Intersectional trauma-informed recovery at a recovery college
Creators: name: Miguel-Lorenzo, Xandra
Publisher: name: F1000 Research Limited
Year: 2025

description: Introduction<br>
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Recovery Colleges are a cornerstone to implementing the recovery approach to mental health (Department of Health 2011; Perkins et al. 2012; Perkins et al. 2018) and the community mental health transformation (NHS England and NHS Improvement and the National Collaborating Central for Mental Health 2019).  Recovery Colleges are an educational mental health intervention in the UK since 2009 (Perkins et al. 2012) and imported to countries outside of Europe, such as Japan, New Zealand, Canada, Australia or Africa. Clinical and lived experience experts co-produce recovery courses for self-management, self-understanding, meaning-making, promoting hope, agency, and healthy relationships (Ibid). Bringing cultural change to mental health services through community-based recovery practice (Repper &amp; Perkins, 2003; Department of Health, 2011; NHS, 2019). Recovery Colleges’ role in implementing the trauma-informed approach for mental health and trauma recovery (see Sweeney et al. 2018; Kennedy et al. 2020; and Emsley et al. 2022) to improve mental health recovery rates (Mental Health Taskforce 2016) has not been studied. The author presented this poster, underpinning the theoretical justification of her post-doctoral research project for long-term co-produced ethnographic research, at the Refocus on Recovery 2023 Conference (6-7 September, Nottingham) and in her role as NIHR Mental Health for All Fellow, based in the UCL Department of Applied Health Research, and embedded researcher in the Camden &amp; Islington Recovery College, North London NHS Foundation Trust (NLFT), where she works as a Senior Peer Recovery Tutor since 2021. <br>
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This poster results from the author’s interest in understanding how different elements of Recovery College course content delivery are conducive to intersectional trauma-informed recovery and the trauma-informed approach implementation. The author argued that according to the Camden &amp; Islington Recovery College courses for mental health recovery and well-being content, four elements are conducive to intersectional trauma-informed recovery: safety, sharing, self-regulation, and self-care, comprising the ‘Self-Recovery X4S Model’, and thus Recovery College courses offers students the possibility of post-traumatic growth (Slade et al. 2019). If Recovery College courses’ content reflects the ‘collective wisdom’ (Perkins et al. 2018:18) of lived experience experts, clinical professionals, and the communities they serve, the author concluded that the collective wisdom informing Camden &amp; Islington Recovery College course on what works for mental health recovery, indicated that mental health recovery is trauma recovery, and hence, we ought to consider mental health challenges as responses to traumatic events. <br>
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Traumatic events include physical, domestic, and sexual violence; adverse childhood experiences; poverty, racism, or war. Experienced as life-threatening can have a negative long-lasting impact on a person’s physical, mental, emotional, and/or social well-being (SAMHSA, 2014: Sweeney et al. 2016:175), including developing post-traumatic stress disorder and complex PTSD (Herman, 1992). PTSD, manifesting in unwanted upsetting memories or nightmares can develop when a person is exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, by witnessing the trauma; learning that a relative or close friend was exposed to a trauma; or indirectly by exposure to aversive details of the trauma, usually in the course of professional duties (American Psychiatric Association, 2013). These traumatic experiences have been defined as ‘Capital T Trauma’ and differentiated from ‘Small T trauma’ to include traumatic experiences such as ‘bullying by peers, the casual but repeated harsh comments of well-meaning parents, or even just a lack of sufficient emotional connection with the nurturing adults’ (Maté &amp; Maté, 2022).<br>
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During the covid-19 pandemic (2020) the Camden &amp; Islington Recovery College co-produced with the Camden &amp; Islington Traumatic Stress Clinic its course ‘How to cope with traumatic events’. Trauma and mental health recovery popularised during the coronavirus pandemic (Wilton 2020). Before, in 2016, Camden &amp; Islington Recovery College co-produced courses with the charity AVA ‘Against Violence and Abuse’ on domestic violence: ‘Surviving abuse: a women’s space’ and ‘Self-care for women with experiences of abuse’. Dheensa et al. (2022) identified that up to 31.3% of healthcare staff had lived experience of trauma. Mauritz et al. (2013) found that 47% of patients in mental health services had been physically abused and 37% sexually abused. Daryn et al. (2015) argued that women face disproportionated rates of violence, homelessness, and unemployment and thus women are overrepresented among people with mental illness. <br>
