A high proportion of psychiatric patients have experienced sexual abuse or violence. Yet very few patients are even asked if this has occurred, let alone treated appropriately – as survivors tweeting using the new hashtag #AbusedByServices made clear this week.

A recent systematic review of 21 studies – four from the UK – showed that between 0 and 22 per cent of psychiatric patients are asked about experiences of abuse and violence. This is despite the fact that the Department of Health have required staff to ask about these experiences since 2003.

Survivors are unlikely to disclose spontaneously, so not asking maintains a culture of silence. This is important given the early experiences of psychiatric patients with serious mental health problems. Between 13 to 64 per cent have experienced childhood sexual abuse, and between 22 to 66 per cent childhood physical abuse.

UK news in pictures Show all 50 1 /50 UK news in pictures UK news in pictures 18 September 2020 A model presents a creation during the Bora Aksu catwalk show at London Fashion Week 2020 Reuters UK news in pictures 17 September 2020 World kickboxing champion Carl Thomas during his attempt to run a marathon while pulling a plane at Elvington Airfield near York. The attempt is raising funds for Ollie's Army Battling Against Battens, an organisation campaigning to raise GBP 250,000 to fund a clinical trial aimed at saving the sight of children with CNL2 Batten Disease PA UK news in pictures 16 September 2020 Labour deputy leader Angela Rayner speaking during Prime Minister's Questions UK Parliament/AFP/Getty UK news in pictures 15 September 2020 People enjoying the autumn sunshine as they punt along the River Cam in Cambridge PA UK news in pictures 14 September 2020 Early morning light bathes the skyscrapers of the City of London, at the start of a week in which the UK is expected to bask in temperatures of more than 30 degrees PA UK news in pictures 13 September 2020 England celebrate after they dismissed Australia's Alex Carey to win the second ODI match of the series at Emirates Old Trafford, Manchester PA UK news in pictures 12 September 2020 Protesters outside BBC Broadcasting House in central London, as marches and rallies form across the country calling for a 15% pay rise for NHS workers and an increase in NHS funding PA UK news in pictures 11 September 2020 An empty migrant dinghy floats off the beach at St Margaret's Bay after the occupants landed from France in Dover Getty UK news in pictures 10 September 2020 A view of small boats thought to be used in migrant crossings across the Channel at a storage facility in Dover, Kent PA UK news in pictures 9 September 2020 EU's chief negotiator Michel Barnier, left, arriving from the Eurostar with EU Ambassador to the UK, Portuguese diplomat Joao Vale de Almeida at St Pancras International railway station, London, for the latest round of the negotiations on a free trade deal between the EU and the UK PA UK news in pictures 8 September 2020 Dawn over Coquet Island, a small island off Amble on the Northumberland coast PA UK news in pictures 7 September 2020 A hovercraft arrives to Southsea, Hampshire from the Isle of Wight PA UK news in pictures 6 September 2020 Forensics officers near the scene of multiple reported stabbings in Birmingham Reuters UK news in pictures 5 September 2020 Anti-migrant protesters demonstrate in Dover against immigration and the journeys made by refugees crossing the Channel to Kent PA UK news in pictures 4 September 2020 Activists take part in a demonstration against the HS2 hi-speed rail line outside the Department of Transport AFP via Getty UK news in pictures 3 September 2020 Peter Baker, who plays Trigger in the musical version of Only Fools and Horses, sweeps the stage of the Theatre Royal Haymarket in London, after observing a 15 minute silence to show solidarity with those in the theatre industry that have lost their jobs due to the coronavirus pandemic PA UK news in pictures 2 September 2020 Kadie Lane, right, 11, and Brooke Howourth, 11, hug on their walk to Marden Bridge Middle School in Whitley Bay, Tyne and Wear, for their first day of term, as schools in England reopen to pupils following the coronavirus lockdown PA UK news in pictures 1 September 2020 Extinction Rebellion protesters sitting outside The Houses of Parliament in Westminster, London PA UK news in pictures 31 August Surfers at Long Sands Beach, Tynemouth PA UK news in pictures 30 August Black Lives Matter protesters march through Notting Hill in London in the first Million People March EPA UK news in pictures 29 August A protester reacts as she demonstrates against the lockdown and use of face masks, amid the coronavirus disease outbreak, outside Downing Street in London Reuters UK news in pictures 28 August Caribbean soca dancers display their costumes as they promote the first ever digital Notting Hill Carnival, following the cancellation of the normal Carnival festivities due to the continued spread of the coronavirus disease, in London Reuters UK news in pictures 27 August Father and son team Chris and Sam Milford from historic building conservation specialists WallWalkers begin restoration work on the spire of Norwich Cathedral, which stands at over 312ft high. The first known spire was