Health Professionals’ Experiences of Providing Trauma-Informed Care in Acute Psychiatric Inpatient Settings: A Scoping Review

Abstract

Background: Trauma-informed care is increasingly recognized as the ideal model of care for acute psychiatric inpatient units; however, it continues to be a challenge to implement. The aims of this review are (1) to synthesize the research exploring health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient settings and (2) to examine these experiences through a gender lens, particularly relating to gender-based violence. This research will provide additional insights to facilitate implementation of trauma-informed care in acute psychiatric inpatient care. Method: A comprehensive scoping review methodology was adopted. English-language, peer-reviewed articles published between January 1998 and March 2018 were identified from seven databases. Inclusion criteria included a qualitative or mixed-method study design. Results: Eight full-text articles were found. This review highlights the importance for health professionals to have a reflective environment and a multilayered level of collaboration to adopt trauma-informed care. However, negative attitudes toward female consumers and inconsistent implementation strategies continue to hold back implementation of trauma-informed care in acute psychiatric inpatient units. Overall, limited consideration for gendered issues and gender-based violence in the implementation of trauma-informed care in acute psychiatric inpatient settings was found. Conclusion and Implications: There is a lack of research on health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient units, with even less research considerating gender-based violence. We argue that more research is needed to gain a better understanding of the experience of health professionals from acute psychiatric inpatient settings to inform future implementation of trauma-informed care.

The Lancet Psychiatry Commission on intimate partner violence and mental health: advancing mental health services, research, and policy

“…[234][235][236] Mental health services that are predicated upon power relations and conditions of coercion and control can re-enact abusive relationships, 237,238 causing survivors to feel re-traumatised rather than supported through their contact with services. 239,240 For example, the use of coercive treatment, such as seclusion, restraint, and forced medication, in inpatient settings can cause retraumatisation. 238 Less research has been conducted on the impacts of subtler forms of coercion in community settings, such as around the management of disclosure and pressure to comply with treatment.…”

Is trauma informed care possible in the current public mental health system?

“…12 It also requires overt acknowledgement of the tensions between the principles of TIC and practices such as compulsory legislated treatment and restrictive containment. 13 These components are frequently not addressed in efforts towards TIC implementation in Australia, with clinicians and managers reporting expectations to model the principles of TIC while concurrently experiencing contradictory organisational pressures. 3…”

What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers

“…2020; Lutton & Swank 2018; O’Dwyer et al . 2020), and limited systemic support for change (Hodgdon et al . 2013; Knight 2019; Yatchmenoff et al .…”

“…While TIC is increasingly emphasized in mental health policy and frameworks in Australia (Australian Government 2017), people working in mental health settings have reportedly struggled to translate the values and principles of TIC into their everyday practice (Muskett 2014;Wilson et al 2017). Across settings, this difficulty has been linked to a lack of clarity of the definition of trauma , misunderstandings of the intended change (Isobel 2016;Sweeney & Taggart 2018), a lack of clear components and measures (Hopper et al 2010;Hornor et al 2019), a dominant biomedical model of services Lutton & Swank 2018;O'Dwyer et al 2020), and limited systemic support for change (Hodgdon et al 2013;Knight 2019;Yatchmenoff et al 2017).…”