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Women who are domestic violence victims experience poor mental health (Women’s Aid UK, 2021a; Howard et al. 2010a; Trevillion et al. 2012; Devries et al.2013; Howard et al., 2013; Oram et al. 2014), manifesting in depression, anxiety, PTSD (Trevillion et al. 2012a) and suicidality (White et al.2024); worsening with repeated cycles of victimization (Walby et al. 2016). Chronic exposure to intimate partner violence is associated with more severe mental health problems (Dillon et al. 2013). Women who were psychiatric patients with severe mental illness in contact with community services, compared to the general population, showed higher levels of reported domestic and sexual violence (Khalifeh et al. 2015; Jonas et al. 2013) and interpersonal violence (Sweeney et al., 2016). <br>
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An argument as to why Recovery College courses have developed to be responsive to trauma recovery needs might be because according to Hayes et al. (2023), the majority of Recovery College students’ population is female (57.5%), with an average of 40.7 years old, and mostly White/White British (71.5%) and yet including Black/Black British (8.9%) and Asian/Asian British (6.4%) students (Ibid) and other ethnicities. Camden and Islington Recovery College’s ‘Self-Recovery X4S Model’ shares principles of recovery with feminist intersectional recovery models (Mizock &amp; Kaschak 2015), although mental health recovery and interpersonal trauma recovery models are separated in history (Wallcraft &amp; Bryant, 2003), this poster shows its remaining connections because of trauma being a key element in mental health recovery. <br>
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In light of this, the author proposed a new definition for recovery, which is intersectional and trauma-informed: “Intersectional Trauma-informed Recovery is a process by which a person (1) learns how traumatic events impact mental and physical health and how different levels of discrimination intersect and determine a person’s capacity to minimise chances of becoming mentally unwell; (2) learns to feel safe among people, shares knowledge and works together with other people, understands who the person is in relation to others and re-discovers aspirations and a life purpose; (3) learns how to regulate her nervous system by herself or with others, to feel present, safe, and socially connected to other people; and (4) learns how to take care of her self at body, mind, emotional, social relationships, and spiritual level, to affirm the self and to cope with challenges. This process facilitates the recovery of the self and post-traumatic growth. Some people might fully recover others might be in a journey of ongoing recovery throughout their lives (Miguel-Lorenzo, 2023).” <br>
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This differs from previous recovery definitions offered. William Anthony defined recovery as ‘A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life, even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life’ (Anthony, 1993). The leading authors in recovery in the UK, Rachel Perkins and Julie Repper, alongside Miles Rinaldi and Helen Brown defined recovery as ‘A personal journey of discovery' that 'involves making sense of, and finding meaning in, what has happened; becoming an expert in your own self-care; building a new sense of self and purpose in life; discovering your own resourcefulness and possibilities and using these, and the resources available to you, to pursue your aspirations and goals’. (Perkins et al. 2012). <br>
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The Recovery College course delivery ‘Self-Recovery X4S Model’ and its four elements for intersectional trauma-informed recovery<br>
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Safety<br>
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Students can increase a sense of safety within themselves and among others by the Recovery College creating a ‘culture of safety’. This is achieved by the Recovery College offering direct enrolments via the Recovery College’s website, or in person during enrolment sessions by completing an enrolment form, without need of professional referrals, identity or residence proof; students choose the courses they want to take; students can meet tutors during enrolment sessions, open days, and end of term celebrations; students have access and sign by completing the enrolment form that they have read and understood the students’ charter and code of conduct and the attendance policy; the