completed in 1297 PA UK news in pictures 26 August Giant waves at Seaham in County Durham, as the bad weather continues PA UK news in pictures 25 August An assistant at the Wallace Monument cleans the case which houses the William Wallace sword in the Hall of Arms room at the monument near Stirling as they prepare to re-open PA UK news in pictures 24 August Restored World War Two landing craft LCT 7074 is transported from from the Naval Base in Portsmouth to its final resting place at the D-Day Story at Southsea PA UK news in pictures 23 August Jenny Nguyen and Tony Cao, from Vietnam, pose for wedding photos on Tower Bridge in London, as it remains closed to vehicles after it was stuck open on Saturday due to a "mechanical fault". The landmark's Twitter account confirmed only pedestrians and cyclists could use it on Sunday morning PA UK news in pictures 22 August England's Zak Crawley hit 267, joining the exclusive Double Hundred club, on day two of the Third Test match against Pakistan at the Ageas Bowl, Southampton PA UK news in pictures 21 August Harri Teale gathers lavender during the annual harvest on the Wolds Way Lavender farm near Malton in North Yorkshire PA UK news in pictures 20 August Parents and a student react after checking GCSE results at Ark Academy in London Reuters UK news in pictures 19 August Tate Modern workers hold a strike outside the gallery in London, to protest the institution's announcement that it would cut more than 300 jobs from its commercial arm, Tate Enterprises PA UK news in pictures 18 August Two rescued brown bear cubs, Mish (left) and Lucy, cool off in a pool after arriving at their new home with the wildlife conservation charity Wildwood Trust in Herne Bay, Kent. The orphaned pair, who have been living in a temporary home in Belgium since they were found abandoned and alone in a snowdrift in the Albanian mountains, will be acclimatised to their new life in the country before moving to a permanent home PA UK news in pictures 17 August A level students celebrate outside the Department for Education in London after it was confirmed that candidates in England will be given grades estimated by their teachers, rather than by an algorithm. The government U-turn comes just days after Education Secretary Gavin Williamson vowed there would be "no U-turn, no change. PA UK news in pictures 16 August Wasp players take a knee as Northampton Saints stand prior to kick-off in their Premiership match at Franklin's Gardens PA UK news in pictures 15 August Piper Colour Sergeant Lil Bahadur Gurung attends the VJ Day National Remembrance event, held at the National Memorial Arboretum in Staffordshire, Britain Reuters UK news in pictures 14 August People including students hold placards on Whitehall outside Downing Street as they protest against the downgrading of A-level results. The government faced criticism after education officials downgraded more than a third of pupils' final grades in a system devised after the coronavirus pandemic led to cancelled exams yes AFP via Getty UK news in pictures 13 August Benita Stipp (centre) and Mimi Ferguson (left) react as students at Norwich School receive their A-Level results PA UK news in pictures 12 August 2020 A train derailment near Stonehaven has left three people dead. Driver Brett McCullough, conductor Donald Dinnie, and a passenger were killed when the 6.38am Aberdeen to Glasgow Queen Street service crashed amid heavy rain and flooding BBC UK news in pictures 11 August 2020 A woman hydrates in the sun after open water swimming at the West Reservoir Centre in north London Tolga Akmen/AFP via Getty UK news in pictures 10 August 2020 Prime Minister Boris Johnson takes part in an archery session as he visits Premier Education Summer Camp at Sacred Heart of Mary Girls' in Upminster Reuters UK news in pictures 9 August 2020 People cycle through Cambridge as the heatwave continues in Britain EPA UK news in pictures 8 August 2020 Healthcare workers take part in a protest in London over pay conditions in the NHS Getty UK news in pictures 7 August 2020 Emergency services make their way along the seafront on Bournemouth beach in Dorset on one of the hottest days of the year PA UK news in pictures 6 August 2020 Alison Murphy poses for a picture by husband Peter as she walks through a field of sunflowers in Altrincham, Cheshire PA UK news in pictures 5 August 2020 Pakistan's Abid Ali being bowled by England's Jofra Archer during day one of the First Test match at the Emirates Old Trafford, Manchester PA UK news in pictures 4 August 2020 The 'Timbuktu tumblers' from Kenya perform their balancing act on the Southsea waterfront as Zippos Circus reopens in Portsmouth Rex UK news in pictures 3 August 2020 Pelicans interact with a visitor in St James's Park in London PA UK news in pictures 2 August 2020 Lewis Hamilton drives with a puncture towards the finish line to win the Formula One British Grand Prix at Silverstone POOL/AFP via Getty UK news in pictures 1 August 2020 Arsenal's Pierre-Emerick Aubameyang celebrates with the trophy and teammates after winning the FA Cup, as play resumes behind closed doors following the outbreak of the coronavirus disease Pool via Reuters UK news in pictures 31 July 2020 People enjoy the sunny weather at a Bournemouth Beach Reuters

