Investigating community mental health services’ responses to racial trauma during the 2024 UK far-right riots

Abstract

Background

Trauma-informed care (TIC) is a critical approach for addressing the mental health needs of individuals exposed to various forms of trauma, including racial discrimination. Community mental health services are uniquely positioned to support both service users and staff in navigating the psychological impact of societal and interpersonal events. However, there is limited research on how these services can effectively address racial trauma, foster culturally responsive care, and support staff wellbeing within trauma-informed frameworks. This study examines the experiences of staff at a community psychological intervention service in the UK in supporting service users during the 2024 UK far-right riots. It investigates the challenges faced and lessons learned for enhancing care-delivery.

Methods

A mixed-methods design was employed, using an online survey completed by 31 staff members, including Clinical Psychologists, Psychological Practitioners, Psychotherapists, Trainee Psychologists and Assistant Psychologists. The survey consisted of Likert-scale, multiple-choice, and open-ended questions to gather quantitative and qualitative data. Descriptive statistics and thematic analysis were used to analyse the responses.

Results

Findings indicated that most staff engaged in race-related discussions but often relied on service users to initiate them. Key barriers included discomfort, lack of training, and uncertainty about appropriate responses. Organisational and peer support mechanisms, such as supervision and reflective practice, were valuable but constrained by time pressures. Participants highlighted the need for ongoing training and clearer protocols.

Conclusions

The study emphasises the importance of proactive race-related discussions, culturally responsive care, and structured organisational support within trauma-informed practices. Recommendations for practice, policy, and research are proposed to strengthen long-term efforts in addressing racial trauma and supporting staff in community mental health settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-13036-6.

Background

Step Forward is a National Health Service (NHS) Primary Care Mental Health Service located in Liverpool, United Kingdom (UK). The service integrates trauma-informed practices when engaging with service users to support their mental health and wellbeing. Step Forward previously highlighted its agenda for widening access within minoritised ethnic communities by adopting service changes such as the prioritisation of clients from minoritised ethnic groups during the assessment and intervention processes [1]. The service remains committed to further advancing this initiative, recognising that this work is necessary to address systemic barriers and ongoing challenges faced by minoritised ethnic communities when accessing mental health support [2].

During the Summer of 2024, the UK experienced a series of riots, widely described in media and government reports as being incited by far-right groups. The events which occurred from the end of July to the beginning of August exposed communities to acts of racial violence and discrimination [3]. With evidence suggesting that experiences of racial discrimination impact negatively on mental health and can result in racial trauma, authors investigated the services’ response during this period.

In this study, we use specific terms such as ‘racial trauma’, ‘minoritised ethnic’, and ‘far-right riots’ to describe the experiences and events under investigation. We recognise that language in this area is complex, contested and often evolving. The terms used here are intended to reflect the current landscape within the field of mental health and trauma-informed care. However, we acknowledge that these terms may not fully capture the diverse experiences of all individuals affected by racial discrimination or violence. Our use of this terminology is not meant to oversimplify or essentialise these experiences but rather provide a shared language for discussing critical issues.

Similarly, we acknowledge a lack of consensus surrounding a definition for trauma-informed care which can vary across disciplines and contexts, with the tendency for each definition to focus on how trauma affects individuals within that specific context. While definitions may vary, most trauma-informed care (TIC) models share key principles including safety, trustworthiness, choice, empowerment, collaboration, peer support and cultural and historical considerations [4–6]. In this study, we examine whether the application of trauma-informed principles within service equipped staff to effectively address racial trauma.

Racial trauma

Racial trauma, or race-based stress, arises in response to events perceived as threats related to racial discrimination [7]. Research [8] indicates that a higher frequency of racial microaggressions correlates with an increase in traumatic symptoms. Furthermore, the adverse effects of racial trauma extend to both physical and psychological wellbeing [7, 9, 10]. Previous research highlights that race-based traumatic stress predicted risky drinking behaviour among female college students from minoritised ethnic backgrounds in the United States (US) [11]. Similarly, Carter et al. [9] noted that negative race-based encounters can lead to post-traumatic stress experiences such as anxiety and low mood. Cenat [12] introduces the concept of complex racial trauma. Through identifying the origins of racial trauma in early life experiences and its continued persistence throughout life, he explores how this ongoing exposure to racial discrimination can lead to the internalisation of racism which can significantly impact mental health. During the course of this study, it became apparent that much of the existing literature surrounding racial trauma and its effects is based in the US. While these studies provide valuable insights, they may not fully account for the distinct social, cultural and institutional dynamics shaping racial trauma in the UK. It is therefore important to explore how racial trauma is addressed within UK settings to provide insights that can inform service delivery and policies relevant to the population.