tutors also have a code of conduct that they are inducted into when they join the Recovery College and refer to during reflective spaces; the Recovery College has a protocol to ‘Responding to traumatic disclosures whilst delivering a Recovery College course’; all tutors attend the Camden &amp; Islington Recovery College ‘Train the Trainer co-production course’; courses are delivered in safe venues, the address only disclosed to students enrolled in a course, and the allocation of courses to venues change every term; all courses start by the students co-producing a group agreement a list of rules that ensured students feel comfortable and they know how to relate to each other that might include confidentiality, respect, active listening, non-judgment, non-discrimination, sharing the time, validating, non-blaming, being punctual, silent phones, not giving advice or sharing too many graphic details of traumatic events; tutors let students know that there is a NLFT’s safeguarding pathway for disclosures of harm; all courses activities are offerings and not compulsory, students choose to participate or not in the activities offered; all courses contain signposting information and tutors can signpost  students to services in the community for further support specific to their needs; tutors do pre-course calls to students to ensure that students’ learning needs are met, accessibility options are offered and students know how to get to the venues; tutors also offer post-course calls when the students require further support after a course session; students do not need to disclose if they are seeing mental health professionals, hospitalised or are professionals; the Camden &amp; Islington Recovery College operates upon the values of nourishment, uniqueness, trustworthiness and openness, in addition to  Recovery College’s values of hope, choice and opportunity; it follows ImROC’s policy papers for best practices; and it operates considering the North London NHS Foundation trust values and policies: ‘Clinical strategy’ (2024-2029) and its service principles: trauma-informed, recovery-oriented, and evidence-based; its ‘Equality, diversity, and inclusion strategy’ (2022-25); and its Camden and Islington NHS Foundation Trust ‘Trauma informed organisational strategy; (2022), which includes (Greenfield; McNicholas &amp; Rose, 2021) ‘Model for Trauma Informed Organisational Change’. <br>
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Sharing <br>
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The sharing of lived experience of mental health challenges and recovery by Recovery College tutors and students alike during courses allows for ‘connection in community’. This is achieved by ensuring that classrooms are inclusive of students’ learning needs, identity differences, and protected characteristics according to the Equality Act 2010; tutors are gender responsive and considerate of the impact of violence against women and girls as well as childhood sexual abuse and exploitation; tutors are responsive to different types of discrimination; there is not a hierarchy of expertise, students co-produce the course content by sharing their experiences of recovery in situ during the course, offering peer-to-peer support, and this is equally valuable to the Recovery College lived experience tutors and clinical professionals co-facilitating a course; students spend time together in the same space for a short course, a day course, or a multi session course spread over a number of weeks (usually four to six weeks) and this usually helps with their nervous system co-regulation, in other words, feeling safe in the presence of other people while learning or preparing a hot drink, which can translate in changing from feeling hyper-alert, fearful or reactive to feeling calm and trusting; students learn about mental health symptoms and that other people also experience them, thus normalising the experience, moving away from diagnoses, labels and stigma; students learn self-management tools for specific challenges; students learn how to tell their recovery story including how different forms of discrimination or identity intersect yet focusing on their strengths, skills, agency, empowerment and achievements, thus offering hope to themselves and to others that the work of recovery is worthwhile, make sense of what happened to them, find meaning and purpose moving forward with hopes and dreams; students learn about themselves via self-discovery activities and tools; students learn social skills to become more assertive or build healthy relationships, for example, and practice and rehearse those social skills safely in the context of the Recovery College under the group agreement auspice; and students are offered a Learning Guidance Conversation, a thirty minutes call with a tutor, to identify recovery learning goals to achieve via Recovery College courses and other support in the community. <br>
