Towards trauma-informed, integrated care for young people in Europe

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Andrea Fiorillo, President of the European Psychiatric Association (EPA), discusses the growing mental health crisis among young people in Europe, highlighting successful integrated care models that provide early, holistic support for youth

The mental health crisis among Europe’s young people is deepening. In recent years, the European Psychiatric Association (EPA) has drawn attention to the rise in anxiety, depression and loneliness (an estimated 25% increase since 2021) and to the steep increase in years lived with disability over the same period (30.9 %). When 74% of mental disorders begin before age 24, the failure of services to provide timely and appropriate care fuels a major public health concern. In 2025, the EPA, through the 2025-2027 Presidential Action Plan, is committed to focusing on expanding mental health care beyond hospitals and clinics, developing innovative care settings and services, and working closely with patients, families, and communities.

A particular focus is trauma: adverse experiences such as violence, neglect, catastrophes and natural disasters, forced migration or discrimination are widely recognised as potential negative drivers of mental health conditions. Traumatic events take on many different forms and affect each person differently. Approximately two-thirds of young people are exposed to a traumatic event by the time they turn 16. In particular, traumatic events – such as war, migration and economic crisis – have a detrimental impact on the mental health of young people. Children process trauma differently compared to adults because their brains are still developing. This means that the types of experiences that children live as traumatic, and how they understand them, can be very different from those of adults.

Effective integrated care models for trauma-affected youth

International best practices demonstrate that integrated, youth-friendly services can deliver early, holistic support. In Europe, several models exist specifically focusing on youth mental health.

The first early intervention service in Europe was developed in Birmingham, UK, in 1994. The service, initially dedicated to psychosis, became a model for national roll-out from 2001. In recent years, the service changed to the Youth Space, creating a non-stigmatising, youth-friendly service for young people experiencing various mental health problems.

Since 1999, in France, the Maison des Adolescents (MDAs) has been established; more than 100 MDAs provide integrated, youth-friendly facilities offering a daily health and prevention space, multidisciplinary consultations, mobile teams visiting hospitalised adolescents or meeting them at home, network meetings and parent support groups. The MDAs target 11-21 year olds, aligning with the World Health Organization’s definition of health as complete physical, mental and social wellbeing.

Jigsaw – The National Centre for Youth Mental Health in Ireland – uses a primary care, early intervention model for 12-25 year olds with mild to moderate difficulties. The programme enhances knowledge about mental health, teaches coping skills and helps young people navigate critical developmental transitions. Importantly, it has comparable accessibility for males and females.

Since 2006, a well-established model of care for young patients is the ‘Headspace National Youth Mental Health Foundation’ in Australia, which adopted a primary care model designed as a ‘one-stop shop’ for people aged 12-25. It offers ‘soft entry’ points with reduced barriers, putting together mental health service, physical health promotion and vocational services, integrating peer workers and early intervention, and – more importantly – removing the hard age cut-off at age 18. Government investment has scaled the network to 156 centres across the country, and more than 446,000 young people have accessed face-to-face or digital support.

These few examples of national initiatives share features highlighted by a 2019 scoping review of integrated community-based youth service hubs: rapid access, early intervention, youth and family engagement, youth-friendly environments, and robust partnerships. By bringing health, education, social care and peer support into a single space, they reduce system fragmentation and the stigma around mental health. For trauma-affected young people, this integration is crucial.

Experiences of trauma cut across mental, physical and social domains. Responses must therefore be coordinated across those areas. According to the U.S. National Child Traumatic Stress Network (NCTSN), trauma-informed integrated healthcare puts medical and mental health treatment at the same level, streamlining communication among providers and families, and developing organisational policies that promote trauma awareness. Evidence indicates that integrating mental health services into paediatric medical settings enhances access, improves quality and reduces stigma.

Siloed systems across health, education and social care impede coordinated support.

