Transformation and trauma-informed care

By Richard Barber, Trauma-Informed Lead for Community Mental Health Transformation and Visible Project Director

(Trigger warning – mentions of several types of traumatic experience.)

What is trauma-informed care? Is it just the latest buzzword in mental health? A ‘psychology power-grab’? A challenge to psychiatry and the medical model…?

Or is it, perhaps, best viewed as a new and exceptionally useful ‘lens’ to use, to look at our work afresh? Could it be a way of making our work in community mental health and primary care more understandable, more explicable, more rewarding, more interesting, even (dare I say it) more enjoyable?

When NHS England included the phrase ‘trauma-informed’ in the instruction to transform community mental health services, they didn’t exactly say what they meant. But no matter – many thinkers within mental health (and beyond) have been shaping our thinking on this for quite a few years now. And, much more importantly, the voice of people with Lived Experience – people who’ve survived unimaginably horrible things – has been more properly heard. We do know what ‘trauma-informed’ means – and, in Leeds, we’re taking it very seriously.

So, what is it? And why is it important?

There are a lot of people in healthcare services who’ve lived through traumatic experiences – childhood sexual abuse, sexual violence, domestic violence, coercive control, emotional neglect, military combat, bullying, racism, oppression, trafficking, poverty (the list, sadly, goes on and on).

A woman who has experienced sexual violence will probably feel terrified at the prospect of attending a cervical screening check. A person-of-colour who has experienced racism and discrimination likely won’t feel trusting of White, Western workers and services. An adult who suffered through childhood sexual abuse will almost certainly not feel safe around mental health workers who hold any degree of power. It really goes without saying that health and wellbeing outcomes for traumatized people are poor; and that we need to do more to help.

‘Being trauma-informed’ basically just means to recognize all this; and to take steps to ensure that services and workers are able to work well with traumatized people. It means understanding that it’s very easy for us to re-traumatize people, through inadvertent misuse of our professional power; by not listening enough; by not making the effort to situate a person’s actions, reactions and ‘behaviours’ in the context of their past experiences. It means recognizing that people who’ve been harmed by others will probably be very afraid of us (this might come out as fear, or anger, or in many other ways) – so we have to work hard to make them feel safe before we can carry out any other ‘interventions’.

‘Being trauma-informed’ means moving away from thinking about what’s wrong with a person, towards wondering about what happened to them. It means supporting the workforce to work confidently with disclosures of past abuse; and ensuring that compassionate and non-judgemental responses to distress are always offered. It means making sure that workers are able to really think about the quality of the relationship they are able to offer; and to take care of their wellbeing – having a reflective, secure workforce is fundamental in supporting people who’ve experienced trauma.

‘Being trauma-informed’ is NOT a buzzword – it’s a major step towards addressing social injustice; and making reparation to all those who’ve been harmed, whether through abusive acts, or oppressive inequality. It makes us better, happier, more curious workers. It helps to heal people who’ve been harmed.

And what else are we here for, if not that?

Richard Barber, Trauma-Informed Lead for Community Mental Health Transformation and Visible Project Director