The effects of societal events on mental health

The recent far-right riots in the UK have profound implications for the mental health of affected communities. These events cause harm not only to direct victims but also create ripple effects across society, potentially leading to vicarious trauma for witnesses. Individuals exposed to reports of racial discrimination through social media, news outlets or community discussions may experience heightened distress [13–16]. This phenomenon was notably observed following the murder of George Floyd, which sparked global outrage and significantly boosted support for the Black Lives Matter movement [17]. Subsequent research has explored the role of vicarious trauma in minoritised communities, such as a qualitative study by Wyatt et al. [18], which revealed that Black physicians and trainees, though not direct victims of racial violence, reported experiencing trauma vicariously from exposure to racial violence during the summer of 2020. Moreover, reports of client experiences of racial discrimination significantly predicted secondary traumatic stress among mental health clinicians, regardless of their ethnic backgrounds [19].

Clinicians of colour face a compounded issue of experiencing both direct and vicarious racism, with research indicating they are likely to encounter racism yet feel unsupported by their institutions [20]. While implicit bias may decrease temporarily following movements like Black Lives Matter, the ongoing emotional toll of racism and experiences of it can lead to isolation and despair for both those directly and indirectly exposed to it [21, 22].

Barriers to addressing racial trauma

Mental health professionals frequently encounter challenges in addressing racial trauma. Engaging in meaningful discussions about race and culture can be particularly difficult, often leading to these topics being overlooked in therapy [23]. Although addressing these issues can strengthen the therapeutic relationship [24], evidence shows that many professionals struggle to initiate conversations about race and culture with clients [23, 25]. For instance, mental health providers have reported discomfort discussing race with both clients and colleagues due to a lack of awareness and training in culturally competent care [26]. Clients may also feel hesitant to address racial trauma, stemming from past negative interactions with mental health professionals or fears of being misunderstood [27, 28]. Research indicates that ethnic minoritised clients often avoid discussing race and culture with white therapists, feeling their experiences may not be validated. However, they report feeling understood when therapists demonstrate compassion and comfort in discussing these issues [29]. Additionally, the level of calmness or ease therapists are perceived to demonstrate during therapeutic discussions including those about cultural identity, was a meaningful indicator of variability in relation to clients’ racial/ethnic status and termination status [30].

Community-based services

Community-based services like Step Forward play a vital role in addressing the mental health needs of minoritised communities while simultaneously supporting the wellbeing of the staff who provide these services. A core aspect of this support is the implementation TIC, which focuses on understanding and addressing the impacts of trauma through key principles such as safety, trustworthiness, empowerment and cultural considerations [4, 5]. Step Forward has established various mechanisms to embody these principles. For staff, this includes regular peer supervision groups, reflective practice sessions and one-to-one supervision which offer protected spaces for staff to process clinical and emotional challenges [1]. As part of its widening access initiative, the service created a dedicated Assistant Psychologist role, held by the current study’s first author, focused on improving access to psychological support for minoritised ethnic groups [1]. Furthermore, the service operates a monthly Equality and Diversity working group, providing staff with a space to explore issues around race, identity and inclusion [1]. Additionally, the service holds a monthly peer support group to provide staff from minoritised ethnic backgrounds with a safe space to connect and share experiences [1]. The service utilised these spaces to support staff in responding to the riots.

Step Forward supports clients through mechanisms aligned with trauma-informed principles as well. These include Voices for Change a monthly group for service users to discuss their concerns and experiences. Furthermore, attendance at community events have helped to build relationships with minoritised ethnic communities, improve awareness of the service and encourage feedback surrounding access to mental health services [1]. Within service, Step Forward promotes communication and understanding by ensuring service users are provided with interpreters and extended sessions when needed [1] which aligns with TIC by reducing barriers, validating lived experience and promoting client agency.

In their response to the riots, Mersey Care Trust also provided supportive mechanisms which were outlined on a webpage on the internal staff site. These supportive mechanisms included continued professional development resources for managers and staff, including how to support staff during the riots and guidance about how to respond to Racism/Islamophobia. Furthermore, the Trust operated supportive groups including a programme of Culture Cafés which provided space for colleagues to support one another and discuss the impact of the riots.

By integrating TIC into its framework, Step Forward aims to not only equip its staff to cultivate supportive environments for clients but also foster resilience and recovery among those they serve. Given that trauma-informed interventions such as racial trauma therapy training have been shown to enhance the perceived efficacy of addressing racial trauma among community mental health clinicians [31], exploring their broader application may be beneficial. The impact of racial trauma alongside recent events highlighting systemic inequalities, underscores the need for responsive and adaptable interventions. This research examines how Step Forward can further develop its practices to address these challenges. By evaluating the ongoing evolution of TIC, this study seeks to support Step Forward in maintaining its role as a valuable resource for the communities it serves.

Methods

Aim

This study aims to examine the experiences of staff at an NHS community-based psychological intervention service, in supporting service users with racial trauma during the UK far-right riots from 30th July to 30th September. Specifically, the research questions include:

1. What challenges and successes did staff experience when supporting service users with racial trauma during and after the 2024 far-right riots?