Barriers to adopting trauma-informed approaches

Despite the promise of these models, Europe faces a crucial challenge: the lack of a shared definition and standards. A rapid evidence assessment commissioned by the UK Department for Levelling Up, Housing and Communities found that inconsistent definitions of trauma-informed care and the absence of benchmarks for training and service delivery represent key barriers to implementation and assessment. Without a common language and measures, services cannot be compared in terms of effectiveness or justified for investment.

Additionally, public spending cuts and payment-by-results contracts limit organisations’ capacity to adopt trauma-informed practices: short-term funding makes it hard to invest in workforce training or to adapt physical environments. In addition to staff turnover and inadequate time for training, traditional risk-averse clinical cultures and continuous cycles of new initiatives create scepticism and reduce adherence to trauma-informed principles.

It is very common for young people suffering from mental health conditions to experience a hard transition at 18, losing continuity of care when moved from child to adult services. Siloed systems across health, education and social care impede coordinated support. Finally, stigma and lack of awareness remain pervasive: even within healthcare, practitioners may not recognise trauma’s impact or differentiate trauma-informed care from general good practice.

Embedding trauma-informed principles in psychiatric training

To achieve a cultural shift, high-quality training is crucial. Trauma-informed integrated care requires training for health professionals and staff to provide trauma-informed paediatric healthcare, and emphasises evidence-based resources for the workforce. Psychiatry curricula across Europe should therefore:

• Integrate trauma science from the undergraduate level onwards. Trainees need to understand the neurobiology of trauma, developmental impacts, gender and cultural aspects, and how trauma is linked with social determinants of health. Reflective practice and supervision should address vicarious trauma and encourage providers to examine their own biases.
• Embed trauma-informed care in continuing professional development. Regular workshops, simulation exercises, and e-learning modules can help clinicians translate theory into practice. Training should be inter-professional, bringing together psychiatry, paediatrics, primary care, psychology, social work, and education, reflecting the integrated nature of care.
• Ensure service user involvement. Co-designed training materials and lived-experience educators can challenge stigma and highlight the importance of cultural humility and empowerment.
• Develop European guidelines and accreditation. The EPA, working with partners such as the European Union, could develop consensus guidelines and a credential for trauma-informed psychiatric practice, creating benchmarks that address the current gap identified by evidence reviews.

Building integrated, trauma-informed pathways

To deliver on its action plan, it is key to promote collaboration across health, education, social care and youth services. Key strategies include:

• Co-locate services and create youth hubs. European countries should invest in one-stop youth health centres that offer mental health, physical health, educational support, vocational guidance, and social services under one roof. Such hubs should maintain flexible age boundaries and provide digital access for rural or marginalised communities.
• Develop trauma-informed schools. Schools are often the first place where trauma manifests. Teachers and counsellors should be trained to recognise trauma responses and to use evidence-based interventions. Clear referral pathways should connect pupils to psychiatric services. Partnerships between schools, child and adolescent mental health services and primary care can ensure continuity.
• Strengthen social care linkages. Trauma is often intertwined with housing instability, poverty and exposure to violence. Integrated youth hubs should therefore include social workers and case managers who can address housing, legal or financial needs.
• Use digital tools to enhance access and continuity. Telepsychiatry platforms, online peer support, and eHealth interventions can complement face-to-face care and provide continuity of care during transitions.
• Advocate for policy and funding reform. The EU’s comprehensive approach to mental health stresses adequate prevention, access to high-quality care and reintegration. It includes plans for a child and youth mental health network and initiatives to train more professionals. While these efforts are most welcome, there is a crucial need for dedicated funding streams, flexible commissioning and measurement frameworks that incentivise trauma-informed models.

