Traumatic events (including sexual abuse, domestic violence, elder abuse, and combat trauma) are associated with long-term physical and psychological effects. These events may influence patients' health care experiences and engagement in preventative care. Although the term trauma-informed care (TIC) is widely used, it is not well understood how to apply this concept in daily health care practice. On the basis of a synthesis of a review of the literature, the TIC pyramid is a conceptual and operational framework that can help physicians translate TIC principles into interactions with patients. Implications for clinical practice and future research are discussed in this article.

Trauma informed care in medicine: Current knowledge and future research directions

Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.LEARNING OBJECTIVES• Appreciate broad-based definitions of trauma• Gain an understanding of what trauma-informed approaches are and why they have emerged, including the potential for (re)traumatisation in the mental health system• Consider how to practise trauma-informed approaches, including in ‘trauma-uninformed’ organisations, and the potential barriers to and opportunities from doing soDECLARATION OF INTERESTA. 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.

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

Purpose




The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.




Design/methodology/approach




The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.




Findings




There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.




Originality/value




This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.

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Trauma-informed mental healthcare in the UK: what is it and how can we further its development?

Objective Recovery, defined as a personal process of living with mental illness, has become a prominent concept in mental health care. We aimed to map the state of the art of conceptualizing recovery, its promoting and impeding factors, recovery-oriented practice, and the assessment of recovery. Method A scoping review of systematic reviews and meta-analyses was performed. Systematic searches were conducted, supplemented with hand-searching in reference lists. Results Of 228 articles that were identified and 33 that were reviewed, a total of 25 were included. This review showed that the CHIME conceptual framework for personal recovery is widely endorsed, containing the elements of connectedness, hope and optimism, identity, meaning in life, and empowerment. Although personal recovery first and foremost starts from individual preferences, the CHIME framework should be adapted according to culture and unique population characteristics. "Difficulties and trauma" should be added, and the person's choice, risk taking, and coping with challenges should be emphasized. Barriers to recovery are stigma and negative effects of mental health services and medication. Facilitators of recovery include spirituality, personal agency, and social support. Recovery-focused interventions, in which peer providers are involved, enhance recovery, hope, and empowerment. For assessing recovery outcomes, multiple instruments are accepted as methodologically sound. Conclusions Personal recovery is conceptualized as complementary to clinical recovery and represents processes rather than outcomes. Additional work is needed to bridge the gap between the concept of recovery-oriented practice and routinely provided interventions. A broad framework of recovery is needed, and more research is needed into the working mechanisms of personal recovery processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses.

The Syndemic Illness of HIV and Trauma: Implications for a Trauma-Informed Model of Care

Trauma-informed care is an emerging value that is seen as fundamental to effective and contemporary mental health nursing practice. Trauma-informed care, like recovery, leaves mental health nurses struggling to translate these values into day-to-day nursing practice. Many are confused about what individual actions they can take to support these values. To date, the most clearly articulated policy to emerge from the trauma-informed care movement in Australia has been the agreement to reduce, and wherever possible, eliminate the use of seclusion and restraint. Confronted with the constant churn of admissions and readmissions of clients with challenging behaviours, and seemingly intractable mental illness, the elimination of seclusion and restraint is seen to be utopian by many mental health nurses in inpatient settings. Is trauma-informed care solely about eliminating seclusion and restraint, or are there other tangible practices nurses could utilize to effect better health outcomes for mental health clients, especially those with significant abuse histories? This article summarizes the findings from the literature from 2000-2011 in identifying those practices and clinical activities that have been implemented to effect trauma-informed care in inpatient mental health settings.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/inm.12012

Coral Muskett

Papers

Trauma-informed care in inpatient mental health settings: a review of the literature.