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
The Trauma-informed Care and Practice Project is in the final diagnostic phase, as of December 2019.
The responses received from the TICP in Mental Health Services survey (October 2018) from more than 100 consumers and 500 clinicians has helped shape project diagnostics. To date, there have been a total of six co-design clinician focus groups across three LHDs, nine mental health service manager interviews, three consumer focus groups (including one focus group conducted in an Aboriginal Medical Service), one carer focus group and three environmental audits conducted.
The data-analysis and planning workshop occurred in November 2019, with expert consultation across numerous peak agencies across the mental health sector. The workshop consolidated data sets and commenced the preliminary solution process.
The next step includes a solution design workshop that aims to draw on expert opinion and interpretation of the diagnostic phase.
- Trauma-informed care and mental health in NSW [Evidence report]
- Trauma Informed Care and Practice [Diagnostic Report] Following on from the Trauma-informed care and mental health in NSW [Evidence report], this report summarises experiential and observational data collected across mental health services in NSW in an effort to understand ‘what needs to happen’ to become trauma-informed.
- Bateman J, Henderson C, Kezelman C. Trauma-informed care and practice: towards a cultural shift in policy reform across mental health and human services in Australia, a national strategic direction. Position paper and recommendations of the national trauma-informed care and practice advisory working group. Sydney: Mental Health Coordinating Council; 2013.
- Blue Knot Foundation. The last frontier: practice guidelines for treatment of complex trauma and trauma informed care and service delivery. Sydney: Blue Knot Foundation; 2012.
- Blue Knot Foundation. Trauma-informed care and practice. Sydney: Blue Knot Foundation; .
- Echo. Resources [infographics]. Echo: 2019.
- Healthcare Improvement Scotland. From observation to intervention: a proactive, responsive and personalised care and treatment framework for acutely unwell people in mental health care. Healthcare Improvement Scotland; 2019.
- Klinic Community Health Centre. Trauma-informed: the trauma toolkit (2nd ed). Winnipeg, Canada: Klinic Community Health Centre; 2013.
- Mental Health Coordinating Council. Trauma-informed care and practice organisational toolkit (TICPOT). Sydney: MHCC; 2018.
- Mental Health Coordinating Council. Trauma-informed care and practice (TCIP) Project resources. Sydney: MHCC; 2018.
- Mental Health Coordinating Council. Trauma-informed events checklist and policy and protocol. Sydney: MHCC; 2018.
- NHS Education for Scotland. Transforming psychological trauma. A knowledge and skills framework for the Scottish workforce. NHS Education for Scotland: 2017.
- NSW Ministry of Health. The case for change: integrated prevention and response to violence, abuse and neglect in NSW Health. Sydney: NSW Ministry of Health; 2019.
- NSW Ministry of Health. Working with Aboriginal people: enhancing clinical practice in mental health care. Sydney: NSW Ministry of Health; 2019.
- Ohio Department of Mental Health and Addiction Services. Is your work trauma informed? A self-assessment tool. Ohio: MHAS; 2018.
- Orygen. What is trauma-informed care and how is it implemented in youth healthcare settings? Melbourne: Orygen; 2018.
- Royal Commission into Victoria’s Mental Health System. Witness statement of Professor Patrick McGorry. Royal Commission into Victoria's Mental Health System; 2019.
- Substance Abuse and Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma-Informed approach. SAMHSA; 2014.
- Te Pou o te Whakaaro Nui. Trauma-informed care literature scan. Auckland, New Zealand: Te Pou o te Whakaaro Nui; 2018.
- Trauma Informed Oregon. Trauma informed care screening tool. Trauma Informed Oregon; 2018.
- Urquhart C, Jasiura F, British Columbia Mental Health and Substance Use Planning Council, TIP Project Team (B.C.). Trauma-informed practice guide. [Victoria, B.C.]: [BC Provincial Mental Health and Substance Use Planning Council], 2013.
- Young J, Taylor J, Paterson B, et al. Trauma-informed practice: a paradigm shift in the education of mental health nurses. Mental Health Practice. 2019;22(5):14-19.
- Azeem M, Reddy B, Wudarsky M, et al. Restraint reduction at a pediatric psychiatric hospital: a ten-year journey. J Child Adolesc Psychiatr Nurs. 2015 Nov;28(4):180-4. DOI: 10.1111/jcap.12127
- Becker-Blease KA. As the world becomes trauma–informed, work to do. Journal of Trauma & Dissociation. 2017;18(2):131-138. DOI: 10.1080/15299732.2017.1253401
- Beckett P, Holmes D, Phipps M, et al. Trauma-informed care and practice: practice improvement strategies in an inpatient mental health ward. Journal of Psychosocial Nursing and Mental Health Services. 2017;55(10):34-38. DOI: 10.3928/02793695-20170818-03
- The Bouverie Centre. Guidelines for trauma informed family sensitive practice in adult health services. Melbourne: La Trobe University; 2013.
