Mental health service research, trauma-informed care and freedom of information requests

Despite its potential value, only a relatively small group of studies have leveraged data from routine care provision, obtained through freedom of information (FoI) requests, to map care delivery in mental health services in England and Wales (see, e.g. Ashmore & Carver, 2017; Frith, 2017; Griffiths & Dhuffar, 2014; Griffiths & Steen, 2013; Rojas et al., 2023). As professionals and researchers interested in the use of FoI requests for research purposes, we read McNally et al.'s (2023) recent contribution to the journal. The reported analysis involved gathering data from English mental health trusts via a FoI request-based approach. The analysis served to highlight the limited availability of training in trauma-informed care (TIC) for NHS professionals, including for routine enquiry into trauma in clinical practice, raising questions about how trauma-informed provision is as a result.

Given the contribution adds to a growing body of work illustrating the utility of FoI requests in mental health research, we wanted to raise two points, relating to research ethics and how McNally et al.'s analysis may be extended.

First, McNally et al. (2023) do not make explicit reference to research ethics. To a greater degree, the use of FoI requests corresponds with established methods of data collection, like questionnaires, where data are generated at the behest of the researcher. However, unlike these methods, the researcher adopting this approach does not hold the same responsibilities for assessing potential risks involved because submitting a FoI request is a citizenship right (Savage & Hyde, 2014). As such, the responsibility for assessing this risk resides with the organization/s to whom the request is made. It is also debatable that university or other relevant institutional ethical review committees can make firm recommendations about researchers using, or not using, FoI requests; at the very least, committees have no real jurisdiction to prevent researchers from doing so (Walby & Luscombe, 2018).

Despite this, there are ethical considerations to be mindful of with a FoI-based approach, not least because this kind of work is captured under the umbrella of research activity and aligns with institutional codes of conduct for research practice and related frameworks associated with the collection of data (Archard et al., 2023). Notably, there are risks of FoI legislation being used aggressively to access data not obtainable by other means (Hammond et al., 2016). FoI requests create administrative costs which impact the public purse and, directly or indirectly, impinge on the provision of healthcare services by the time and resources taken for organizations to respond. A clear rationale needs to be made regarding the added value, in terms of knowledge generation or scientific gain.

Another issue to consider is the accidental disclosure of personal information by organization representatives when anonymized information is requested. In this scenario, protocols can be developed detailing how such disclosures will be responded to, and their development can be aided via appraisal through institutional ethical review (Archard et al., 2023).

The second point we wanted to raise relates to the different ways TIC is integrated in mental health services, including but also extending beyond the provision of training for staff. Criticisms of TIC have highlighted how the language of TIC can be deployed in a way that obfuscates a concern for the social determinants of trauma and adversity (Birnbaum, 2019). Instead, it is suggested the term morphs into a synonym for relational care delivery at an individual level, rather than an orientating framework for progressive change in the delivery and organization of care services. Acknowledging this, McNally et al.'s (2023) analysis provides a helpful foundation—it is, as they describe it, ‘a baseline measure’ of current TIC training in mental health trusts. But there is a need to augment this, perhaps fruitfully in using publicly available data and FoI requests. Relationships can be considered between the embracement of a TIC philosophy (including how this is framed at a local level), training/support to staff within mental health trusts in terms of organizational readiness (Williams & Smith, 2017), and in relation to other contextual factors relating to population need.

We are grateful to McNally et al. for their contribution and the insights it provides into this aspect of commitment to TIC across services. We also hope that there can be further discussion amongst mental health clinicians and academics regarding considered use of FoI requests in empirical enquiry, including the reporting of such endeavours.