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Self-Care <br>
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All Recovery College courses include a combination of participatory activities to share and co-produce knowledge around a topic; information delivery on the topic; self-management tools and self-care practices. While self-management tools focus on how to manage a mental health challenge or relational problem; self-care ideas and activities are usually offered to manage the impact of experiencing difficult situations, this might be the challenges experienced in their lives, their mental health challenges or challenges implementing self-management tools, such as ‘Saying No’. Thus, self-care practices are offered to create or reinforce a sense of ‘being a worthy human being’ who attends to herself, making time for, or prioritising herself. Self-care practices can be focused on different areas: the body (having a bath, resting, exercising, practicing yoga…); the mind (meditation, reading affirmations…); the emotions (listening to music, dancing, going to therapy…); the social relationships (seeing family and friends, attending a peer group, volunteering…); and/or the spiritual realm (attending religious group activities, spiritual practices, going to nature...). <br>
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Self-Regulation <br>
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Student can learn to increase being present in their bodies through bodywork practices that help them regulate their nervous system. These practices can be offered as self-management or self-care offerings, nonetheless, they have the purpose of the students become more aware of their body experience and be more embodied or present in their experience. This can include mindfulness practices such as body scans, short mediations, guide imaginary stories, breath work, somatic practices such as dance, movement, or yoga, collaborative practices, nature-based activities, and compassion-based practices such as bringing your hard to your heart while offering to yourself reassuring and kind words. These embodied activities can help students to come out of traumatic responses that have become habitual by introducing the learning of the opposite: for example, calmness can be introduced via a mindfulness practice when in a state of fighting/arguing; a sense of belonging and collaboration can be introduced with a team practice or pair activity when in a state of flying/feeling, restlessness, isolation or lack of rootedness to the place; movement or dance can be introduced to come out of a state of freezing/feeling stuck, unable to take action; compassion-based mindfulness activities can be introduced when in a state of appeasing/ suppressing anger, being compliant, not wanting to disappoint others, or not being able to give to themselves what they need; somatic practices such as tapping the body, self-touch or yoga movement can help to come out of a state of flopping/ feeling numb, disconnected or dissociated from the body. All tutors have attended the Camden &amp; Islington NHS Foundation Trust internal training ‘Introduction to Trauma Informed Approaches’ developed by Shirley McNicholas, founder of the Drayton Women’s Crisis House, Dr Philippa Greenfield, and women with lived experience of using services, and most of the tutors have received training on the Porges’ Polyvagal Theory (1995, 2011) via a trauma-informed yoga course. <br>
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The Polyvagal Theory offers a framework to understand that the automatic responses of the ‘autonomic nervous system’  are adaptive functions for survival, alleviating shame or guilt around ‘unexpected [automatic] behaviour’. The theory argues that the autonomic nervous system goes as far as identifying risk in the environment and initiating actions of protection before we engage in logical thinking with the brain. Neuroception is a term coined by Porges to describe the ways our automatic nervous system responds to cues of safety and life-threatening danger from within our bodies, considering the world around us, and our connections to others. Neuroception precedes perception, it is 'detection without awareness'- a subcortical experience happening far below the realm of conscious thought. Recovery College tutors can recognise the autonomic states the students are in and offer tools for ‘self-regulation’ and ‘co-regulation’, to regulate individually or in group, to shift their states, and to learn how to move across different autonomic states. Applying the Polyvagal approach (Dana 2018) in a group setting. <br>
