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.
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- 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.
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- 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
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