Trauma-informed care has gained significant attention and traction across institutions in recent decades. This model of care has been adopted in education institutions, healthcare settings, and mental health clinics. However, the definition of trauma-informed care remains a mystery as researchers and health institutions have not come to a consensus on the definition to use. The National Child Traumatic Stress Network defines TIC as a care model in which all participating stakeholders focus on assessing, recognizing, and responding to the impacts of trauma on healthcare providers, caregivers, and children (American Academy of Pediatrics, 2023). Contrarily, SAMHSA (2014) defines trauma-informed care as an approach that focuses on preventing the re-traumatization of trauma survivors and the healthcare staff. This analysis examines the barriers and enablers of trauma-informed care in mental health services.
Overview
Trauma-informed care (TIC) is an approach to healthcare that acknowledges and responds to the trauma impacts on an individual’s physical, emotional, and mental well-being. This care model emphasizes safety, trustworthiness, choice, collaboration, and empowerment to promote healing and recovery. The recovery-oriented practice promotes hope, self-determination, and meaningful life roles and activities for people with mental illness. There is a strong connection between trauma-informed care and recovery-oriented practice, as trauma is often a common experience among people with mental health and substance use disorders. Trauma-informed care recognizes the role of trauma in shaping an individual’s experiences and responses to care and seeks to provide care that is responsive to those experiences. The recovery-oriented practice aims to support individuals in building resilience, developing self-efficacy, and reclaiming their lives after trauma or other adverse experiences.
Some fundamental principles of trauma-informed care relevant to recovery-oriented practice include safety, transparency and trustworthiness, empowerment and choice, collaboration and mutuality, and cultural, historical, and gender issues (Bowen & Murshid, 2016). Safety is achieved by creating a physically and emotionally safe environment for patients. Establishing trustworthiness and transparency involves building trust with patients by being transparent and consistent in care delivery. Collaboration and mutuality mirror efforts to involve patients in care decisions and treatment planning. Empowerment and choice are achieved by supporting patients in making informed choices about their care and treatment (SAMHSA, 2014). Acknowledging cultural, historical, and gender issues involves recognizing and addressing the impact of culture, history, and gender on patient experiences and treatment needs. Incorporating trauma-informed care principles into recovery-oriented practice can help mental health professionals build stronger, more trusting relationships with patients and support them in achieving their recovery goals. This care model also helps reduce the risk of re-traumatization during recovery, which is critical for promoting long-term healing and well-being.
Barriers to TIC in Mental Health Services
Inadequate awareness, education, and training among mental health professionals
Kantor et al. (2016) note that most trauma survivors do not willingly seek mental health services. This reluctance is tied to the lack of awareness of effective care models such as trauma-informed care. These survivors need a reassurance that this treatment model is safe for them. This reassurance can only be provided by well-trained and confident health professionals. However, since trauma-informed care is a new approach that is not adequately understood across mental healthcare settings, most professionals in this field still lack adequate training and expertise on implementing this care model. Inadequate awareness can lead to insensitivity and a lack of understanding toward trauma patients. Stigter et al. (2022) note that inadequate training can result in insensitive treatment which can further traumatize patients. Without adequate training and education, mental health professionals may not effectively screen for trauma or recognize the signs and symptoms of trauma-related disorders.
Lack of a standardized Definition/terminology
Defining trauma-informed care is still a significant challenge across institutions. The disagreements on the standard definition of this care model have resulted in various definitions by different institutions (Menschner & Maul, 2016). For instance, the National Child Traumatic Stress Network defines TIC as a care model where all participating stakeholders focus on assessing, recognizing, and responding to the impacts of trauma on healthcare providers, caregivers, and children (American Academy of Pediatrics, 2023). Contrarily, SAMHSA (2014) defines trauma-informed care as an approach that focuses on preventing the re-traumatization of trauma survivors and the healthcare staff. Trauma-informed care is a relatively new approach to mental health services, hence, the lack of a universally accepted definition or set of principles that guide its implementation. This lack of clarity makes it challenging for mental health services to adopt trauma-informed care in a consistent and effective manner. Without a clear definition and set of principles, mental health professionals end up with different interpretations of what trauma-informed care entails, leading to inconsistency in its implementation. This challenge has resulted in confusion among mental health professionals, undermining the effectiveness of the approach. The lack of a universal understanding of this model has also made it difficult to set standard outcome parameters, measure the effectiveness of trauma-informed care, and compare outcomes across different settings. These varying definitions have obscured this model’s true meaning, making it challenging for mental health institutions to synthesize its benefits and fully embrace it.