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Thus, Recovery College’s courses' four elements that facilitate intersectional trauma-informed recovery are dynamic, which means that Recovery College tutors might bring different elements of those to respond to students’ needs with flexibility. For example, if something very traumatic is shared in a course students might ‘de-regulate’ going into a ‘fight’ state, for which the tutor might offer a compassion-focus mindfulness practice, or become ‘frozen’ for which the tutor might offer a movement practice away from their chairs. This is why the ‘Self-recovery X4S Model’ includes Dana's (2018) autonomic ladder, a reference to how tutors assess the autonomic nervous system state students and tutors are on an on-going basis to bring change when they are experiencing de-regulation. This is when their autonomic nervous responses do not match the situation or the environment, it is not adaptive for survival. <br>
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The vagus nerve is the main nerve of the parasympathetic nervous system (PSNS), which works in opposition to the sympathetic nervous system. From the brain stem at the base of the skull, the vagus nerve travels in two directions: downward through the lungs, heart, diaphragm, and stomach and upward to connect with nerves in the neck, throat, eyes, and ears. The ventral vagal part of the vagus nerve is more active when we are feeling safe and connected with other people, feelings of calmness are associated with this state, and in this state, people tend to make eye contact, smile, initiate conversations, offering support, feel grateful and with dignity. The dorsal vagal part of the vagus nerve is more active when feeling in a state of immobilisation, collapse, frozen, dissociation, or appeasement. Feelings of hopelessness, abandonment, numbness, sadness, fogginess, tiredness, and emptiness are associated with this state, and in this state, people tend to look like not being present, immobile, and not responsive to other people’s cues for connection, such as responding to questions or falling asleep. The sympathetic nervous system controls the ‘fight-or-flight’ responses and responses in this state like arguing, shouting, threatening, and leaving a space, with tense muscles appearing in the face and body, like squinting eyes or clenching fists. The vagus nerve can help to shift the ‘fight-or-flight’ state by moving towards states of feeling connected with others, so sometimes appeasing or immobility in a dorsal state can be helpful to  minimise violence escalation and harm reduction. These are autonomic states of our human makeup to increase survival. <br>
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Trauma and Recovery Models <br>
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Judith Lewis Herman first discussed trauma recovery in her seminal book ‘Trauma and Recovery: The Aftermath of Violence’ (1992) and the stages of the nonlinear and never-complete recovery included: a healing relationship, safety, remembrance and mourning, reconnection, and commonality. A healing relationship is that offered by a therapist ‘on demand’, enabling the therapeutic relationship to be led by the client, working on principles of choice and control, trust, collaboration, empowerment, promoting the client’s strengths and resources, and where the therapist would become an ally, or advocate, and person to experience a reconnection with another human being. Safety included trauma response psycho-education to increase control of traumatic responses, social strategies to mobilise natural support systems, environmental safety, housing, money, mobility, self-care, and freedom. Remembrance and mourning entailed people telling their story from the past to the present, to facilitate integration or processing, meaning-making, grieving losses, and identifying self-responsibility. Reconnection with the self and others entailed embracing the new self through re-education, having aspirations, hopes, and dreams, letting go, forgiving, having compassion, an increasing sense of control, learning to fight well, and engaging in peer groups and other social groups. Commonality further increased self-esteem by sharing the personal experience with trauma and other social groups with advocacy purposes that lead to feeling understood and recognised, in community and ‘co-production’ like activities. These five stages were summed up later in Herman’s three stages of trauma recovery (1998): establishing safety, retelling the story of the traumatic event, and reconnecting with others. <br>
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Herman’s work develops in the 1970s US, in the context of the Women’s Mental Health Collective in Somerville, Massachusetts, the women’s liberation movement. It had connections with the Radical Therapist Academic ‘anti-psychiatric group’ that included: Ernest Becker, Erving Goffman, R.D. Laing, Thomas Scheff, and Thomas Szasz, advocating for social and political change, not behaviour modification; The Mental Patients Liberation Front in Boston; The Ex-Patients’ Movement; the Psychiatric survivors movement and the work of Judi Chamberlin, a psychiatric system survivor, championing an intersectional approach to mental health recovery being a disable Jewish woman. Also, Judith Herman had collaborated with Bessel van der Kolk and J. Christopher Perry, for seven years before Herman's book publication in 1992, both colleagues in the Department of Psychiatry at Harvard Medical School, at the time of writing this book. <br>