- Carello J, Butler LD, Critelli FM. Introduction to trauma and human rights: context and content. In: Butler L, Critelli F, Carello J. (eds) Trauma and Human Rights. Palgrave Macmillan, Cham; 2019. DOI: 10.1007/978-3-030-16395-2_1
- Elze DE. The lives of lesbian, gay, bisexual, and transgender people: a trauma-informed and human rights perspective. In: Butler L, Critelli F, Carello J. (eds) Trauma and Human Rights. Palgrave Macmillan, Cham; 2019.
- Felitti V, Anda R, 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. Am J Prev Med. 1998;14(4):245-58.
- Hale RD. Implementation of a trauma-informed care program for the reduction of crisis interventions. Minneapolis, Minnesota: Walden University; 2019.
- Hales T, Nochajski T, Green S, et al. An association between implementing trauma-informed care and staff satisfaction. Advances in Social Work. 2017;18(1): Special Issue: Trauma-Informed Practice.
- Hegarty K, Tarzia L, Rees S, et al. Women’s input into a trauma-informed systems model of care in health settings (The WITH Study) Final report. Sydney: Australia’s National Research Organisation for Women’s Safety; 2017.
- 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. DOI: 10.3109/01612840.2014.982842
- Isobel S. Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: a practice development process. International Journal of Mental Health Nursing. 2017;26(1):88-91. DOI: 10.1111/inm.12236
- Isobel S, Angus-Leppan G. Neuro-reciprocity and vicarious trauma in psychiatrists. Journal of Australasian Psychiatry. 2018 Aug;26(4);388-90. DOI: 10.1177/1039856218772223
- Isobel S, Edwards C. Safe and collaborative communication skills: a step towards mental health nurses implementing trauma informed care. Journal of Archives of Psychiatric Nursing. 2018;32(2):291-96. DOI: 10.1016/j.apnu.2017.11.017
- Isobel S, Goodyear M, Foster K. Psychological trauma in the context of familial relationships: a concept analysis. Journal of Trauma, Violence and Abuse. 2017;1:11. DOI: 10.1177/1524838017726424
- McLean S. The effect of trauma on the brain development of children: evidence-based principles for supporting the recovery of children in care. Canberra: Australian Institute of Family Studies; 2016.
- Matta G, Woodward-Kron R, Petty S, Salzberg M. Eliciting and responding to patient histories of abuse and trauma: challenges for medical education. Med J Aust. 2016;205(6):248-49.
- Menschner C, Maul A. Key ingredients for successful trauma-informed care implementation. Hamilton, New Jersey: Center for Health Care Strategies; 2016.
- Moloney B, Cameron I, Baker A, et al. Implementing a trauma-informed model of care in a community acute mental health team. Issues in Mental Health Nursing. 2018;39(7):547-53. DOI: 10.1080/01612840.2018.1437855
- Muskett C. Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing. 2014 Feb;23(1):51-9. DOI: 10.1111/inm.12012
- Pickens I, Howard M, Halladay‐Goldman J, et al. Development and pilot of the national child traumatic stress network trauma‐informed juvenile court self‐assessment. Juv Fam Court J, 2019;70:31-54. DOI:10.1111/jfcj.12135
- Posselt M, Deans C, Baker A, Procter N. Clinician wellbeing: the impact of supporting refugee and asylum seeker survivors of torture and trauma in the Australian context. Aust Psychol. 2019;54:415-26. DOI: 10.1111/ap.12397
- Sweeney A, Taggart D. (Mis)understanding trauma-informed approaches in mental health. Journal of Mental Health. 2018;27(5):383-387. DOI: 10.1080/09638237.2018.1520973
- Wall L, Higgins D, Hunter C. Trauma-informed care in child/family welfare services. CFCA Paper No. 37. Canberra: Australian Institute of Family Studies; 2016.
- Wilson A, Hurley J, Hutchinson M. 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):326-343. DOI: 10.1111/inm.12344
- Yatchmenoff D, Sundborg S, Davis M. Implementing trauma-informed care: recommendations on the process. Advances in Social Work. 2017;18(1): special issue: trauma-informed practice. DOI: 10.18060/21311
- The Anna Institute
- Blue Knot Foundation
- Mental Health Coordinating Council
- PTSD: National Center for PTSD. US Dept of Veterans Affairs
- Seeking Safety
- Sidran Institute: traumatic stress education and advocacy
- Substance Abuse and Mental Health Services Administration (SAMHSA) U.S. Department of Health & Human Services
- Surviving Spirit
- Survivors of Incest Anonymous
- Trauma Centre at Justice Resource Institute
- U.S. National Council for Behavioural Health. Trauma-Informed Care Learning Community
Webinar series - Trauma Informed Transformations: Innovations in COVID
- 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.