Understanding the gaps in mental health services for trauma patients at risk for post-traumatic stress disorder.

Abstract

Trauma surgery patients are at risk for developing mental health sequelae following injury. In response, the American College of Surgeons Committee on Trauma developed guidelines for mental health care in this population. We aim to evaluate current practices, determine guideline adherence, and identify areas for improvement in the mental health services provided to trauma patients. We conducted a qualitative evaluation using semistructured interviews with hospital social workers. Nine social workers were interviewed. Data were analyzed thematically to identify the patient pathway, successes, and barriers to mental health care utilization in trauma patients. Social workers described existing clinical practices for trauma patients, including a lack of structured mental health care during admission. Most were unaware of the American College of Surgeons Committee on Trauma guidelines but engaged in practices that closely aligned with the guideline recommendations. Social workers reflected on personal practices and team strengths, emphasizing clinical competence, compassion, and leadership in developing mental health resources. Social workers identified barriers that included insurance limitations, the absence of standardized follow-up protocols, and high patient-to-social worker ratios. This study conveys perspectives on mental health care for trauma patients, including strengths in current practice and opportunities for improvement. We noted how the social work clinical model reflects the American College of Surgeons Committee on Trauma guidelines despite no deliberate mention of the guidelines, indicating a discrepancy in dissemination at our site. These findings can help create a framework for continued success in caring for mental health concerns and highlight the need for additional training to support consistent implementation of established guidelines.