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In the UK, a black-led women's organisation for domestic and sexual abuse advocacy called ‘Women and Girls Network’  defined its ‘holistic empowerment recovery model’, known as the ‘HER model’, to include: a gender-responsive approach, a relational approach, a strengths-based approach, a trauma-informed approach, recovery-oriented practice, intersectional theory and cultural responsiveness, and holistic practice’. Published by its author Dr. Akima Thomas in the book ‘Drop the Disorder’ (2019), edited by Jo Watson, includes contributors such as Dr. Lucy Johnstone and Dr. James Davies, and it is an anti-psychiatric stand to mental health recovery. The author was taught by Dr. Akima Thomas at the Women and Girls network  course ‘Level 3 Certificate, Counselling and Therapeutic Interventions for Women Overcoming Experiences of Violence: A Feminist and Intersectional Approach.’ when she was working as an independent domestic violence advocate (IDVA) for Solace Women's Aid.  The Women and Girls Network has written training material that includes Porges’ Polyvagal Theory to explain how survivors respond and recover from trauma. In this context, the author learned about Bessel van der Kolk’s book ‘The Body Keeps The Score’ (2014) and Kimberlé Crenshaw’s (1991) work on intersectionality. <br>
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The SAMHSA (2014) principles of the trauma-informed approach include: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, and cultural, historical, and gender issues. In the UK, the Office for Health Improvement and Disparities (Gov UK 2022) includes principles for trauma-informed practice: safety, trustworthiness, choice, collaboration, empowerment, and cultural considerations, including gender responsiveness. Finally, the Camden &amp; Islington NHS Foundation Trust, now the North London NHS Foundation Trust, proposed a ‘Model for trauma-informed organisational change’ (Greenfield et al. 2021) including principles of choice, collaboration, safety, equity, trustworthiness, and empowerment, honouring the nine protected characteristics of the Equality Act (2010). <br>
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The recovery approach to mental health in the UK is underpinned by a seminal paper published in 2008 by the Sainsbury Centre for Mental Health and co-authored by Professors Geoff Shepherd Mike Slide and Consultant Psychiatrist and Lead for Social Inclusion at the Royal College of Psychiatry Dr. Jed Boardman, titled ‘Making Recovery a Reality’. The paper identified the following principles for recovery: Having a meaningful life, as building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems; strengths-based approach, moving away from pathology, illness and symptoms to health, strengths and wellness; hope, by people experiencing active control over their lives (‘agency’) and by seeing how others have found a way forward; self-management; clinicians ‘on tap not on top’, offering a collaborative relationship between clinicians and patients, more to be understood as ‘coaches’ or ‘partners’ on a journey of discovery; social inclusion, being able to take on meaningful and satisfying social roles within local communities, rather than in segregated service, not feeling isolated; self-discovery, discovering – or re-discovering – a sense of personal identity, separate from illness or disability; story telling to support the creation of a sense of hope and possibility; recovery-based services, which emphasises the personal qualities of staff, and their capacity for hope, creativity, care, compassion, realism and resilience; social support, including family support and peer support. These principles for recovery lack some of the key ingredients for trauma recovery included in trauma recovery models, such as  intersectionality, gender, cultural responsiveness or advocacy. Thus, to conclude the principles of mental health recovery need to be reviewed and responsive to people's mental health recovery needs, that according to the Recovery College course delivery is also holistically responsive to trauma, particularly from gender-based violence, interpersonal trauma, racism, justice and structural discriminations. The recovery approach to mental health and Recovery Colleges are not 'anti-psychiatric', although they criticised the medical model to mental health. They do not encourage social justice advocacy, which might be a barrier to the widening inclusion of diverse students' identities in Recovery Colleges. <br>