2. How effectively did trauma-informed practices and support mechanisms implemented at Step Forward help staff address the needs of service users and their own wellbeing during the riots?

3. What lessons can be learned from staff experiences at Step Forward to enhance future responses to racial trauma within the community?

By addressing these questions, the study aims to identify lessons that can inform future efforts to enhance trauma-informed and culturally responsive care within community mental health services, particularly in the context of significant societal events that may trigger racial trauma.

Setting

The NHS is the UK’s publicly funded healthcare system, providing free medical and mental health services. Operating under this system, Mersey Care NHS Foundation Trust delivers a range of specialist mental health and community-based services, including Step Forward.

Step Forward comprises three community-based services located across Merseyside, all working towards a common goal of providing mental health support to individuals experiencing a range of complex psychological difficulties including trauma. While Step Forward Liverpool specifically implements the Widening Access initiative to prioritise clients from minoritised ethnic groups throughout the service pathway [1], all three services share a commitment to addressing systemic barriers within healthcare. Including all three services in the study allowed for a more comprehensive understanding of how trauma-informed practices are implemented within this region.

The study focuses on the 2024 UK far-right Riots, a period of heightened racial tension and violence that exposed communities across the UK to racial discrimination. This context provided a unique opportunity to examine how Step Forward’s trauma-informed practices and support mechanisms were utilised during a time of societal crisis, highlighting the service’s role in addressing racial trauma within a community-based setting.

Design

This study employed a mixed-method design to explore the experiences of staff in supporting service users with racial trauma during and after the 2024 UK far-right riots. An online survey was used to collect quantitative and qualitative data, allowing for a comprehensive understanding of staff perspectives, challenges and successes. The survey was distributed online via Microsoft Forms between 21 st October 2024 and 22nd November 2024.

A bespoke survey was designed to capture both quantitative and qualitative data, using a combination of Likert-scale, multiple-choice, and open-ended questions. The inclusion of multiple response types allowed for a nuanced understanding of staff perspectives. The development process involved several steps to ensure clarity, relevance and alignment with the study’s objectives:

• Initial drafting: The survey was drafted by the first author to address key areas of interest, including staff engagement in race-related discussions, confidence and preparedness in addressing racial trauma, perceived barriers and access to support mechanisms. The questions were shaped by conversations between the three authors about race, trauma and clinical practice which drew on discussions that had taken place within service and across Mersey Care NHS Trust in response to the riots. A decision was reached to incorporate both quantitative and qualitative data, as the authors were interested in gaining a comprehensive understanding of staff experiences, including measurable patterns and trends in behaviour and personal insights which could provide context and direction for service improvements. At this point it was also agreed that some of the items (5, 6, 7, 8, 12, 15) within the survey should relate to staff members’ general experiences around engaging in race-related discussions and addressing racial trauma. This was decided to provide a broader context for interpreting perceptions during the focal timeframe of the riots.

• Internal review: The draft survey was reviewed by the two co-authors. At this stage revisions were made to refine the wording of questions, eliminate ambiguities and ensure coherence.

• Pilot testing: The survey was pilot tested by one of the co-authors to assess its clarity and usability, leading to minor adjustments before final distribution.

Participants

All clinical staff employed at Step Forward services at the time of the study were invited to participate in the survey. Participants included Clinical Psychologists, Psychological Practitioners, Trainee Psychologists, Psychotherapists and Assistant Psychologists, all of whom had direct interaction with service users and were likely to engage in discussions related to race or racial trauma. Staff who do not occupy a clinical role within service, i.e., administration staff and managers were excluded from the study. Of the 42 invited, 31 staff members completed the survey, yielding a response rate of 74%.

There were five staff who were not working in Step Forward services during the time of the riots their responses to questions about general practices and attitudes were retained, as they offered valuable insight into staff perspective on managing race-related discussions in clinical practice. However, responses to questions specifically related to the riots (items 1–4, 9–11, 13–14) were excluded from the analysis. Similarly, there were staff who did not have contact with clients from minoritised ethnic backgrounds during 30th August to 30th September, the timeframe investigated in this study, the responses from these staff were retained as their insights reflect prior experiences within service working with service users from minoritised ethnic backgrounds and their perceptions could also inform service improvement. The authors also acknowledge that while these staff may not have had direct contact with service users from minoritised ethnic backgrounds at this time, they could still encounter race-based discussions triggered by the events of the riots. Their inclusion in this study reflects the necessity for staff to be equipped to engage with such discussions proactively, regardless of client background. Finally, some participants did not respond to certain questions. These instances were treated as non-responses in the analysis. For further details about the response rate for each question, refer to Appendix B.