Stigma and Bias
Stigma and bias surrounding mental illness and trauma can create significant barriers to trauma-informed care. Knaak et al. (2017) document the stigma attached to mental illness as a significant barrier to implementing effective interventions. The authors note that most trauma survivors often feel ashamed or embarrassed to discuss their experiences or seek help because of the negative image created out of such mental or psychological health problems. Mental health services that do not prioritize trauma-informed care inadvertently reinforce this stigma by creating an insecure and unsupportive environment for individuals to disclose their trauma. Health professionals may also perpetuate stigma when they fail to acknowledge the impact of trauma, mostly by dismissing or downplaying a client’s experiences. Mental health professionals may hold negative attitudes towards patients with a history of trauma, leading to negative treatment experiences and a lack of trust between patients and providers. The stigmatization and biased approach toward mental illness makes it difficult for patients to disclose their experiences of trauma, thus limiting themselves from fully engaging in the recovery process.
Intervention Strategies to improve Trauma-informed Awareness
Training and Education
Inadequate skills and expertise in trauma-informed care are significant barriers to its effective implementation and sustainability across mental health services. Training and education of mental health professionals is a vital strategy for improving these skills, enhancing awareness of TIC, and acknowledging mental illness as a problem of concern (L’Estrange & Howard, 2022). Mental health professionals need to receive ongoing training and education on the principles of trauma-informed care and how to implement them in practice. The training should cover topics such as recognizing trauma, screening for trauma-related disorders, and providing trauma-informed interventions. Training should also focus on creating a safe and supportive environment for individuals who have experienced trauma (Bugajski et al., 2019). Training should also address how to communicate effectively with patients who have experienced trauma, including using trauma-sensitive language and the importance of creating a safe and supportive environment.
Improving access to resources and materials on trauma-informed care
Inadequate resources have significantly depressed efforts to integrate trauma-informed care into healthcare services expansively. Mental health care professionals need adequate training and education on trauma and trauma-informed care perspective to acknowledge and practice it confidently (Stigter et al. 2022; Ervin et al., 2021). Access to resources is fundamental to improving awareness and reducing the stigma around mental illness. Providing mental health professionals with access to high-quality resources and materials on trauma-informed care can help them better understand the principles and practices of trauma-informed care, which in turn can improve their ability to provide effective care to individuals who have experienced trauma. Resources can range from financial to education and training materials and facilities like books, e-learning modules, workshops, podcasts, webinars, and articles. Improving access to resources and materials on trauma-informed care can also help mental health services keep up with the latest research and developments in the field. As the field of trauma-informed care continues to evolve, it is important for mental health professionals to stay up-to-date with the latest research and best practices.
Peer support and Lived Experience Expertise
Peer support can give patients a sense of connection and belonging, helping reduce feelings of isolation and promote healing. Peer support workers can provide valuable insights into the experience of trauma and recovery, helping to inform the development of trauma-informed policies and practices within mental health organizations (Silk, 2016). Lived experience expertise involves incorporating the perspectives and experiences of individuals who have experienced trauma into mental health services, including developing training materials, policy development, and providing services. Peer support and lived experience can be fundamental approaches to eradicating the stigma on trauma and related mental health problems. Most trauma survivors hesitate to seek help due to the stigma. This intervention can help enhance patients’ trusts in the mental health facility and its professionals and improve care quality.
Conclusion
Conclusively, becoming trauma-informed in mental health services is crucial to providing effective and compassionate care to individuals who have experienced trauma. However, several barriers hinder the implementation of trauma-informed care in mental health services, including lack of knowledge, stigma and bias, and lack of a universal definition of TIC. To address these barriers, mental health organizations should prioritize ongoing training and education for mental health professionals, peer support and lived experience expertise, and improving access to healthcare resources. By working collaboratively, mental health professionals, organizations, policymakers, and other stakeholders can promote healing and recovery for individuals who have experienced trauma, ultimately improving mental health outcomes for everyone.
References
American Academy of Pediatrics. (2023). Trauma Informed Care: Pediatric Mental Health Minute Series. Retrieved from https://www.aap.org/en/patient-care/mental-health-minute/trauma_informed_care/#:~:text=Trauma%2Dinformed%20care%20(TIC),%2C%20caregivers%2C%20and%20healthcare%20providers.
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Menschner, C., & Maul, A. (2016). Key Ingredients for Successful Trauma-Informed Care Implementation. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf
SAMHSA. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14–4884. Rockville, MD: Substance Abuse and Mental Health Services.
Silk, W. P. (2016). Trauma-Informed Peer Support. Retrieved from https://cmhawwselfhelp.ca/wp-content/uploads/2016/11/Trauma-Informed-Peer-Support.pdf
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