Trauma can be defined as an event, or series of events, which are very stressful, frightening, distressing and/or disturbing. Causes of trauma include domestic abuse, sexual abuse, exposure to crime and bereavement; however, it is very much an individual reaction and there is no exhaustive list of causes.

Trauma can be triggered at any stage in a person’s life and occurs when some kind of external factor causes them to recall the event which was traumatic to them. Again, triggers are very personal and hugely varied, but some common examples can include a smell, visual object or a certain word or phrase. The reactions caused by trauma are equally unique, but often can be likened to the symptoms of a panic attack. The instinct of the individual may well be to retreat, shut down on an emotional and/or communicative level, or to react with a desire to protect themselves. Reactions can manifest on a physical, emotional and psychological manner. The effects have a huge impact on the individual personally, not just in the moment when the trigger occurs but for some time after. They can be hugely debilitating and distressing for the individual concerned.

Trauma is by nature unpredictable and affects so many areas of life for those who live with it. It can manifest in the most mundane and unexpected of situations; for example, at a dental appointment or visiting a chiropractor, chatting with another carer at a support group or taking your child for a health check. It can result in the individual withdrawing and disengaging from these services, which leaves them in a position where they may not receive the level of care and support that they need and are entitled to.

The Healthwatch Essex Trauma Ambassador Group have created the Trauma Card as a tool to empower cardholders to make those they are interacting with aware of when they are experiencing the effects of trauma, and to inform those in receipt of the card about trauma and how to more effectively support, and work with, those living with the effects of trauma.

If you have been presented with a trauma card, the person you are interacting with is living with the effects of trauma, and the situation you are currently in has generated a trigger for them.

Please show the person who has given you this card empathy and understanding. They are in a situation where their immediate instinct may be to leave or ‘shut down’ and not engage. This comes from the need to protect themselves as they feel unsafe and not in control of the situation. It does not mean that they do not wish to engage with you and whatever process they are there for; it means that, at this moment in time, they are unable to do so through no fault of their own.

Please be patient and give the person time, without pressure. If they are able to communicate, ask them if there is anything you can provide that would help, such as being in a separate room or going outside for some fresh air. It may be that there is a song on the radio which has triggered them; this could be turned off. There are endless possibilities, but if you are able to communicate in a sensitive and understanding manner, the person may feel able to tell you what they need.

If this is not the case, the individual may need to remove themselves from the current situation as soon as possible. This does not mean that they don’t wish to engage or continue at a later date with the process that was underway; it simply means that they are unable to do so at this moment in time. Please assure them that you will reach out to them to discuss how they wish to proceed at a later date. It is important for them not to feel that their care or support will be adversely affected by something that is out of their control.

The Trauma Ambassador Group (TAG) is a group of individuals who have come together under the umbrella of Healthwatch Essex to utilise their skills and lived experiences to help inform, shape and develop health, care and wellbeing services. The group, with each individual member’s lived experience of trauma, has the following aims;

1. To educate and enhance the knowledge and understanding of trauma in those who commission, provide and deliver our health, care and wellbeing services with the aim of improving these services.
2. To raise awareness of the effects of experiencing and living with trauma, thus creating better understanding within the public and professionals.
3. To encourage those in similar situations to access support and empower them to improve their experiences.

The most important thing you can do for someone affected by trauma is to offer them time, space and understanding. The behaviours they are exhibiting are symptoms which, at this particular point in time, they are unable to control through no fault of their own. Each person’s trauma is individual and therefore requires an holistic, person-centred approach.

Your employer should be able to provide you with support and training around working with trauma, but there are also specific organisations which can provide information:

• The UK Trauma Council
• Mind
• UK Psychological Trauma Society

You can also get in touch with the Healthwatch Essex Information and Guidance Service which is available Monday-Friday, 9am -5pm, to provide information, signposting and support. Outside of these times a voicemail can be left, and you will be called back at the earliest opportunity. We are here to assist individuals living with the effects of trauma with all aspects of their health, care and wellbeing, as well as their friends, families and professionals engaging with them.

The individual presenting is from the local asylum seeker site. They have probably experienced trauma, and they are in a country where English is not their first language and may speak very little English. Whilst we find vaccinations normal, someone from another country may not be used to being vaccinated. This involves a lot of injections, and they may become wary. Uptake for vaccinations for asylum seekers is typically low. We have a section in the asylum trauma page which helps to explain for them why it is a good idea to be vaccinated.  Please scan the barcode for them and click the button for individuals, chose the language for the individual and then open the plus sign on injections / vaccinations so that they can read it in their own language to understand. They may still decline but at this point they are making a more informed choice to decline which is person-centred in approach.