Participants were informed about the study’s purpose, their rights and assurances of confidentiality through an information sheet provided at the beginning of the survey. To ensure anonymity, demographic information such as ethnicity, gender and years of experience was not collected. Participation was voluntary, and the survey took approximately 11 min to complete. Recruitment was conducted through staff meetings and email invitations, ensuring broad accessibility to all eligible staff members.

Ethical considerations

Retrospective approval to commence the evaluation was granted by Mersey Care NHS Foundation Trust Research and Development Department on 13.12.2024. This evaluation did not require management within the UK Policy Framework for Health and Social Care Research and not Research Governance Framework for Health and Social Care, and an ethical review with a Research Ethics Committee (REC) was not required.

Data analysis

The quantitative and qualitative data collected from the survey were analysed separately.

Quantitative analysis included responses from Likert-scale and multiple-choice questions using descriptive statistics. Frequencies and percentages were calculated to identify patterns in participants’ behaviours, attitudes and comfort levels when engaging in race-related discussions and supporting service users.

Qualitative analysis included open-ended responses using thematic analysis, following Saunders et al.’s [32] three-step approach. This approach was selected for its structured and practical design which aligns with the applied nature of the study, aimed at informing improvements in our community mental health service’s responses to racial trauma. While Braun and Clarke’s [33] approach is widely used and provides flexibility for more interpretive work, Saunder’s was better suited to the practical nature of the study offering a more systematic guide for our psychology-focused team to ensure consistent and transparent analysis.

Step 1: reading

All manuscripts were read thoroughly to become familiar with the content. Summary memos were then written reflecting initial impressions and observations, which helped to frame the data for further analysis.

Step 2: coding

In this stage, responses were examined individually based on survey items. Each response was coded by identifying relevant thoughts or sentences related to the research questions. Codes were applied to the text to reflect recurring ideas and key themes within each individual item.

Step 3: theming

After coding individual responses based on survey items, all responses were reviewed together to identify overarching themes. The themes were developed by grouping related codes and looking for broader patterns across the data. This process allowed for the identification of significant themes that captured key aspects of participant experiences such as “Client-Centred Approaches to Discussing Race” and “Organisational and Peer Support in Addressing Racial Trauma”.

Reflexivity

At the time of this study, all authors were employed at Step Forward Liverpool. The first author was working in the role of Assistant Psychologist for Widening Access, a role developed as part of the widening access initiative, while the co-authors were Clinical Psychologists. The authors recognise the enduring barriers that individuals from minoritised ethic backgrounds face in accessing mental health services particularly those at primary care-level and remain committed to acknowledging and addressing these inequities within their clinical and research practice.

A reflexive approach was adopted to support awareness of how the authors’ positions and experiences may shape the research process and the interpretation of findings. Several reflexive strategies, including regular research supervision, peer supervision and engagement in discussions about racial inequities in healthcare and the impact of the riots in various formal and informal settings, e.g., attendance at the Equality and Diversity group. This provided the authors with a wide range of views surrounding the topics being investigated. The first author engaged in weekly clinical supervision with one of the co-authors providing opportunities to reflect throughout the research process including discussions about the insights gained through other forums such as peer supervision or the Equality and Diversity group. These measures helped to ground the analysis in participant narratives.

Results

Quantitative findings

The quantitative findings were organised into distinct categories to highlight key patterns in staff behaviours, attitudes, and comfort levels regarding race-related discussions and support mechanisms. These categories align with the study’s research questions. This structure enables a focused examination of staff engagement with racial trauma, barriers to discussions, and available support resources during the far-right riots in the UK 2024.

Staff engagement in race-related discussions

Most participants (68%) reported checking in with service users about the impact of the riots. Of those, responses were evenly split between staff-initiated (43%) and service user-initiated (43%) conversations. Most staff (58%) did not have contact with service users from minoritised ethnic backgrounds during the investigation.

Comfort and frequency of race-related conversations

Most participants (63%) felt “somewhat comfortable” discussing race with service users. None indicated that they felt “very uncomfortable” engaging in discussions about race.

Regarding the frequency at which these conversations occur, 52% of participants engaged in discussions about race “occasionally”, while 23% did so “frequently” or “rarely”. Only one participant (3%) reported “never” engaging in these discussions and none indicated “always”.

Barriers to discussing race

The most common barrier reported when discussing race was “worries about how to respond during the conversation” (50%). This was followed by “lack of training” and “my own discomfort discussing the topics” (33%). Similarly, staff perceptions of “client discomfort” experienced during these discussions was a barrier for 27%. Few staff indicated that a “lack of opportunity” (23%) was a barrier. Notably, only one participant cited “previous negative experiences” as a barrier to having discussions about race.

Staff confidence, preparedness and support mechanisms

When participants were asked about their abilities to support service users during the riots, 48% agreed that they felt equipped. Similarly, 33% of participants felt confident addressing racial trauma. Most participants (44%) agreed that the service provided the support needed to perform their roles during the riots.

