A paradigm shift: relationships in trauma-informed mental health services

Abstract

Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking 'What is wrong with you?' to considering 'What happened to you?'. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by 'trauma-uninformed' staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.

Learning objectives: •Appreciate broad-based definitions of trauma•Gain an understanding of what trauma-informed approaches are and why they have emerged, including the potential for (re)traumatisation in the mental health system•Consider how to practise trauma-informed approaches, including in 'trauma-uninformed' organisations, and the potential barriers to and opportunities from doing so.

Declaration of interest: A. S. is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. This article presents independent research partially funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

Keywords: TIA; TIC; Trauma; iatrogenic harm; psychiatric trauma; retraumatisation; service users; social trauma; trauma survivors; trauma-informed approaches.

FIG 1

Ten key principles of trauma-informed approaches (adapted from Elliot ; Bloom ; Substance Abuse and Mental Health Services Administration 2014).