How trauma-informed practice can improve mental health care

So, what is it to be trauma-informed?  Trauma-informed practice recognizes the intersectionality of trauma, mental health, and substance abuse, and involves an awareness that anyone may have experienced trauma, whether they have disclosed it or not.  Trauma-informed practice aims to create environments that prevent re-traumatization and promote a sense of safety.  The individual client’s safety, choice, and control is prioritized throughout services, and an approach of collaboration, learning, and building trust is used.  There should be a non-hierarchical and supportive organizational culture, and there is a focus on strengths and building resiliency, and hope that recovery is possible.

One area where being trauma-informed has the potential to make a huge difference is when it comes to seclusion and restraints.  The use of seclusion and restraints can lead to significant psychological or physical harm, and can be a major source of traumatization or re-traumatization.  The British Columbia Centre of Excellence for Women’s Health identified several strategies for a trauma-informed approach to seclusion and restraints:

  • staff training in de-escalation
  • have comfort rooms with low sensory stimulation
  • promote the development of crisis plans or advance directives to identify triggers and preferred interventions
  • assess for and address any unmet needs that may be influencing behaviour
  • debriefing following any use of seclusion or restraint to identify why it happened and what was learned.

When I was doing my masters degree one of my classmates was working in a psychiatric intensive care unit where they had instituted changes in their approach to seclusion and restraints in order to provide trauma-informed care.  My classmate had nothing but good things to say about this, and the unit had achieved very significant reductions in trauma and restraint utilization.

My most memorable occasion of being in seclusion was when I had taken myself into hospital, with the support of my community psychiatrist, and said that I was feeling suicidal and needed ECT.  They decided to commit me under the Mental Health Act and put me in seclusion, even though I had gone in voluntarily.  When I was informed I would be locked in seclusion I asked to be sedated, because I didn’t want to be trapped with nothing but my thoughts.  The nurse said there was nothing ordered.  I asked if it would make a difference if I told her that I’d throw my tiny tube of hand cream at her.  She disappeared, I heard a “code white” (aka violent patient aka me) being called over the PA system, and she returned a few minutes later with a bunch of security guards to give me the injection I’d asked for in the first place.  How very therapeutic.

Sometimes in the field of mental health care certain approaches or practices will become buzzwords, and many organizations will jump on board.  I think this has happened, at least to some extent, with trauma-informed practice, and it’s generally seen as something desirable.  Where the problem lies, though, is that there’s a difference between claiming to be trauma-informed and actually being trauma-informed.  I’m sure that the mental health and addictions program I work for would claim to be trauma-informed, just like they claim to be recovery-oriented.  But in practice, it’s just lip service, although I highly doubt the people running the place would see it that way.

I think all mental health care organizations should be trauma-informed, but it’s essential that it look trauma-informed from the client perspective, not just the staff or management’s perspective.  While individual care providers for the most part try (with varying degrees of success) to be empathetic, it’s difficult for some clinicians, and particularly for organizations, to have any real understanding of what the client perspective looks like.

Would you consider the mental health services that you’ve accessed to be trauma-informed?

 

Sources: British Columbia Centre of Excellence for Women’s Health Trauma-Informed Practice Guide and Trauma-Informed Approaches to Seclusion and Restraint Reduction

 

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27 thoughts on “How trauma-informed practice can improve mental health care

  1. Meg says:

    I’m sorry you had such a needless, clueless experience with that stupid nurse. It boggles the mind that people could be so heartless and stuck on rules and regulations. She probably really did feel threatened by your silly tube of hand cream. You were trying to explain how the rules should be bent, and she was cowering in fear. (Idiot.) [Eyeroll.] It must all go back to human nature. Eventually, that nurse will be on the other side, and she’ll realize the error of her ways.

    I was only restrained once, at the age of fifteen. I was on the mental hospital, and I threw a small object (not at anyone, but at the wall, which was deliberate, because I didn’t want to hurt anyone). And they took me willingly (I walked with them and was immediately compliant–no resistance) to a room with a cot with straps on it. They made me take off all my clothes, including my bra but not my panties, and made me lie on the cot, saying if I didn’t remove my clothing for them, they’d strap me down. They said they’d be watching from the overhead camera to see how long I could lie still. I think they must have been either deranged, perverted, or sadistic, but I’m not sure.

  2. marandarussell says:

    Oh geesh, that is ridiculous that you went through that! I am glad when I was hospitalized that the staff was all very understanding, especially once they understood I was autistic. One night I had a huge panic attack and convinced myself I could talk my way out of the hospitalization if I went to the nurses station and just threatened to sue them for keeping me against my will lol. Didn’t work, but at least they didn’t act like jerks in response.

  3. lavenderandlevity says:

    I suppose you could call some of the ones I dealt with trying to get help for my sibling in the place I call the 9th Circle of Hell “trauma informed” – in that they informed me quite well what it was like to be traumatized… 🙁

      • lavenderandlevity says:

        Oh, if you think that’s bad. I may or may not have made the same statement about my care in an official recorded record talking to an insurance paperpusher about clawing back some fraudulent bills services by the abusive group home when I was feeling like snark beat dissociation for repeating what was happening *instead* of the services that place was billing for…

        • lavenderandlevity says:

          Er my “care experience” – which is weird enough given technically in that case I was the patient designated representative, not the patient. I get why it’s a weird distinction with a limited verbal client, but when insurance tries that with the family of sectioned individuals who *wish* to speak and can – instead of asking them – that is so wrong.

          • lavenderandlevity says:

            I’ll put “the patient is the patient, and if we’re being serious, no care is trauma-informed if it uses a surrogate to ask about an experience of a patient because going and observing directly, using the communication system they need, or just freaking asking them is possible but just inconvenient.”

              • lavenderandlevity says:

                Though…I do have to say that while my east coast psychiatrist likes me enough to make very insensitive comments about other patients *to me* and the office itself looks like it’s not sure if it’s a prison or a Communist office building, I did somehow manage to find one genuinely trauma-informed in the non-snarky way in my current city. The main way she showed it was by apologizing immediately for the state of the rest of the place at first meeting than asked what I felt I wanted from our experience. Given my answer at the time was “to show up to play the CYA game because insurance balks at prescribing stimulants without at least playacting at therapy,” I’m kind of surprised that she actually is good. Like, good enough I vaguely implied I’d write about how she got through to someone as jaded, quick to sarcasm and deeply traumatized by a lifetime of dealing with broken systems as me.

  4. Navigator8 says:

    Reblogged this on Audrey's blog and commented:
    I am yet to consider this mental health services to be trauma informed. Rather, i agree that this should be viewed from the patient perspective and not only from staff and management view point.

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