Supervision (53%) and peer supervision (43%) were the most used supportive mechanisms to address challenges faced during this period. The Equality & Diversity Group (27%) provided by the service was accessed by fewer participants as a form of support. Supportive mechanisms provided by NHS Trust were the least commonly utilised with one participant (3%) having used the Responding to Racism/Islamophobia Guidance and no participants making use of the Culture Café.

Qualitative findings

The qualitative findings were grouped into themes based on recurring concepts that were identified from the staff responses. This thematic organisation reflects the factors influencing staff experiences in addressing racial trauma within the context of the riots. Four overarching themes were established from the analysis of the data, which include: (1) Client-Centred Approaches to Discussing Race, (2) Experiences Discussing Race with Cultural Competence, (3) Organisational and Peer Support in Addressing Racial Trauma, and (4) Building Capacity to Address Racial Trauma.

Client-centred approaches to discussing race

Staff members often rely on client cues to initiate conversations about race, with the primary factor identified being whether the client raises the issue themselves. One participant explained, “I would always wait for clients to bring things up first, even if indirectly”. The decision to engage in these discussions was also shaped by a range of contextual and identity-related factors. These included ethnicity, religion, family and immigration status with participants stating, “it usually comes up when speaking about family relationships”, and another asserting, “if we know that this is a specific factor impacting treatment or presentations, e.g., working with asylum seekers”.

Participants mentioned how race-related discussions are often ethno-specific indicating that a motivator to discuss race was “if I am working with a service user from a minoritised ethnic background”. While staff felt it was important to initiate conversations when race was “relevant” to service user’s experience, others hesitated due to concerns about making the situation “worse” or saying the wrong thing. There was also suggestion that “permission” was needed before addressing race with a service user, though it was not elaborated about how permission is obtained or determined. Staff also highlighted that feeling “uncomfortable” can prevent these discussions from occurring.

Experiences discussing race with cultural competence

Participants noted that discussing race with service users contributed to a “strengthened therapeutic relationship” and improved “trust”. Staff reported that providing space for service users to express their experiences created opportunities to share the impact of racism and the personal concerns of the service user. Staff felt that these conversations enhanced “understanding” of service user experiences and enabled them to provide more “culturally” appropriate interventions and informed service user formulation “where race has been an important theme to come back to”. Further to this, staff report positive experiences such as “accommodating appointments around fasting” because of culturally competent discussions.

Organisational and peer support in addressing racial trauma

Participants emphasised the importance of organisational and peer support in helping them address the challenges of racial trauma during the riots. Reflective practice and peer support emerged as valuable supportive mechanisms with staff benefiting from “shared experience(s)” and discussing strategies to address racial trauma. As one participant explained, “it allowed a space to talk about the impact on clients and on myself”. Leadership within teams was also identified as “especially important” during this time. Participants described leaders as instrumental in providing guidance and facilitating team-wide decisions about how to respond to the riots with one participant noting, “it was really helpful to address these issues in our weekly team meetings in relation to possible approaches”. Where participants perceived this support was lacking, they highlighted the need for a more “proactive” approach from leadership when supporting staff during the riots.

However, some participants highlighted barriers that limited their ability to fully engage with supportive mechanisms such as competing work “commitments” and “time” constraints. These challenges underscored the need for accessible and integrated forms of support to ensure staff could better respond to similar situations in the future, with staff explaining “we was trying to support service users, at the same time as managing our own anxieties”.

Building capacity to address racial trauma

Participants highlighted the need for “more training” to enhance their ability to discuss and address racial trauma. Suggestions included training on how to facilitate race-related conversations, understanding cultural differences, and developing strategies for responding to service users with far-right racist views. One participant suggested, “regular in-house training, I know we have had training but this would be good as an ongoing training opportunity”. Staff also called for clearer guidance and protocols on how to respond to racial trauma and racism. One participant explained “direct guidance given on whether to contact ethnic minority clients/initiate discussions around their experiences of racism; advice on how to have such conversations” while another stated “having a protocol within the wider team and making sure that no client is missed out to discuss the race riots”.

Additionally, there was a strong desire for more “open”, “scheduled” conversations and integration of Equality, Diversity and Inclusion initiatives into team practices. One participant suggested that “scheduled meeting at times through the year to discuss race, identity and culture and any themes arising for example current issues, war, cost of living, health inequalities etc. and how this is impacting our clients and how we can support them” could be helpful in supporting staff to address racism and facilitate discussions about race. Gathering feedback from service users or local community groups was suggested by some participants to further improve service delivery. As one staff member suggested, “service user/experts by experience coming to discuss aspects they think may be helpful to improve care delivery from service user perspective”.