Traumatic early experiences have clear, demonstrable, long-term effects on the psyche, body and soul. For example, being abused can shatter a basic sense of safety, locking the body into a state of hyper-vigilance, and provoking a number of later symptoms such as hearing voices, feeling alienated or experiencing disturbances in one’s basic sense of self.

If only one traumatic event has occurred, it can be easier to speak about, especially if people in the immediate environment recognise that something bad has happened. If violence and abuse have been recurrent in one’s childhood, it can be more difficult to articulate.

The current focus on labelling and medication, which patients are socialised into from their first contacts with mental health services, can mask the fact that many symptoms that appear problematic to the distanced observer are actually desperate attempts to cope and survive.

Rage, for example, is often an attempt to keep the other at a safe distance: to mobilise some feeling as a defence against a hopelessness which would alternatively lead to suicide. Self-harm can serve to give a sense of control and agency which would not otherwise be present. Attempting to get rid of these types of feelings and behaviours, without attending to why and how they developed, is always silencing and can provoke a suicide attempt.

Sinead O'Connor posts candid video describing her mental health

Mental health services can end up re-traumatising people who have experienced abuse and violence. For example, women who have been abused are often restrained by a team of men, or are punished for their attempts to cope by being stitched up after self-harm without anaesthetic. Many report that when they try to talk about experiences of abuse or violence, it is not taken seriously, being told that it is a delusion, or that they are “making it up to seek attention”.

It is as if society can only bear its victims to look and present in a certain way – to be able to proffer a clear narrative and demonstrate a trust that authority figures can help. This belies the legacy of early abuse and violence. When people present in a more messy way – for example by oscillating between desperate attachment to staff and then pushing them away – they are likely to receive a diagnosis such as “borderline personality disorder” which makes survivors feel like there is something fundamentally wrong with their character.

These kind of labels are deeply damaging: an ideological violence which serves to allow staff to distance themselves from the root causes of pain at the expense of the understanding and compassion so desperately needed.

Years & Years frontman Olly Alexander talks of 'outrageous' LGBT mental health problems

Survivors using the #AbusedByServices hashtag report having been desperate to speak to staff about experiences of abuse and violence for five, 10, 20 even 30 years. I wish evidence suggested this was an exaggeration. In fact, the few specialist services that are available are desperately overstretched.

Given the prevalence of abuse and violence in the psychiatric population, the only way forward is to teach the whole workforce to be able to work using a “Trauma Lens”. Staff often report feeling unsure about asking about abuse and violence, because of a lack of confidence that there are appropriate services to refer people to and a fear that they will not be able to contain distress. This has to change.

Trauma Informed Care is a movement which is beginning to gain traction internationally. This approach shifts the focus of care from asking “what is wrong with you”, to “what has happened to you”. Trauma Informed Care tasks include auditing services to make certain that they do not actively re-traumatise patients and ensuring all staff are skilled to ask about, and be able to work, with the sequelae (condition resulting from disease or trauma) of abuse and violence.

We have a two-tier situation in the UK. Survivors with financial means can access long-term psychotherapy privately, where there is time and space to explore what symptoms are trying to communicate. Those from less advantaged backgrounds, already more likely to have experienced abuse and violence, are stuck with the NHS where, despite pockets of excellence, there is a paucity of understanding of the effects of abuse and violence, and where re-traumatisation is rife.

This is simply not good enough. It is time to listen to survivors of abuse and violence. It is time to move towards Trauma Informed Care.