(Mis)understanding trauma-informed approaches in mental health

Abstract

These articles join other evidence demonstrating that large numbers of people in contact with mental health services have experienced traumatic events (Khalifeh et al., 2015), that these experiences are causal in the development of mental distress (Felitti et al., 1998;Morrison, Frame, & Larkin, 2003) and that there is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health (Dillon, Johnstone, & Longden, 2012). For instance, there is evidence of a strong link between childhood trauma and adulthood psychosis (Varese et al., 2012), and intimate partner violence and depression (Devries et al., 2013). It is also argued that social factors such as poverty and racism can be considered forms of trauma and that traumatic experiences are more common within ethnic minority and socially disadvantaged groups (Hatch & Dohrenwend, 2007;Paradies, 2006). This, coupled with evidence of iatrogenic harm in psychiatric services, has led to the development of trauma-informed approaches.Despite growing international interest, trauma-informed approaches can seem fuzzy, complex, something that service providers already do, or a theorised call for practitioners to "be nicer." However, writing as trauma survivors and academics/clinician, the more we learn about trauma-informed approaches, the more we argue that these approaches have the potential to lead to a fundamental shift in how mental health services are organised and delivered, meaning that they are better able to meet the needs of service users. In this editorial, we will explore the central drivers for traumainformed approaches, outline the key principles of the approach, discuss some common misconceptions and highlight some of the dangers associated with trauma-informed practices. We conclude by arguing for the need for survivor organisations to have a key role in shaping the agenda.

“We have to put the fire out first before we start rebuilding the house”: practitioners’ experiences of supporting women with histories of substance use, interpersonal abuse and symptoms of post-traumatic stress disorder

“…This policy was meant to ensure successful coordination of care via input from various relevant services, including for example substance use services, but in practice this is often not the case (Simpson et al 2009). Furthermore, organisational TIP in UK mental health services remains elusive (Sweeney and Taggart 2018).…”

Adapting IAPT services to support frontline NHS staff during the Covid-19 pandemic: the Homerton Covid Psychological Support (HCPS) pathway

“…Furthermore, as these difficulties may originate from a multitude of potentially traumatising frontline experiences, specialists have stressed the importance of a trauma-informed response across these phases. As summarised by the Covid Trauma Response Working Group, this will be achieved through delivering interventions that acknowledge various 'dos and don'ts', which echo the key principles of trauma-informed care (Billings et al, 2020;Sweeney and Taggart, 2018).…”

The Rivers Centre in Scotland: An Attachment‐Based Service Model for People With Complex Posttraumatic Stress Disorder

“…As the full impact of attachment experiences has become apparent, there have been calls for services across the mental health system to become more sensitive and responsive and to work in ways that do not reactivate past relational experiences. The rich body of work on trauma‐informed care has pointed the way in this respect (Harris & Fallot, ), identifying themes of choice, collaboration, trust, empowerment, and safety, and mapping a direction of travel for new models of service: “From fear to safety, from control to empowerment, and from abuse of power to accountability and transparency” (Sweeney & Taggart, , p. 384).…”