Discussion

The findings from this mixed-methods study provide important insights into the challenges and experiences of staff within a community-based psychological intervention service, in supporting service users during the UK far-right riots in the summer of 2024. By combining qualitative and quantitative data, this study highlights key considerations for improving trauma-informed approaches to addressing future racial trauma within community mental health services. In the following discussion, the findings are examined in relation to the three main research questions: the challenges and successes staff experienced in supporting service users with racial trauma during the riots (1), the effectiveness of trauma-informed practices and support mechanisms in addressing these challenges (2) and the lessons learned for future responses to racial trauma (3).

The first section of the discussion addresses research question one with focus on the challenges and successes staff experienced in supporting service users during the riots. In considering how staff engage in race-related discussions, we discovered that participants often waited for service users to raise these topics rather than initiating conversations themselves. This dynamic highlighted both successes and challenges for staff when addressing racial trauma and race-based discussions. It could be suggested that practitioners may defer to service users as part of a client-centred approach intended to respect autonomy and comfort. Research indicates that therapists should generally follow the service user’s lead in discussing ethnicity, but it also emphasises that they should be prepared to initiate discussions when clients do not bring up such issues spontaneously [34]. Moreover, staff appeared skilled in picking up on cues from service users to engage in race-related discussions, with contextual factors such as family relationships or religion influencing these conversations. However, the data suggests that this approach may lead to avoidance, particularly when staff feel unprepared or uncomfortable broaching sensitive topics such as race. Survey findings revealed that 50% of staff expressed concerns about how to respond appropriately, with some worrying about “saying the wrong thing” or causing harm. These concerns are supported by literature indicating that healthcare professionals often fear forcing clients to discuss sensitive issues or unintentionally causing harm by engaging in race-related conversations [35]. Such concerns are not unfounded, as research highlights that cultural incompetence displayed by a practitioner is linked to negative outcomes including client dissatisfaction, breakdowns in the therapeutic relationship, and an increased likelihood of therapy termination [30, 36–38]. Whilst this study underscores the importance of race-related discussions in mental health services, it is important to acknowledge that service users’ willingness to engage varies. A client-centred approach can be most effective when staff are confident in initiating these conversations within therapeutic practice ensuring safety, openness and respect for individual preferences.

Furthermore, the nuance staff describe when identifying opportunities to engage in race-related discussions could result in challenges when forming therapeutic relationships. Missed opportunities to address race-related issues are particularly concerning given evidence that clients from minoritised ethnic backgrounds report lower satisfaction when culture is not explicitly included in mental health treatment [39]. Staff decisions to engage in race-related discussions also appeared influenced by the ethnic background of clients. This approach aligns with the suggestion that in a Black-White dyad, the responsibility for initiating conversations about race often falls to the Black person [25]. However, research indicates that clients from minoritised ethnic groups may hesitate to raise these topics themselves due to fears of invalidation or negative reactions [29]. Without proactive efforts from clinicians, racial trauma may remain unaddressed. Additionally, there is a risk of reinforcing the perception that race is only relevant to specific populations; this could result in overlooking broader race-related concerns, such as vicarious trauma, social consciousness development, or experiences of racism within therapy. These findings underscore the importance of adopting a proactive and universal approach to integrating discussions about race and identity into routine practice, making these conversations accessible to all service users rather than limited to specific demographics.

In relation to successes staff experience when engaging in discussions about race, the outcomes highlighted their crucial role in delivering effective and culturally responsive care. Research on cultural humility suggests that openness to discussing race and identity can strengthen therapeutic alliance, particularly for clients from minoritised ethnic backgrounds [40]. Furthermore, perceptions of cultural humility are associated with improved relationship quality in counselling [41]. Staff reported that these conversations fostered stronger therapeutic relationships, improved trust, and deepened understanding of service users’ lived experiences. Survey findings indicated that 63% of staff feel “somewhat comfortable” discussing race with clients, which may contribute to more open and meaningful dialogue. These conversations create opportunities to shape treatment around service users’ needs, for example, accommodating appointments around practices such as fasting. Adapted interventions are linked to greater symptom improvements for minoritised ethnic groups after treatment [42]. Staff also noted that engaging in race-related discussions informed clinical formulation, aligning with literature that suggests incorporating racial identity can foster a shared understanding of the broader social context between service users and therapists [43]. By integrating race-related discussions into routine practice, mental health services can move beyond reactive responses to racial trauma and instead adopt a proactive systemic approach that prioritises cultural responsiveness and equity, in line with the principles of trauma-informed care.