The individual presenting is from the local asylum seeker site. They have probably experienced trauma, and they are in a country where English is not their first language and may speak very little English.

Asylum seekers can usually get medications free of charge but need an HC2 certificate to show that they are entitled to free prescriptions.  People receiving support from the Home Office, should have been given an HC2 certificate

People seeking asylum who are in receipt of section 95 support from the Home Office should automatically receive a HC2 (help with health costs) certificate within 21 days of their section 95 grant letter. Those on section 98 support (temporary support before section 95 decision) or section 4 support (support for people refused asylum) will need to complete an HC1 form.  

Any person seeking asylum who requires an urgent prescription will need to contact the NHS Business Services Authority (BSA) on 0300 330 1343.  If the application has been processed, then a certificate number will be available which can be used to obtain a free prescription prior to actually having the paper certificate.  This has to be done by the individual themselves for confidentiality.  

If an application has not been made or has not been received or processed, the individual should tick the ‘L’ box on the back of the prescription (HC2 full help certificate).  Individual asylum seekers cannot be refused the service/medications by the pharmacy.  The pharmacy should therefore tick the “evidence not seen” section. NB if the pharmacy is using Real Time Exemption Checker patients may show up as non-exempt, teams need to be aware of this.

The NHS BSA routinely undertake checks to verify that people are exempt from health cost charges to prevent and detect fraud or error, and issue charge notices to any individual without a valid exemption/application. Given urgent needs will arise in advance of receipt of an exemption certificate NHS England has agreed with the NHS BSA that all large accommodation sites will be exempted from this process through the sharing of accommodation site addresses. 

If the individual is attempting to purchase something over the counter, they may not understand that this element is a commercial set up. Please direct them to question about over the counter medication this part of the site as it will explain that the pharmacy is under no obligation to supply.  They should be advised to contact their GP if their condition does not improve or in your opinion is more serious. Please note that asylum seekers are on £9.10 per week income and cannot work or volunteer. Please be mindful and kind in how you support them as they are in the most challenging of situations when presenting to you.

The individual presenting is from the local asylum seeker site. They have probably experienced trauma, and they are in a country where English is not their first language and may speak very little English. They are trying to find their way back to the asylum centre at Wethersfield. There are three ways they can make their way back and the best options depends on where they are in relation to the pick-up point in Braintree or near the site where the address is Wethersfield, Braintree CM7 4AZ. The phone number for the people who run the transport shuttle is 07481 164536.

The individual presenting is from the local asylum seeker site. They have probably experienced trauma, and they are in a country where English is not their first language and may speak very little English. Depending on their background a surgery setup maybe slightly alien to them. It means you might need to take more time with them. Equally it might help to take them to the same question on this site for them. It will help them to understand, in their own language, what the surgery is there to do for them. It may also manage their expectations if they are presenting for a different reason and help you to redirect them to the right place.

The individual presenting is from the local asylum seeker site. They have probably experienced trauma, and they are in a country where English is not their first language and may speak very little English. To add to this, they have been in hospital because the issue they are experiencing is extended beyond what can be managed in primary care. They are trying to find their way back to the asylum centre at Wethersfield. There are three ways they can make their way back and the best options depends on where they are in relation to the pick-up point in Braintree or near the site where the address is Wethersfield, Braintree CM7 4AZ. The phone number for the people who run the transport shuttle is 07481 164536.

In England, you can dial 111 on any telephone.

NHS 111 is the gateway to urgent care, and at IC24, we are proud to provide this service across Mid and South Essex. The 111 service provides urgent care triage if you think you need A&E but it’s not life-threatening, and advice when your GP, pharmacy or dental practice is closed.

Please note: If there is a danger to life or serious injury, dial 999 or go straight to A&E.

You can also visit the website Get help for your symptoms – NHS 111 (111.nhs.uk), for any urgent healthcare advice.

NHS111 Online will not give you a diagnosis, but we will direct you to the best place to get help for your symptoms.

NHS111 cannot:

• issue fit notes – you need to contact your GP surgery
• make or cancel appointments for you in other parts of the NHS

If you need help in another language:

British sign language (BSL): Use signvideo.co.uk/nhs111

Other languages: Call 111 and ask for an interpreter.