Looking ahead

The EPA’s mission is to support mental health across Europe. As the Action Plan acknowledges, psychiatrists must venture beyond traditional clinics and work collaboratively in schools, workplaces and communities. Trauma-informed integrated care models illustrate how youth participation, early intervention, co-location of services and cross-sector collaboration can transform care. The barriers are considerable: insufficient definitions, funding constraints, fragmented systems and cultural inertia. Yet Europe now has an opportunity. The EU’s 2023 comprehensive approach to mental health emphasises prevention, high-quality care and reintegration. By embedding trauma science in training, creating integrated youth hubs, engaging schools and social services, and advocating for supportive funding and policies, the EPA can help ensure that no young person is left behind.

References

1. Benoit, L., Cottin, P., & Moro, M. R. (2018). What is a “Maison des Adolescents”? A history of integrated youth health care services in France. Early Intervention in Psychiatry, 12(3), 1–6. This paper describes France’s network of “Maisons des Adolescents,” noting that more than 100 centres offer health and prevention services, multidisciplinary consultations, mobile teams, art workshops, remedial education, and parent support groups for 11- to 21-year-olds.
2. European Commission. (2024). A comprehensive approach to mental health (updated 22 May 2024). European Commission. The Commission’s web report outlines the EU’s three guiding principles for mental health—adequate and effective prevention, high-quality and affordable mental healthcare, and reintegration into society—and lists initiatives such as the Child and Youth Mental Health Network, the Youth First flagship, and the European Mental Health Capacity Building Initiative.
3. Fiorillo, A. (2025). A roadmap for better and personalized mental health care in Europe: the priorities of the European Psychiatric Association. European Psychiatry, 68(1), e60. DOI: 10.1192/j.eurpsy.2025.2456. The EPA’s president highlights the sharp rise in anxiety, depression and loneliness among young Europeans and calls for new models of care beyond hospital settings.
4. O’Reilly A, O’Brien G, Moore J, Duffy J, Longmore P, Cullinan S, McGrory S. Evolution of Jigsaw – a National Youth Mental Health Service. Early Interv Psychiatry. 2022;16(5):561-567. Surveys indicate that over 90 % of young people report improvements in their mental health, and 96 % are satisfied with the support they receive. Key attributes of the Jigsaw service model, including therapeutic service, scope of practice, youth mental health promotion, youth participation, and monitoring/evaluation, are described in this paper. Information on key enablers (funding and governance/quality) and service providers is also included.
5. McGorry, P., Trethowan, J., & Rickwood, D. (2019). Creating headspace for integrated youth mental health care. World Psychiatry, 18(2), 140–141. DOI: 10.1002/wps. 20619. This editorial describes Australia’s headspace model—an enhanced primary care “one stop shop” that co-locates mental health, physical health, substance use and vocational services. Government investment has scaled headspace to more than 110 centres serving over 446,000 young people, with evaluations reporting significant improvements for roughly 60 % of users.
6. National Child Traumatic Stress Network. (2018; updated 2021). Trauma Informed Integrated Care for Children and Families in Healthcare Settings. NCTSN Policy Brief. This fact sheet defines trauma-informed integrated healthcare as prevention, recognition and response to trauma through collaboration between physical and mental health professionals and families, including co-location of services. Evidence cited in the brief shows that integrated care increases access, improves quality and reduces stigma.
7. Revolving Doors & CFE Research. (2023). Trauma informed approaches to supporting people experiencing multiple disadvantage: A rapid evidence assessment. Department for Levelling Up, Housing and Communities. This report identifies system-level barriers to trauma-informed practice—such as a lack of a shared definition, resource constraints, outcome-based commissioning, and resistance to change—and highlights the challenges posed by rigid rules and punitive cultures.
8. Settipani, C. A., Hawke, L. D., Cleverley, K., Chaim, G., Cheung, A., Mehra, K., Rice, M., Szatmari, P., & Henderson, J. (2019). Key attributes of integrated community-based youth service hubs for mental health: A scoping review. International Journal of Mental Health Systems, 13, article 52. The scoping review synthesises evidence from 110 documents. It identifies common principles of integrated youth service hubs, including rapid access, early intervention, youth and family engagement, youth-friendly spaces, evidence-informed approaches and robust partnerships.