Trauma-Informed Care and Practice in Mental Health Services
The aim of the Trauma-Informed Care and Practice (TICP) project is to improve outcomes and experience for people who access mental health services in NSW through the development and evaluation of evidence-based strategies and approaches to promote a trauma-informed health system that recognises the impact of trauma and promotes resilience and healing.
- To understand the current state of TICP in mental health services.
- To identify and define key principles of TICP to support implementation in mental health services across NSW.
- To develop evidence-based resources and strategies to support implementation of TICP .
- To share best practice initiatives in NSW.
The case for change
What is trauma?
Trauma is defined as an event, series of events or set of circumstances that are experienced as physically or emotionally harmful or life threatening. Trauma can result in acute and/or ongoing adverse effects, distress or disruption to the individual's life. This many lead to a disruption of overall functioning, mental, physical, social, emotional or spiritual wellbeing. This definition was adapted from the SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.1
What is TICP ?
TICP is a strengths-based approach which understands and responds to the impact of trauma. The elements include realising the prevalence and impacts of trauma, recognising how trauma has affected the person, responding by putting this into practice and ensuring that care does not re-traumatise.1
Did you know?
Trauma can affect many aspects of an individual’s life. For mental health consumers, trauma has the potential to influence one’s social, emotional and physical wellbeing.
One of largest international studies on TICP is the ‘Adverse Childhood Experiences’ (ACE) study.2
The study found that:
- nearly two out of three people had at least one adverse experience in childhood
- with six or more adverse experiences in childhood people die up to 20 years earlier than the general population
- experiencing depression and being at risk of suicide increases with adverse experiences
- the risk of drug and alcohol dependence increases with experiencing trauma.
Research has found that:
- childhood trauma is the single most significant predictor that an individual will have contact with the mental health system3,4
- nine out of 10 people accessing mental health services have experienced trauma at some stage in their life5,6,7,8
- two in three people presenting at emergency, inpatient or outpatient mental health settings have experienced underlying complex trauma secondary to childhood physical or sexual abuse9
- experiencing trauma can influence brain development which may lead to problems with mood, self-esteem, emotions, learning and memory10
- the risk of experiencing seclusion, restraint and enforced medication in mental health units is increased with trauma experience11,12
- experiencing trauma leads to an increased chance of developing a psychotic disorder.
Benefits of a TICP approach
Services where TICP is implemented have been shown to provide benefits for consumers, service providers and organisations by:
- improving the overall experiences of care for consumers12
- enhancing the relationship between consumer and caregiver13,14,15
- supporting the transparency and predictability of mental healthcare15
- reducing the use of seclusion, restraint and enforced medication11,16
- decreasing staff injuries, turnover and sick leave.14
Allyson Wilson (TICP Project Manager) joined the team early May 2019 and will continue to support the project until late December 2019. Allyson joins us from MNCLHD and brings extensive expertise trauma-informed care and data analysis.
The TICP Project continues to progress and is currently in the diagnostic phase. The responses received from the TICP in Mental Health Services survey (October 2018) from more than 100 consumers and 500 clinician/practitioners has helped shape project diagnostics and next steps.
To date, there have been a total of six co-design clinician focus groups across three LHDs (SLHD, MNCLHD and ISLHD), eight mental health service manager interviews and two environmental audits conducted (MNCLHD and SLHD). Data analysis has occurred as data has been collected to prevent data saturation of themes.
Consumer and carer focus groups as well as patient journey mapping have been scheduled for early September 2019. Outstanding site visits to mental health services across the state (environmental audits) will also occur in September 2019.
After diagnostics is complete, solution design will commence (based on data analysis, interpretation and expert opinion).
- Substance Abuse and Mental Health Services Administration.SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach . Rockville, MD: SAMHSA; 2014 [cited April, 2018]. Available from: https://store.samhsa.gov/shin/content/SMA14-4884/SMA14-4884.pdf
- Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine.1998 ;14(4):245-58.
- Kezelman C, Stavropoulos P. Practice guidelines for treatment of complex trauma and trauma informed care and service delivery. Kirribilli. Adults Surviving Child Abuse, 2012.
- Courtois CA, Ford JD. Treating complex traumatic stress disorders: An evidence-based guide. Guilford Press; 2009 .
- Trickett PK, Noll JG, Putnam FW. The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and psychopathology. 2011 23(2):453-76.
- Mueser KT, Goodman LB, Trumbetta SL, et al. Trauma and posttraumatic stress disorder in severe mental illness. Journal of consulting and clinical psychology. 1998 ;66(3):493.
- Mueser KT, Salyers MP, Rosenberg SD, et al. Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: demographic, clinical, and health correlates. Schizophrenia Bulletin. 2004;30(1):45.
- Cusack KJ, Frueh BC, Hiers T, et al. Trauma within the psychiatric setting: A preliminary empirical report. Administration and Policy in Mental Health and Mental Health Services Research. 2003;30(5):453-60.
- Read J, Os JV, Morrison AP, et al. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica. 2005112(5):330-50.
- Baker CN, Brown SM, Wilcox PD, et al. Development and psychometric evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) scale. School Mental Health. 2016 ;8(1):61-76.
- Azeem MW, Aujla A, Rammerth M, et al. Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. Journal of Child and Adolescent Psychiatric Nursing. 2011 ;24(1):11-5.
- Wilson A, Hutchinson M, Hurley J. Literature review of trauma‐informed care: Implications for mental health nurses working in acute inpatient settings in Australia. International journal of mental health nursing. 2017 26(4):326-43.
- Ashcraft L, Anthony W. Eliminating seclusion and restraint in recovery-oriented crisis services. Psychiatric Services. 2008 59(10):1198-202.
- Borckardt JJ, Madan A, Grubaugh AL, et al. Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital. Psychiatric Services. 2011 ;62(5):477-83.
- Isobel S. ‘Because That's the Way It's Always Been Done’: Reviewing the Nurse-Initiated Rules in a Mental Health Unit as a Step Toward Trauma-Informed Care. Issues in mental health nursing. 2015 ;36(4):272-8.
- Ashcraft, L. & Anthony, W. Eliminating seclusion and restraint in recovery-oriented crisis services. Psychiatric Services. 2008;59(10):1198–1202.