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

Summary & key facts

This paper explains why mental health services are shifting to 'trauma-informed' care. Trauma-informed care asks 'What happened to you?' instead of 'What is wrong with you?'. The authors say trauma is common among people using mental health services, can add up over time, and is linked with worse health and higher costs. They describe how services can retraumatise people and how staff can be affected too. Small studies suggest trauma-informed changes can cut symptoms, reduce use of seclusion and restraints, improve coping and shorten hospital stays, but the evidence base is still growing.

Key facts:

• Many people who use mental health services have histories of childhood or adult trauma, and these rates are higher than in the general population.
• A large retrospective study of over 17,000 mostly White, middle-class Americans (Felitti et al.) found childhood trauma was common and was linked with worse adult physical and mental health and shorter life expectancy.
• Traumatic effects are cumulative: research cited in the paper reports that the more traumatic experiences a person has, the greater the impact on mental and physical health.
• The paper notes that trauma can change the brain and nervous system, making people more easily triggered into high or low arousal states (for example, panic or numbness) and leading to coping behaviours such as substance misuse or self-inju
• The authors say trauma-uninformed mental health care can retraumatise service users, and practices like restraint and seclusion can also traumatically affect staff.
• A small number of studies of trauma-informed approaches have reported reductions in symptoms and in the use of seclusion and restraints, and improvements in coping skills, physical health, treatment retention and shorter in-patient stays, b
• DSM-5 defines trauma in a narrower way (exposure to actual or threatened death, serious injury or sexual violence), while other frameworks (including ICD-11 and SAMHSA) include broader social and interpersonal harms and, in ICD-11, a diagno

Abstract

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.

Topics

Child Abuse and Trauma Migration, Health and Trauma Psychiatric care and mental health services

Categories

Clinical Psychology Psychology Social Sciences

Tags

Business Distress Major trauma Marketing Medicine Mental health Mental healthcare Nursing Psychiatry Psychology Psychotherapist Seclusion Service (business)

Conditions & symptoms

Addiction Depression PTSD Addiction or harmful habbits Feeling disconnected from others Poor appetite or overeating Sadness or low mood