Why access to trauma treatment still depends on who you are, not what happened to you.

One of the questions that has occupied my thinking over recent years is, “Why do some survivors of trauma appear to have more support and a clearer path towards recovery than others?”

We live in a time when our understanding of trauma has never been greater. As outlined in my previous articles, neuroscience has transformed our understanding of the nervous system. Researchers have spent decades studying Post-Traumatic Stress Disorder, Complex PTSD and the long-term physiological consequences of prolonged exposure to fear, threat, abuse and violence. Public awareness campaigns have increased understanding, and conversations that once took place quietly behind closed doors now appear regularly across mainstream media, healthcare settings and political discussions.

On the surface, it would be easy to assume that survivors are therefore receiving better support than ever before. Yet for many people, recognition and recovery remain two very different things.

We know trauma exists, we know support exists, but access to meaningful and effective support once that trauma has been recognised seems too far away for so many of us.

Over the past few years, I have found the research guiding me repeatedly to the comparison between military trauma and sexual trauma. The experiences are not identical, but society has become relatively comfortable acknowledging one whilst continuing to struggle with aspects of the other – even after the #metoo movement and the landmark case of Gisele Pelicot.

Most people understand that soldiers returning from conflict may require specialist support. We recognise that exposure to violence can leave lasting psychological, emotional and physiological consequences. We understand that rehabilitation may take time and that treatment often needs to extend far beyond an initial crisis response.

As a result, many countries have spent decades building systems designed to support veterans. Specialist charities, dedicated treatment programmes, residential facilities, and research funding all exist, with public sympathy on a global scale being acknowledged through remembrance days.

They emerged because societies collectively accepted that trauma has consequences and that those consequences deserve a response. Yet when we turn our attention to survivors of sexual violence, a different picture often begins to unfold.

The trauma itself may now be acknowledged, with awareness campaigns having increased. Public conversations have expanded, and research has grown significantly. Yet many survivors still find themselves navigating fragmented services, lengthy waiting lists, inconsistent access to specialist therapy, complex compensation processes and healthcare systems – all filled with experts struggling to connect the dots between traumatic experiences and long-term physiological symptoms.

The result is a recovery gap.

The contrast becomes particularly visible when we look beyond awareness campaigns and into treatment pathways themselves. Over the past decade, significant attention has been directed towards understanding and treating military-related PTSD. Specialist veteran services have been developed internationally, with dedicated charities emerging; and increasing research funding has been allocated to explore innovative approaches to trauma recovery. Whilst access remains far from perfect, the principle that veterans deserve specialist support is now widely accepted.

For many survivors of sexual violence, however, the journey often looks very different. Research examining Sexual Assault Referral Centres across England found that the majority of survivors displayed significant trauma symptoms, with around 71% showing ‘probable PTSD’ shortly after accessing support services. Despite these high levels of need, many survivors reported difficulties accessing ongoing mental health care, fragmented pathways and long waits for specialist support.

And herein lies another one of the problems: ‘Probable PTSD’. The wording matters because when we break down the words Post Traumatic Stress Disorder, and then doubt that a woman can have traumatic stress disorder after being raped – an invasion of her body, a total disregard for her choices and boundaries, and a dismissal of her as a person with rights to her own agency, then we have a problem.

Soldiers KNOW they are going into war. Women who are raped do not know they are about to be raped.

And dismissing a woman and how her PTSD presents, when we know there are huge data gaps in the entirety of women’s health, this creates a gap in the acknowledgement of suffering. It is not a legitimacy gap, but a gap in access; a widening distance between what decades of research have taught us about trauma and what survivors are actually able to access when they need support most.

I have experienced aspects of that gap personally.

When I visited my doctor after being spiked and raped, it took me courage to leave the house. I got dressed, brushed my hair and applied my make-up, all acts of putting on my armour against the world. A way of preventing neighbours and strangers from pitying me with the ‘way I looked post-rape.’ When I met with my doctor, a female no less, she refused to diagnose my PTSD because I ‘was well put together, could maintain eye contact, and left with a smile’. Being well put together came with a wardrobe of conscious choices throughout the years to represent myself well in business and life, and a style of dress I was accustomed to. Maintaining eye contact is something I have always done. It shows respect to the person we are conversing with, and as for having a smile on my face when I left, this was simply a sign of trying to fake it until I made it.

Like many survivors, I spent years attempting to understand changes occurring within my own body and nervous system whilst simultaneously navigating the practical realities of everyday life. There were my children to raise and protect from the trauma I was experiencing. There were books and articles to write, businesses to run, clients to support and responsibilities that did not disappear simply because trauma had entered the picture.

At the same time, there were disrupted sleep patterns, periods of exhaustion, hypervigilance, physiological changes, health concerns and questions that often seemed to generate more uncertainty than answers.

What struck me repeatedly was not simply the challenge of managing these symptoms, but how much responsibility rested upon me, and other individual survivors, to find solutions.

There is a particular frustration that emerges when you understand enough about trauma to recognise what is happening within your own body, yet still find yourself moving through systems that seem determined to view each symptom separately, despite the evidence increasingly pointing towards a much larger picture.

Whilst I’ve spent considerable time attempting to navigate the various systems and the keywords that trigger action within the support services, it has become increasingly apparent that understanding the problem and accessing meaningful solutions are often two very different things.

There is a particular frustration that emerges when you understand enough about trauma to recognise what is happening within your own body, yet still find yourself moving through systems that seem determined to view each symptom separately, despite the evidence increasingly pointing towards a much larger picture.

I know I am one of the ‘lucky ones’ because I can research, have the strength to keep fighting, the drive to keep living (although at times, the thought of even living was too much) and the ability and knowledge on how to write letters that made things happen because I’d researched the conditions, found the specialists, joined the waiting lists, and was able to pay privately if possible.