The second research question examines how effectively trauma-informed practices and supportive mechanisms implemented in service helped staff address challenges faced by the riots. It is therefore important to acknowledge that discussions about race and racial trauma within mental health services are not only shaped by the individual dynamics between clinicians and service users but also by broader societal and systemic factors. In the UK, societal discomfort around race coupled with historical and ongoing racial inequalities can create challenges for practitioners and service users when addressing race-related issues. Systemic barriers such as ingrained institutional biases and a lack of adequate training or support can inhibit the integration of race-related discussions into everyday practice [44]. This becomes even more apparent in the wake of events like the 2024 UK far-right riots, which highlighted the racial tensions within society. The impact of these events prompted the majority of staff (68%) to check in with service users, despite most clinicians not having any contact with service users from minoritised ethnic backgrounds during the period from 30th July to 30th September. This suggests that staff were responsive to the wider social context, recognising the importance of providing space for service users to reflect on significant events. However, this also raises broader concerns about the access and engagement of service users from minoritised ethnic backgrounds and raises the issue of whether those who were most likely to be impacted by racial trauma during the riots were able to access support when it was most needed. Research highlights that individuals from minoritised backgrounds may face greater risks of trauma or emotional distress, whether through direct involvement or vicarious exposure to racial violence and unrest [13–16]. The literature emphasises the importance of culturally responsive and trauma-informed approaches in service delivery including during periods of racial unrest. Strengthening awareness and capacity in this area could help meet service users’ needs more comprehensively in the future.

Organisational and peer support mechanisms were critical for helping staff navigate the challenges of addressing racial trauma. The service’s ‘Widening Access’ initiative was highlighted as useful in aiming to reduce barriers such as language differences, systemic mistrust and cultural stigma for minoritised ethnic groups [1]. This initiative reflects an organisational commitment to address systemic inequities which is crucial for advancing racial equity in the workplace [45]. Quantitative data showed that 44% of staff agreed that the service provided adequate support during the riots with supervision and peer supervision being the most accessed resources. These mechanisms provided a safe space for staff to debrief, process the emotional and psychological impact of the riots and collaboratively plan for future responses. This is in alignment with trauma-informed principles which emphasise peer support and creation of safe spaces to enable staff to address the impact of trauma-related issues including those surrounding race [32]. However, 32% of staff neither agreed or disagreed with the statement that they felt supported by the service during the riots. This could be explained by the barriers staff noted which limited their ability to fully engage with these resources, including time constraints and competing work demands. For example, only 27% of staff attended the Equality & Diversity Group which provided an opportunity to discuss issues related to the riots suggesting that while initiatives exist, they may not be perceived as accessible for staff. This aligns with findings from a report on Improving Access to Psychological Therapies (IAPT) professionals which cited these factors as barriers when improving service access for minoritised ethnic communities [46]. Similarly, research on supervision further supports this, highlighting that supervisors face similar challenges when addressing racism with their supervisees, with time constraints acting as a significant obstacle [47]. Thus, indicating a wider systemic issue of prioritising effectual change.

In response to research question three focusing on how the service can enhance future responses to racial trauma, staff called for enhanced training to improve their ability to discuss race-related issues, facilitate culturally sensitive conversations and manage challenging situations, such as responding to service users with far-right views. Staff confidence in addressing racial trauma was low, with fewer than half (48%) feeling equipped to support service users during and after the riots, and only 33% feeling confident in addressing racial trauma. There is evidence that training on topics such as racial trauma and microaggressions can improve perceived efficacy in addressing these issues, although the effect was only observed among White clinicians in relation to racial trauma [31, 48]. However, the gap between perceived preparedness and actual confidence suggests that knowledge alone is not sufficient; active skill development and supervision are needed to ensure individuals can apply their knowledge effectively in real world situations. Staff highlighted the need for organisational guidance and protocols for handling race-related discussions and responding to events like the riots. Additionally, staff expressed the desire to incorporate service user perspectives into service delivery, ensuring that their needs and experiences are considered. Such an approach can enhance outcomes by tailoring interventions to service user needs, improving engagement and empowering service users as active contributors [49]. This echoes literature that advocates for organisational policies and practices aimed at dismantling institutional and systemic racism through multi-level approaches [50]. Such initiatives cannot only improve staff competence in managing racial trauma but also create a more supportive and equitable environment for both staff and service users, ensuring that mental health services are better equipped to address the complexities of racial issues in a meaningful and sustained way.

Recommendations

Based on the findings of this study, several key actions are recommended to improve staff readiness and enhance the delivery of culturally responsive, trauma-informed care. These recommendations aim to better support both staff and service users in addressing racial trauma and related issues in a more comprehensive and effective way.

Practice

• Enhance Staff Training: Implement ongoing training on racial trauma, cultural humility and strategies for facilitating race-related discussions, including handling difficult topics such as far-right views.

• Proactive Race Discussions: Encourage and support staff to proactively initiate discussions around race and identity with all service users, rather than relying solely on the service user to raise these issues.

• Strengthen Cultural Competency: Integrate culturally responsive care into routine clinical practice by adapting interventions to reflect clients’ cultural needs and lived experiences.

• Supportive Supervision: Continue reflective practices and peer supervision to help staff process experiences related to racial trauma.

