Trauma-informed care (TIC) is increasingly recognized as an approach to improving consumers' experience of, and outcomes from, mental health services. Deriving consensus on the definition, successful approaches, and consumer experiences of TIC is yet to be attained. In the present study, we sought to clarify the challenges experienced by mental health nurses in embedding TIC into acute inpatient settings within Australia. A systematic search of electronic databases was undertaken to identify primary research conducted on the topic of TIC. A narrative review and synthesis of the 11 manuscripts retained from the search was performed. The main findings from the review indicate that there are very few studies focussing on TIC in the Australian context of acute mental health care. The review demonstrates that TIC can support a positive organizational culture and improve consumer experiences of care. The present review highlights that there is an urgency for mental health nurses to identify their role in delivering and evaluating TIC, inclusive of undertaking training and clinical supervision, and to engage in systemic efforts to change service cultures.

Trauma‐informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re‐traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma‐informed. However, how Australian mental health services should deliver trauma‐informed care is not well documented. Efforts towards trauma‐informed care in any setting require engagement with those who receive care. This qualitative study used an experience‐based co‐design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question ‘what would a trauma‐informed mental health service look like?’ Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma‐informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma‐informed care across settings.

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience‐based co‐design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma‐informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma‐informed they required services to: be aware of staff well‐being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.

The term trauma, from the Greek word meaning "wound," was originally used to refer to an injury of the body. More recently, it has also been applied to include experiences that are psychologically distressing or disturbing (Oxford University Press, 2018). A traumatic event is defined as an actual or threatened death, injury, or violence (American Psychiatric Association, 2013). Complex trauma refers to a type of trauma that occurs repeatedly and cumulatively, usually over a period and within specific relationships and contexts (Courtois, 2008).Trauma and the role it plays in the development of mental health conditions have changed many courses over the years, from the proposed trauma models of the schizophrenogenic mother, to biological determinism, with more recent views holistic yet arguably dominated by the biomedical constructs (Deacon, 2013;Harrington, 2012). It is well known that trauma has long been linked to the development of several mental health conditions and chronic physical illnesses (Felitti et al., 1998). Trauma can lead to changes that are both structural and neurological in the prefrontal cortex and hippocampus, with implications for cognitive processing, emotional regulation and memory (Patel, Spreng, Shin & Girard, 2012). A systematic review conducted by Ahmed-Leitao et al., (2016) found bilateral reductions in the hippocampus and the amygdala in adults with childhood trauma. There is also a statistically significant relationship with adverse childhood experiences and the development of cardiac disease, cerebral vascular diseases, obstructive pulmonary diseases and auto-immune diseases (Felitti et al., 1998;Oral et al., 2016). Trauma is also related to several health risk-taking behaviours (Felitti et al., 1998).The estimated prevalence of trauma among consumers accessing mental health services is approximately between 70% and 90% (Cusack, Frueh & Brady, 2004;Cusack Grubaugh, Knapp & Frueh, 2006;Phipps et al., 2019). Consumers who access mental health inpatient units (MHIPUs) can also experience trauma or retraumatization when accessing such services (Ashmore et al., 2015).Trauma and re-traumatization occur secondary to several common coercive practices such as seclusion, restraint, involuntary treatment and enforced medication compliance, involuntary transport by police or ambulance; the environment in itself is also commonly reported as traumatizing (Wilson, Hutchinson & Hurley, 2017; New South Wales Ministry of Health, 2017). In addition, treatment for trauma is not commonly offered or explored as a treatment option in MHIPUs (Kezelman & Stavropoulos, 2012).There is great variability among the type of coercive practices used in mental health settings internationally (Steinert et al., 2010).Recent Australian data show 57% of mental health admissions were involuntary, 4.2 hr being the average seclusion event and 11.3

Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.