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* The author is currently seeking collaboration partners and funders to conduct long term research on the topic of intersectional trauma-informed recovery in the context of Recovery Colleges and beyond. Please support this project by not reproducing the research concept without the author's consent; cite her poster and poster's description; and help her to make her post-doctoral co-produced ethnographic research project a reality. x.lorenzo@ucl.ac.uk or find me in LinkedIn. <br>
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Literature: <br>
<br>
American Psychiatric Association (2013). <i>Diagnostic and statistical manual of mental disorders</i> (5th ed.). https://doi.org/10.1176/appi.books.9780890425596<br>
<br>
Anthony, William A. (1993). Recovery from mental illness: the guiding vision of the mental health system in the 1990s. <i>Psychosocial Rehabilitation Journal</i> 16(4): 11–23.<br>
<br>
Dana, Deb (2018) <i>The Polyvagal Theory In Therapy. Engaging The Rhythm of Regulation</i>. New York: London. Norton<br>
<br>
David, D. H., Rowe, M., Staeheli, M., &amp; Ponce, A. N. (2015). Safety, Trust, and Treatment: Mental Health Service Delivery for Women Who Are Homeless.<i> Women &amp; Therapy</i>, 38(1–2): 114–127. https://doi.org/10.1080/02703149.2014.978224<br>
<br>
Devries, K.M.; Mak, J.Y.; Bacchus, L.J.; Child, J.C.; Falder, G.; Petzold, M.; Astbury, J. &amp; C.H. Watts (2013). Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. <i>PLoS Medicine</i>, 10 (5): e1001439. <br>
<br>
Dheensa, S. &amp; G. Feder (2022). Sharing information about domestic violence and abuse in healthcare: an analysis of English guidance and recommendations for good practice. <i>BMJ Open</i>, 12 (6): 1-11. Article e057022. https://doi.org/10.1136/bmjopen-2021-057022<br>
<br>
Dillon G.; Hussain R.; Loxton D.; &amp; S. Rahman (2013). Mental and physical health and intimate partner violence against women: a review of the literature. <i>Int J Family Med</i>; 2013: 313909.<br>
<br>
Emsley, E. S.; Smith, J. M.; Martin, D.D.; &amp; N. Lewis (2022). Trauma- informed care in the UK: where are we? A qualitative study of health policies and professional perspectives. <i>BMC Health Services Research</i> 22(1):1164.<br>
<br>
Hayes, Daniel; Camacho, Elizabeth; Ronaldson, Amy; Stepanian, Katy; McPhilbin, Merly; Elliott, Rachel A.; Repper, Julie; Bishop, Simon; Stergiopoulos, Vicky; Brophy, Lisa; Giles, Kirsty; Trickett, Sarah Trickett; Lawrence, Stella; Winship, Gary; Meddings, Sara; Bakolis, loannis Henderson, Claire; &amp; Mike Slade (2023) Evidence‐based Recovery Colleges: developing a typology based on organisational characteristics, fidelity and funding. S<i>ocial Psychiatry and Psychiatric Epidemiology. </i>59(5):759-768.<br>
<br>
Herman, Judith Lewis (1992), Complex PTSD: A syndrome in survivors of prolonged and repeated trauma.<i> J. Traum. Stress</i>, 5:377-391. https://doi.org/10.1002/jts.2490050305<br>
<br>
Herman, Judith Lewis (1998), Recovery from psychological trauma. <i>Psychiatry and Clinical Neurosciences</i>, 52: S98-S103. https://doi.org/10.1046/j.1440-1819.1998.0520s5S145.x<br>
<br>
Herman, Judith Lewis (2015 [1992]). <i>Trauma and Recovery: The Aftermath of Violence</i>. London: Pandora.<br>
<br>
HM Government &amp; Department of Health (2011) <i>No Health Without Mental Health: A cross-government mental health outcomes strategy for people of all ages</i>. https://assets.publishing.service.gov.uk/media/5a7c348ae5274a25a914129d/dh_124058.pdf<br>
<br>
Howard, L.M., Oram, S., Galley, H., Trevillion, K. &amp; G. Feder (2013). Domestic violence and perinatal mental disorders: A systematic review and meta-analysis. <i>PLoS Medicine</i>, 10 (5): e1001452. <br>
<br>
Howard, L.M.; Trevillion, K. &amp; R. Agnew-Davies (2010a). Domestic Violence and Mental Health. <i>International Review of Psychiatry</i>, 22 (5): 525-534. <br>
<br>
Jonas, S.; Khalifeh, H,; Bebbington, PE.; McManus, S.; Brugha, T.; Meltzer, H.; &amp;  LM. Howard, (2014) Gender differences in intimate partner violence and psychiatric disorders in England: results from the 2007 adult psychiatric morbidity survey. <i>Epidemiol Psychiatr Sci</i>. 23(2):189-99. doi:10.1017/S2045796013000292. Epub 2013 Jun 10. PMID: 23745799; PMCID: PMC6998174.<br>
<br>
Kennedy, Angela (2020) <i>Developing real world system capability in trauma informed care: learning from good practice. Academic Heath Science Network</i>. North East and North Cumbria and NHS Northern England, Clinical Networks.<br>
<br>
Khalifeh, H.; Moran, P.; Borschmann, R.; Dean, K.; Hart, C.; Hogg, J.; Osborn, D.; Johnson, S. &amp; L. M. Howard (2015) Domestic and sexual violence against patients with severe mental illness. Psychological Medicine, 45: 875–886. <i>Cambridge University Press</i>2014 doi:10.1017/S0033291714001962<br>
<br>
