We’ve all heard about the stigma that surrounds mental health.
Still, recognition in other areas, such as psychological trauma, tends to fly entirely under the radar or, as is often the case, gets completely overlooked within some communities.
According to trauma experts, trauma is defined as an emotional response caused by experiencing a distressing or traumatic event.
Types of trauma
What feels distressing or traumatic will be different for everyone.
For example, victims of natural disasters are likely to have an entirely different response from each other.
Some people may experience no trauma symptoms at all after a traumatic event, while, on the other hand, others may be completely incapacitated by what they’ve endured.
Inherently, trauma affects us all in different ways, and there are no absolutes to how we process traumatic events.
Trauma types
Trauma often gets viewed as an individual or interpersonal issue within the mental health community.
Across all treatment disciplines, the need for a trauma-informed response is demonstrated, with specific treatment methodologies on how to deliver this type of care without causing re-traumatization for patients.
Three types of trauma
The three types of trauma include:
- Individual trauma: A traumatic event or a series of traumatic events that a person experiences on a physical or emotional level that might be deemed harmful or life-threatening and has lasting adverse effects on the person’s mental, emotional, physical, social, or spiritual functioning.
- Collective trauma: Collective trauma impacts communities and individuals across many generations and includes social, historical, structural, and political traumas.
- Interpersonal trauma: is often referred to as developmental trauma or adverse childhood experiences and involves child abuse, child neglect, maltreatment, domestic violence, and human trafficking.
Trauma-informed approaches in clinical practice
Whether someone has historical trauma, adverse childhood experiences, or collective trauma, trauma-informed services are familiar to many service providers and organizations.
Trauma and violence-informed approaches have recognized the correlation between trauma, violence, and adverse behaviours and health outcomes in more recent times.
Such approaches are vital and promote control, safety, and resilience for those seeking support and who have a history of experiencing violence or being exposed to violence.
Core principles with a trauma-informed approach
Cultivating a trauma-informed approach across all disciplines is vital to ensure that people feel safe, understood and get given the right platform to recover from whatever physical or emotional ailment they might be experiencing.
Trauma-informed medical care
For instance, having a trauma-informed approach to health care is vital in ensuring that patients feel safe and that they successfully adhere to the treatment plans set out for them.
Compassion and empathy
Studies show that when patients receive empathy and compassion from healthcare providers, they are much more likely to adhere to treatment, respond better to medical interventions, and thus, have much better clinical outcomes.
Moreover, cultivating qualities like empathy and compassion also benefits physicians and can reduce physician burnout, which makes a massive difference to the net result for patients.
Principles of trauma-informed practice
There are four main principles associated with a trauma-informed practice.
They include:
- Creating physically and emotionally safe environments for patients
- Understanding trauma and violence and how it impacts peoples’ behaviours and overall quality of life
- Cultivating opportunities for choice, connection, and collaboration
- Providing a capacity and strength-building approach to support the client’s resilience and coping skills
Mental health services
Clinicians and service providers who do not understand the complexities and long-lasting implications of violence and trauma may re-traumatize clients unintentionally.
One of the trauma-informed care’s main objectives is to avoid re-traumatization and minimize harm to clients.
Thus, violence and trauma-informed approaches must be ingrained in all practises and policies to create a series of trauma precautions that provide encouraging support measures for all.
The importance of a trauma – informed approach
The statistics on trauma and violence are prevalent, with one in three women experiencing physical or sexual violence by a spouse or partner (or by a non-partner).
In Canada alone, 32 percent of adults had reported experiences of child abuse when they were younger, and 25 percent of young adults have reported getting bullied.
The above statistics demonstrate how many people seeking support for services such as healthcare, housing, or justice systems are far more likely to have trauma and violence histories.
Health promotion
Service providers treating clients with trauma histories will understand that the main goal is to minimize risk and not treat the trauma.
Trauma-informed approaches focus mainly on minimizing harm and avoiding retraumatization as much as possible.
Safety and control
The above seeks to enhance safety, control, and resilience to all clients engaging in specific treatment programs.
Why implementing trauma-informed care is crucial
There are three vital concepts in delivering trauma-informed care. First, such measures seek to support clients when engaging in specific systems and programs.
Again, the objective of trauma-informed care is not to focus on trauma treatment so much as offering supportive measures, such as minimizing further harm and preventing the re-triggering of additional trauma.
Understanding violence and its connection to trauma are critical in the trauma-informed care model.
Trauma-informed practises
Over the past fifteen years, trauma-informed practises having evolved significantly, with one of the main changes being the addition of ”violence” and its profound connection to trauma.
The concept of recognition in trauma-informed practises is when service providers understand the critical components in the relationship between trauma and violence.
Mental health professionals
Service providers must follow a series of trauma-informed principles, especially in cases of individual and interpersonal trauma such as domestic violence, community violence, and exposure to these types of traumatic stress.
Trauma-informed principles
Keeping in mind the relationship between violence and trauma, mental health professionals and service providers must follow specific protocols and understand the adverse effects of violence and traumatic exposure.
The above includes childhood adversity, family violence, interpersonal violence, and intergenerational trauma.
