Trauma and PTSD

How Trauma-Informed Practice can Improve Mental Health Care

elements of trauma-informed care

So, what is it to be trauma-informed?  Trauma-informed practice recognizes the intersectionality of trauma, mental health, and substance abuse, with an awareness that anyone may have experienced trauma, whether they’ve 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 are prioritized throughout services. The approach focuses collaboration, learning, and building trust. Organizational culture should be non-hierarchical and supportive, and there is an emphasis on strengths and building resiliency, and hope that recovery is possible.

Decreasing seclusion & restraints

Being trauma-informed can potentially make a huge difference when it comes to seclusion and restraints.  The use of seclusion and restraints can cause significant psychological or physical harm, including 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 master’s 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.  She had nothing but good things to say about this, and the unit had achieved very significant reductions in trauma and restraint utilization.

My own experience

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 that I’d be locked in seclusion, I asked to be sedated; the last thing I wanted was 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. A few minutes later, she returned with a bunch of security guards to give me the injection I’d asked for in the first place.  How very therapeutic.

More than just a buzz-word

Sometimes in 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.

Sometimes, there’s not even a semblance of lip service. England’s NHS has a program called Serenity Integrated Mentoring that deals with high frequency service users, who mostly have borderline personality and a history of sexual abuse. These patients with a trauma history are threatened with jail time if they do things like call emergency services or show up in emergency after a suicide attempt. Forget trauma-informed, they’re quite actively trauma-creating and trauma-reinforcing.

I do think that all mental health care organizations should be trauma-informed, but it’s essential that it actually looks 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, especially when their perspective is tinged by stigma.

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

Sources

PTSD Evidence-Based Treatment Options: An Overview mini-ebook

PTSD Treatment Options: An Overview, a mini-ebook that’s available from the MH@H Download Centre, covers a variety of evidence-based therapies for PTSD.

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22 thoughts on “How Trauma-Informed Practice can Improve Mental Health Care”

  1. 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.

  2. 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… 🙁

      1. 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…

        1. 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.

          1. 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.”

            1. 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.

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