holistic, biopsychosocial approach to care in major trauma services.
Statement of interests
Ana Veic has no conflicting interests to declare. Ana Veic acknowledges the use of AI in assisting with the revision of the text to enhance clarity and correctness. This tool has helped with grammar checks and rewriting long sentences to increase the overall quality of the blog.
Edited by
Dr Dafni Katsampa.
Links
Primary paper
Alice Balfe, Megan Powell, Mattia Monastra, Joanna Latham (2025). Perspectives of a newly developed UK major trauma and plastics psychology service: A qualitative service evaluation. Injury, 112619.
Other references
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
Joseph, N. M., Benedick, A., Flanagan, C. D., Breslin, M. A., Simpson, M., Ragone, C., … & Vallier, H. A. (2020). Prevalence of posttraumatic stress disorder in acute trauma patients. OTA international, 3(1), e056.
Katsampa, D. (2021, June 10). Life after injury: physical, psychological and social impact. The Mental Elf.
Moran, C. G., Lecky, F., Bouamra, O., Lawrence, T., Edwards, A., Woodford, M., … & Coats, T. J. (2018). Changing the system-major trauma patients and their outcomes in the NHS (England) 2008–17. EClinicalMedicine, 2, 13-21.
NHS England. NHS Standard contract for major trauma service (all ages).
Olive, P., Hives, L., Wilson, N., Ashton, A., O’Brien, M. C., Mercer, G., … & Harris, C. (2023). Psychological and psychosocial aspects of major trauma care in the United Kingdom: a scoping review of primary research. Trauma, 25(4), 338-347.
Thompson, L., Hill, M., McMeekin, P., & Shaw, G. (2019). Defining major trauma: a pre-hospital perspective using focus groups. British Paramedic Journal, 4(3), 16-23.
Veic, A. (2025, August 8). Not just PTSD: reframing trauma as a public health. The Mental Elf.
Wiseman, T., Foster, K., & Curtis, K. (2013). Mental health following traumatic physical injury: an integrative literature review. Injury, 44(11), 1383-1390.
