There has been an increase in recognition of the need for trauma-informed care in mental health care settings. Trauma has long-lasting effects on a person’s health and can also affect the care that they receive. In this article, we’ll look at what trauma and trauma-informed care are, as well as how mental health professionals can implement trauma-informed approaches in their practice.

What is trauma-informed care?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma-informed care (TIC) is an approach that seeks to “create safer environments for people who have experienced trauma”. A person’s illness experience or behaviors may be linked to past trauma, so these two phenomenon cannot be considered as separate issues. Additionally, TIC recognizes that anyone may have experienced trauma in the past. Therefore, TIC should be used universally, even without knowledge of or disclosure of past trauma. Types of trauma can range from significant life events to childhood adverse events, and even includes negative interactions with health care systems. Trauma can also be individual, cultural, or historical.

TIC encourages a holistic view of a patient’s past, present, and future rather than focusing on the immediate symptoms. All professions that work within (and even outside of) mental health should incorporate a trauma-informed approach in their practice. The core principles of TIC can help with identifying meaningful ways to incorporate trauma-aware and empathetic approaches to mental health care delivery to prevent re-traumatization.

SAMHSA outlined the four R’s of a trauma-informed approach:

1. Realize: having a basic realization about trauma and how it can affect individuals, their social circles, and the community at large
2. Recognize: recognizing the signs of trauma, including with the help screening tools and assessments
3. Respond: responding appropriately using the principles of trauma-informed care
4. Resist re-traumatization: resisting using approaches that may cause additional trauma to clients and staff

The six core principles of trauma-informed care can be used to guide the four R’s:

1. Safety: ensuring physical and emotional safety
2. Trustworthiness and transparency: practicing with the goal of building and maintaining trust, and being open about operational processes and decisions
3. Peer support: providing opportunities for peer and mutual self-help to foster a sense of community
4. Collaboration and mutuality: creating partnerships with all stakeholders (e.g. clients, staff, organization) to achieve a shared goal
5. Empowerment, voice, and choice: being strengths-based and providing avenues for all voices to be heard throughout planning and decision-making
6. Cultural, historical, and gender issues: moving past dated stereotypes and prejudices against vulnerable groups and being attuned to the needs of these individuals

How to implement a trauma-informed approach in mental health care

Creating a safe environment

Creating physically and psychologically safe environments begins with understanding patients’ individualized needs and an awareness of how infrastructure, policies, and procedures can hinder these needs being met. Care professionals are part of institutions and therefore are also relevant and modifiable aspects of a patient’s environment when considering a trauma-informed approach.

• Provide space for physical privacy–for changing, tending to personal hygiene, etc.
• Ensure privacy for confidential conversations
• Minimize stimulation or triggers by dimming lights, reducing noise, or moving a patient to a more suitable area
• Utilize therapeutic communication skills
• Provide opportunities for and engage patients in recreational or therapeutic activities to prevent feelings of neglect
• Provide alternatives when possible, such as nicotine replacement therapy in place of smoking privileges
• Find opportunities to empower patients on a regular basis
• Collaborate with patients to enforce policies rather than imposing strict rules
• Avoid unnecessary use of restraints and seclusion

Staff competencies and education

A solid foundation of knowledge and understanding of what trauma is, trauma-responses, and trauma-informed approaches is key to delivering TIC. Even practitioners who are well-versed in this subject should engage in ongoing reflection and training to ensure that their knowledge and skills are refined and up-to-date. It is also important to consider the impact of work culture on attitudes toward TIC.

• Incorporate trauma-informed care training into the onboarding process for new hires
• Provide yearly refresher education for existing staff
• Provide opportunities for simulation-based training to practice skills such as non-judgmental language and verbal de-escalation
• Stay open-minded and curious about new ideas
• Promote a culture of open dialogue and reflexive practice
• Engage in individual learning about topics related to trauma and TIC
• Revise policies and procedures to reflect the principles of TIC

Patient-centered team collaboration

• Involve the patient as an active participant in treatment and care planning
• Involve members of the interdisciplinary team and social supports to help support the patient’s recovery
• Screen for trauma as part of routine intake assessments
• Create individualized care plans with consideration for past trauma history
• Use person-first language to describe patients and their conditions, such as “person with schizophrenia” rather than “schizophrenic person”

There is no one-size fits all when it comes to trauma-informed care, which can make it difficult to know whether it is effectively implemented. It is not a set of fixed practices but rather an approach that emphasizes compassion and comprehensiveness based on the understanding that all patients have a past. TIC can be slowly implemented in any care setting starting with small, practical changes.