A scoping review of trauma informed approaches in acute, crisis, emergency and residential mental health care

Abstract

Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes. We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included. Most studies (n=23) were conducted in the USA and were based in acute mental health services (n=16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n=7) and the Sanctuary Model (n=6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively. TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.

Alternative approaches to standard inpatient mental health care: development of a typology of service models

“…‘The Sanctuary model’, ‘Enabling Environments’, ‘Therapeutic Communities’ and ‘Democratic Therapeutic Communities’ (DTCs) are approaches that aim to create supportive environments for people experiencing mental health difficulties, including those in crisis. The ‘Sanctuary Model’ focuses on creating trauma-informed environments (89,101), whilst ‘Therapeutic Communities’ are structured environments based on shared values such as attachment and respect, promoting recovery through social relationships and activities (102). DTCs are a type of therapeutic community based on the principles of democratic decision making, communal sharing, permissiveness with consequences, and reality confrontation (103,104).…”

“…Finally, as listed in relation to the acute crisis care ( Section 3.2.3 ), the ‘Sanctuary Model’ also operates in forensic settings (89), as do some ‘Specialist consultancies’ and the ‘Trieste model’.…”

“…Inpatient psychiatric services with a specific therapeutic model 'Safewards', 'Star Wards', 'Talk 1 st , the 'Tidal Model', the 'Bradford Refocusing Model', 'Six Core Strategies' and the 'HOPES model' are specific therapeutic models aimed at improving care in inpatient mental health settings (27,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90). They prioritise person-centred care, collaboration, prevention of crises and minimisation of risk.…”

“…Finally, there are also a range of approaches which can be applied across multiple settings. As Finally, as listed in relation to the acute crisis care (Section 3.2.3), the 'Sanctuary Model' also operates in forensic settings (89), as do some 'Specialist consultancies' and the 'Trieste model'.…”

Detection of and response to gender-based violence: a quality improvement project across three secondary mental health services in London

“…9 Such trauma-informed care includes acknowledging links between a broad range of potentially intersecting traumas and mental illness, enquiring sensitively and referring for support, addressing vicarious trauma and re-traumatisation, prioritising trust and amplifying survivors' strengths. 10 The high prevalence of GBV and acceptability of routine enquiry among female patients in secondary mental health services in South London are well-established, 11 irrespective of staff gender, 12 leading to calls for improved training and referral pathways. 13 We aimed to improve GBV enquiry and response in secondary mental health services across South East London, using quality improvement methodology.…”