Gathering evidence, retelling the story, completing yet another assessment, explaining the impact over and over again, proving the consequences again yet again to someone over the telephone following a crib sheet of key words, still meant I had to wait.

Waiting has become one of the least discussed components of trauma recovery.

Whilst NHS England has established waiting-time standards for mental health services, access to specialist trauma support remains highly variable depending upon location, service provision and clinical thresholds. Even where services exist, survivors often describe lengthy delays between disclosure, assessment and treatment, creating a situation in which people are asked to continue functioning whilst their nervous systems remain trapped in survival mode. Once treatment is provided, it is often a ‘stop-gap’: six weeks of therapy, a referral to an online app, a referral to a yoga centre. There is nothing that supports trauma victims that is effective and meaningful.

Time itself becomes part of the injury. A month waiting for treatment may be manageable. Several years can alter the course of careers, relationships, physical health and financial stability, and can often be fatal.

For many survivors, the recovery journey becomes almost a second occupation.

This raises a question that extends far beyond individual experiences. If we now understand that trauma affects the brain, nervous system, immune system, sleep, concentration, physical health, relationships and economic wellbeing, why does accessing treatment remain so difficult for so many people?

The answer is not simple.

Part of it reflects limited resources, whilst competing priorities reflect another issue. Part of it reflects the reality that healthcare systems across many countries are operating under significant pressure; part of it also reflects how societies choose to allocate attention, funding and urgency, because whilst trauma may be universal, investment rarely is.

Perhaps nowhere is the recovery gap more visible than in the emerging conversation around innovative trauma treatments.

One of the most interesting developments in recent years has been the growing research surrounding treatments once considered controversial, including MDMA-assisted psychotherapy and psilocybin-assisted therapy for treatment-resistant PTSD. Several studies have reported promising outcomes, particularly amongst veterans and individuals living with severe trauma-related conditions. Early findings have generated considerable interest because they offer potential hope for individuals whose symptoms have proven resistant to traditional interventions.

What interests me is not simply whether these treatments ultimately prove effective, but how quickly institutions mobilise when certain groups require support compared with others. If a promising treatment demonstrates the potential to alleviate suffering, who gains access first? Who is prioritised? And how long are others expected to wait whilst evidence continues to accumulate?

The same question emerges in relation to medical cannabis.

In recent years, medical cannabis has gained increasing recognition as a treatment option for a range of conditions, including chronic pain, multiple sclerosis, epilepsy and Parkinson’s disease symptoms in some jurisdictions. Research has also begun exploring its potential role in supporting individuals living with PTSD, with observational studies reporting improvements in sleep, anxiety, quality of life and trauma symptoms amongst some patients. Whilst further research is still required and debate continues regarding long-term efficacy, the conversation itself reflects a broader shift in how trauma treatment is being approached.

Yet for many survivors of sexual violence, discussions around innovative treatments can feel strangely distant. Long before questions about psilocybin, MDMA or medical cannabis become relevant, many are still attempting to secure access to basic trauma-informed therapy, specialist psychological support or timely mental health services.

The gap is not simply between old treatments and new treatments. It is between having a pathway and having none at all. These developments undoubtedly offer hope, but they also force us to confront a series of uncomfortable questions.

Who will have access to these treatments?

How long will it take before they become available beyond specialist trials?

Who will decide which forms of trauma qualify for innovative interventions and which do not?

And perhaps most importantly, how many survivors will spend years waiting whilst evidence continues to accumulate around them?

The reality is that every delay carries consequences, and those consequences rarely remain confined to healthcare alone. They appear in workplaces, in relationships, in legal systems, in communities and, most significantly, in the everyday lives of survivors attempting to move forward whilst support remains just out of reach.

Public understanding of trauma has undoubtedly advanced, but understanding alone does not help a survivor secure therapy, access treatment, navigate compensation systems or rebuild a life interrupted by violence. Awareness must now be matched by access, investment and meaningful action.

We have spent decades gathering evidence about the impact of trauma on human lives, bodies, relationships and communities. The challenge before us is no longer one of understanding, but of deciding what we are prepared to do with that knowledge.

As discussed in my article No One Prepares the Stage to be Raped, I covered the questions facing modern institutions and whether they believe survivors without film footage being made and shared.

Now we have to invest in helping survivors obtain justice and recover without being retraumatised to get the help they need. Access to recovery should not depend on who experienced the trauma in the first place, nor whether we fought for our country.

The uncomfortable reality is that none of this is ultimately about whether resources and solutions exist.

In recent years we have witnessed governments, healthcare systems, researchers and pharmaceutical companies achieve extraordinary things when faced with a challenge they collectively decided required urgent action. We saw unprecedented levels of collaboration, funding, research, regulatory flexibility and public investment mobilised in remarkably short periods of time.

The lesson is not that trauma should be treated in the same way as a global pandemic – although it is a global crisis for women from all walks of life.  The lesson is that when institutions decide something matters, progress can happen far more quickly than we are often led to believe.

If we can mobilise billions of pounds, accelerate research programmes and transform healthcare delivery when enough urgency exists, then we can certainly do more for survivors of trauma than asking them to join another waiting list, complete another assessment and wait several more years for support.

We know society possesses the intelligence, expertise and resources to improve trauma recovery, but do we possess the will to support our wives, mothers, sisters, daughters and colleagues?

Every year we delay, another survivor waits.
Another career stalls.
Another family absorbs the impact.
Another nervous system remains trapped in survival mode.
And another life is shaped not only by trauma itself, but by the length of time it takes for help to arrive.

The recovery gap is not inevitable.

It is a choice.

And choices can always be changed.