Trauma-informed principles involve:
- Increasing awareness and attention on the impact of violence on peoples’ well-being and quality of life
- Minimising/reducing harm
- Improving system responses for everyone
#1. Increasing awareness and attention on the impact of violence on trauma survivors and their well-being
Awareness around the impact that violence has on a person’s life and its correlation to trauma help individuals to:
- Understand that a history of violence or ongoing violence may be the primary cause of specific trauma responses
- Recognise the difference between the different trauma types- for example, understanding that trauma caused by a natural disaster will be utterly different to the trauma that arises from violence
- Reduce the propensity to blame or judge other people for their reactions to experiences of violence, and understand that such responses may be a result of trauma
Attention
Drawing attention to the different variables and connecting to broader systems in a trauma-informed practice is a critical component of adhering to trauma-informed care protocols.
For example, drawing attention to the cumulative impact surrounding specific forms of violence, including racism, discrimination, or systemic violence.
Trauma-informed organization
Another critical component of a trauma-informed practice is understanding the importance of organizational-level actions; this may include changes in policies that consider a clients’ experiences of violence and safety.
Additionally, understanding the broader conditions of a person’s life, such as poor mental health or unstable housing, may increase the risk of multiple violence.
The above may include social policies and other organizational policies such as waiting room protocols or the staff-to-client ratio.
#2. Minimising/reducing harm
Another vital component in trauma-informed practice is reducing the risk for further harm.
Trauma awareness
Organizations, mental health professionals, and service providers are not always aware of the harm they can cause to people who have experienced trauma and violence.
Of course, any harm caused is unintentional.
However, service providers must recognize that those interacting with health, housing, child protection, and justice systems are likely to be re-traumatized by their experiences within these systems.
Post Traumatic stress
For example, re-traumatization can occur when children or adults have to re-share their stories of violence or abuse.
The above can happen when seeking help from various services like service providers or when retelling their experiences of stigma or discrimination.
Primary care providers or service providers may unintentionally trigger clients in various ways, such as:
- Service providers using specific language or talking in a way that comes across as negative or judgmental; for example, using statements such as, ”why don’t you just leave your husband or wife?” or ”you’re ringing me again, I said I would call you back when I’m not busy.”
- Touching without permission or warning
- Using dismissive or forceful language when asking a client to complete a task – such as filling out a form or undergoing a medical examination.
- Perceiving a client’s behaviour or actions to be over the top or out of proportion without considering their history, which may have contributed to specific responses or actions
#3. Improving system responses for everyone
Inherently, violence and trauma-informed care practise provide a good platform for organizations and services to be more responsive to clients’ needs.
Moreover, trauma-informed care allows mental health professionals and service providers to offer the most effective support to people.
Such approaches maximize each client’s control, safety, and resilience, irrespective of whether a service provider has experienced violence or trauma themselves.
Disclosure of traumatic life events
Broadly, the objective of violence and trauma-informed care is not about the client disclosing their violence or trauma history since service providers do not need to know the historical trauma to provide proper support.
By cultivating violence and trauma-informed approaches into every aspect of practice and policy and creating universal trauma precautions, service providers can help reduce harm and offer positive support to every client.
Trauma – related reactions
Offering safe care and support is the aim of the trauma-informed approach whether service providers know a person’s trauma history or not.
It is often the case that people do not wish to disclose their trauma histories, mental health problems, or issues with substance abuse to service providers as they may:
- Feel it is not safe or too painful to disclose such information
- Have no memory or limited memory of their past
- Think that revealing their history of trauma is not relevant to the service getting provided
- Find it too upsetting or distressing to disclose
Understanding the depth of trauma
Understanding the depth and virulent impact of traumatic exposure and the many experiences that can lead to various trauma responses is critical in all aspects of recovery.
Whether physical or psychosocial, trauma can have a significant impact on a person’s health and can profoundly influence how they engage with healthcare services.
Trauma recovery
Suppose service providers and healthcare systems break down the many barriers that have a negative effect on some communities and populations.
In that case, trauma must be considered in a much broader, multi-faceted way.
Thus, individual, interpersonal, collective, and structural trauma must be accounted for and embedded within trauma-informed care practises.
Stress response
For example, in intergenerational trauma, a person may experience resilience in their personal lives while still experiencing trauma because of historical events such as genocide or slavery.
The above stress response is identified as both physiological and psychological.
Specific stress responses can cause the body to release stress hormones such as epinephrine and cortisol, which eventually calm down once the stressful event subsides and the person returns to homeostasis.
However, it can often be challenging for those who live in chronic stress environments to return to a homeostatic state.
Substance abuse and mental health
When a person lives in chronic stress and chaos, it can lead to low-level activation of the adrenergic system, leading to significant changes in thinking, responding, and learning.
The above can lead to toxic stress, which researchers say gets linked with psychiatric and substance use disorders, decreased immune responses, and poor health outcomes.
When a person feels unsafe, the body’s autonomic system gets activated; thus, trauma-informed practises must create the safest environment possible for the client to avoid re-traumatization.
Offering resilient-informed care to clients is imperative and acts as a supportive measure to managing and recovering from traumatic experiences.
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