Maté, Gabor, &amp; Daniel Maté (2022) <i>The Myth of Normal. Trauma, Illness &amp; Healing In a Toxic Culture</i>. London: Penguin Random House.<br>
<br>
Mauritz, MW,; Goossens, PJ.; Draijer, N.; van Achterberg, T. (2013) Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. <i>Eur J Psychotraumatol.</i> 4. doi: 10.3402/ejpt.v4i0.19985. Epub 2013 Apr 8. PMID: 23577228; PMCID: PMC3621904.<br>
<br>
Mental Health Tasks force (2016) T<i>he five year forward view for mental health. A report from the independent Mental Health fore to the NHS in England</i> https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf<br>
<br>
Mizock, L., &amp; E. Kaschak (2015). Women with serious mental illness in therapy: Intersectional perspectives<i>. Women &amp; Therapy</i>, 38(1-2), 6–13. https://doi.org/10.1080/02703149.2014.978209<br>
<br>
NHS (2019) <i>The NHS Long Term Plan</i>. www.longtermplan.nhs.uk/publication/nhs-long-term-plan<br>
<br>
NHS England and NHS Improvement and the National Collaborating Central for Mental Health (2019). <i>The Community Mental Health Framework for Adults and Older Adults.</i><br>
<br>
Office for Health Improvement Disparities. (2022). <i>Guidance. Working definition of trauma-informed practice</i>. Government UK. https://www.gov.uk/government/publications/working-definition-of-trauma-informed-practice/working-definition-of-trauma-informed-practice#:~:text=Realise%20that%20trauma%20can%20affect,biological%2C%20psychological%20and%20social%20development.<br>
<br>
Oram, S.; Trevillion, K.; Feder, G. &amp; L.M. Howard (2013). Prevalence of experiences of domestic violence among psychiatric patients: systematic review. <i>The British Journal of Psychiatry</i>, 202 (2): 94–99. <br>
<br>
Perkins, Rachel; Meddings, Sara; Williams, Sue; &amp; Julie Repper (2018). <i>Recovery Colleges 10 Years On</i>. Recovery through Organisational Change (ImROC). Centre for Mental Health, Nottinghamshire Healthcare.<br>
<br>
Perkins, Rachel; Repper, Julie; Rinaldi, Miles: Brown, Helen (2012). <i>Recovery Colleges. Implementing Recovery through Organisational Change</i>. Centre for Mental Health and Mental Health Network NHS Confederation.<br>
<br>
Porges, S.W. (1995) Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A Polyvagal Theory. <i>Psychophysiology,</i> 32 (4): 301- 318<br>
<br>
Porges, S.W. (2011) N<i>orton Series on Interpersonal Neurobiology. The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. </i>New York, NY: Norton.<br>
<br>
Repper, Julie &amp; Rachel Perkins (2003). <i>Social Inclusion and Recovery. A model for Mental Health Practice</i>. New York: Baillière Tindall.<br>
<br>
SAMHSA (2014) <i>SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. </i>Prepared by SAMHSA’s Trauma and Justice Strategic Initiative July 2014.<br>
<br>
Slade, Mike; Rennick-Egglestone, Stefan; Blackie, Laura;, Llewellyn-Beardsley, Joy; Franklin, Donna; Hui, Ada; Thornicroft, Graham; McGranahan, Rose; Pollock, Kristian; Priebe, Stefan;  Ramsay, Amy; Roe, David; &amp; Emilia Deakin (2019) Post-traumatic growth in mental health recovery: qualitative study of narratives. <i>BMJ Open </i>19(9):e029342. doi:10.1136/ bmjopen-2019-029342<br>
<br>
Sweeney, Angela &amp; Danny Taggart (2018). (Mis)understanding trauma- informed approaches in mental health, <i>Journal of Mental Health</i> 27(5): 383-387 doi:10.1080/09638237.2018.1520973<br>
<br>
Sweeney, Angela; Clement, Sarah; Filson, Beth; and Angela Kennedy (2016) Trauma-informed mental health care in the UK: what is it and how can we further its development? <i>Mental Health Review Journal</i>. 21(3):174-192.<br>
<br>
Trevillion K,; Oram S,: Feder G.; and L.M. Howard (2012). Experiences of domestic violence and mental disorders: a systematic review and meta-analysis. <i>PLoS One</i>; 7: e51740.<br>
<br>
Walby, S., Towers, J. and B. Francis (2016). Is violent crime increasing or decreasing? A new methodology to measure repeat attacks making visible the significance of gender and domestic relations. <i>British Journal of Criminology</i>, 5 (6): 1203–1234. <br>
<br>
Wallcraft, Jan &amp; Michael Bryant (2003) <i>The mental health service user movement in England. </i>Policy paper 2. The Sainsbury Centre for Mental Health.<br>
<br>
Watson, Jo (2019) <i>Drop the Disorder.</i> Monmouth: PCCS Books.<br>
<br>
White, S. J.; Sin, J.; Sweeney, A.; Salisbury, T.; Wahlich, C.; Montesinos Guevara, C. M.; Gillard, S.; Brett, E.; Allwright, L.; Iqbal, N.; Khan, A.; Perot, C.; Marks, J. &amp;  N. Mantovani,(2024). Global Prevalence and Mental Health Outcomes of Intimate Partner Violence Among Women: A Systematic Review and Meta-Analysis. <i>Trauma, Violence, &amp; Abuse.</i> 25(1): 494-511. https://doi.org/10.1177/15248380231155529<br>
<br>
Wilton, J. (2020) <i>Briefing 56: Trauma, Mental Health and Coronavirus, Supporting Healing and Recovery</i>. Centre for Mental Health.<br>
<br>
Women’s Aid (2021a) <i>Mental Health and DVA: A Review of the Literature. </i>Bristol: Women’s Aid.