• Foster a Safe and Inclusive Work Environment: Promote policies and practices that aim to dismantle institutional and systemic racism within the workplace, creating a supportive environment for both staff and service users.

Policy

• Develop Clear Protocols: Establish organisational guidelines and protocols for addressing race-related conversations, particularly in the context of high-profile events like riots, ensuring staff are equipped with the tools and knowledge to navigate these discussions effectively.

• Proactive Responses: Promote proactive responses that provide guidance and support for staff during high-profile events like the riots including facilitating race-reflective workshops and open team discussions.

• Sustain EDI Initiatives: Ensure Equality, Diversity & Inclusion (EDI) efforts are integrated into organisational culture through regular review and structured discussions on race, identity and culture.

Research

• Evaluate Training Effectiveness: Conduct longitudinal studies to assess the impact of racial trauma and cultural competence training on staff confidence and service delivery outcomes.

• Explore Service User Perspectives: Incorporate the voices of service users to understand how race-related discussions affect their therapeutic experiences and outcomes.

• Investigate Systemic Barriers: Examine organisational and systemic factors that limit staff engagement in race-related discussions, including workload pressures and time constraints.

• Explore Staff Experiences Across a Broader Range of Services and Populations: Broaden the scope of research by examining staff experiences across different mental health services and service user populations.

It is important to acknowledge that the recommendations outlined in this study cannot achieve their full potential without addressing systemic barriers. Institutional racism, underfunding of mental health services and societal inequalities create significant challenges that limit the effectiveness of individual or organisational efforts. Therefore, while the recommendations presented here are a necessary step forward, they must be accompanied by sustained efforts to dismantle systemic barriers and promote equity within the wider system in which these organisations exist.

Limitations

This study has several limitations. It was conducted within community-based services in Merseyside. While this provides a broader perspective than a single-site study, the findings may not be fully generalisable to other mental health settings outside of this regional or organisational context. Moreover, the absence of service-level data limited our ability to explore contextual factors affecting implementation and outcomes. Additionally, the lack of demographic data on participants limited the ability to examine how factors such as ethnicity or years of experience influenced staff perspectives. Another limitation is the absence of service user perspectives, which could have significantly improved the study by providing valuable insights into how race-related discussions impacted their therapeutic experiences and perceptions of staff responses. Furthermore, due to the survey nature of the study, it was not possible to elaborate further on staff responses or fully explore the reasons for participants’ approaches when engaging with race-related issues. This limitation means that the underlying factors influencing staff comfort and confidence in addressing racial trauma were not fully captured. Finally, the study findings indicate that many staff did not have contact with service users from minoritised backgrounds. While these perspectives were retained to allow staff to draw on previous experiences and inform service improvement, this limited our insight into service delivery during the timeframe of the riots.

Further research could address these limitations by incorporating service user perspectives, exploring staff experiences across a broader range of mental health services and client populations and assessing the long-term impact of organisational and peer support mechanisms. Finally, future investigations could evaluate the effectiveness of training in addressing racial trauma.

Conclusions

In conclusion, this study highlights the challenges and complexities of addressing racial trauma in community-based mental health services. While staff demonstrated a commitment to culturally competent care, there is a clear need for ongoing development in this area. The findings suggest that, in addition to responding to events like the 2024 UK far-right riots, it is essential to embed sustainable and proactive practices into routine service delivery. This includes enhancing training on cultural competence, providing clear organisational guidance for engaging with race-related issues and fostering an environment of support and reflection for staff. By integrating these practices, mental health services can more effectively address the long-term impact of racial trauma, support affected communities and create a service model that is consistently trauma-informed and culturally responsive.

Abbreviations

NHS

National Health Service

TIC

Trauma–Informed Care

UK

United Kingdom

US

United States

EDI

Equality, Diversity and Inclusion

IAPT

Improving Access to Psychological Therapies

Authors’ contributions

All authors conceived of the presented idea. C.T. led on the investigation, wrote the main manuscript text, prepared appendices and references. A.A. and C.M. verified the analytical methods, encouraged C.T. to focus on specific aspects and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript. C.M. is the corresponding author.

Funding

This research received no funding.

Data availability

There are no copyright issues with any included data and materials.

Declarations

Ethics approval and consent to participate

Retrospective approval to commence the evaluation was granted by Mersey Care NHS Foundation Trust Research and Development Department on 13.12.2024. ‘SE2024-95 Racial Trauma: Reflections from a Trauma-Informed Psychological Service Following Race Riots in the UK’ deemed the need for consent to participate unnecessary according to national regulations. This evaluation did not require management within the UK Policy Framework for Health and Social Care Research and not Research Governance Framework for Health and Social Care, and an ethical review with a Research Ethics Committee (REC) was not required. The research adhered to the Declaration of Helsinki ethical principles for medical research involving human participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.