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