Mandate to be ‘recovery oriented’ (MH Policy)Process of understanding what this means for practice and servicesBecoming recovery oriented requires us to recognise and respond to the whole of people’s lives - this includes traumaPrevalence of trauma among MH service users is high, and the impact is profoundServices can’t be recovery-oriented if we don’t understand and respond to trauma.
Mental distress is valued as a legitimate and meaningful human experience; trauma is more common than we have tended to believe, is clearly linked to people’s experiencesof distress and ‘symptoms’; people can recover (process and outcome)Lived experience knowledge is a major contributor to our understandings of these experiences; people have self expertise, people’s responses to their experiences seen as valid efforts to deal with complex (often frightening) experiences.The tensions between what services do and what people need – i.e. different notions of safety (what we do to achieve safety may not feel safe to service users, different definitions of safety), different understandings of “the problem”, Research base is growing in both these areasNot an ‘add on’, involve ‘unlearning’,
Self-defined experiences, self defined needs, Collaborative explorationNon-expert stanceWho decides what is meaningful?Behaviour is not viewed through the lens of diagnosis, but appreciated as the person’s effort to make sense of and manage complex (often frightening) internal experiences.Living a satisfying life within and beyond the limits of one’s experiences How do I support the person’s effortsExamplesVoice hearing is explained to the person as auditory hallucinations (ie not real), as a symptom of schizophrenia, which requires medication, and we provide psycho-education about the course of illness to First - Being interested in how the person understands the experiences, how are they already making sense of these experiences, what are doing to manage them , and how can I support them in their efforts to manage.OrWaiting to engage in conversation with people who are ‘thought disordered’ and expressing unusual beliefs, until the medication ‘kicks in’ToEngaging with people regarding what they are experiencing, being willing to explore the meaning, of these experiences for the person.
What we need to address and overcome to offer truly RO services…Mental distress is valued as a legitimate and meaningful human experience.Lived experience knowledge is a major contributor to our understandings of these experiences.Hope and self-determination are crucial – and messages of hopelessness and dependence are highly disabling.Recovery involves rebuilding a sense of identity, and finding meaning and purposeRecovery recognises diverse explanatory frameworks, and responds with a broad range of approaches, supports, resources and opportunities(kath - )
The challenge – being able to sit with ‘not knowing’ – and not retreat back to certainty and ‘professional’ knowledge being privileged. a representative quote from a student/worker
TIC is not just about what you do as a clinician, it is fundamentally about the way the system you work in responds to the pervasiveness of traumatic experiences in the populations it serves. (Hodas,2006). The characteristics of Trauma-informed Care describe the system in which the care takes place. There are four primary characteristics (Hodas, 2006., Harris & Fallot, 2001).Understanding TraumaUnderstanding the Service UserUnderstanding ServicesUnderstanding the Service relationshipThese four foundations need to be closely interrelated if the organisation is to successfully address the trauma based needs of those receiving services. They could be likened to the foundations of a building, upon which the Core elements (next section) stand.
What we need to address and overcome to offer truly TI servces- We’d need (collectively) to come to terms with 1.the extent of the experience of trauma for those who seek or receive MHS - (give percentages – recent research)2. the nature of family violence and child sexual abuse being ‘traumatic’ – not just bushfires, earthquakes – but the very worst of the trauma that people experience being that which we subject each other to (stats on interpersonal trauma and MHS)3.That sometimes – in spite of best intentions – contact with services is traumatic and causes further harm (practices like seclusion – and e.g. of research on PTSD symptoms from seclusion and restraint – as well as ICU).4. not having done this well in the past – to acknowledge that we have cycled in and out of awareness and response – to denial, and blaming, and marginalising, and specialising ‘trauma’ and not being our ‘core business’ in mental health.It’s easier to see that people are too fragile, too sick, too difficult for their prior trauma to be addressed meaningfully. Denial and minimisation make sense – it eases our discomfort and makes small the seemingly unmanageable – like all coping strategies they need to be respected, but challenged when they outlive their usefulness or make matters worse. Services can ‘compartmentalize’ trauma when it is allowed to be an exclusively specialist area rather than ‘core business’.
To work with the impact of trauma is going to be more painful for the workforce as well- can retreat into denial, minimisation and ‘specialisation ‘ – risks of vicarious trauma - It’s more emotionally demanding, it’s provided in the context of relationships,; offering relationship is more likely to be problematic for people who've been harmed in relationship, does require more training, supervision and more creative and respectful approaches to working with risk.Also – the workforce are not immune! – many have also had these experiences and may or may not consider themselves ‘traumatised’ – so we need to get the balance between acknowledging the personal does impact on the professional – but not guide it entirely (ie because I survived it and am OK – that doesn’t mean that you should be – but it might mean that you can be)These are painful lessons – which we can all take individually and risk losing it again – or together, when we can support the realisations into practice – and work collectively to integrate an awareness of and a response to trauma within MHS.Bit more about history here if we need to….
Michelle Everett & Kath Thorburn presentation
Trauma Informed Care & Recovery Oriented Practice A Mutual Relationship<br />Michelle Everett & Kath Thorburn<br />
What is the relationship between Trauma Informed Care and Recovery Oriented Practice?<br />
TIC & ROP: Common Ground<br />Address underlying beliefs about trauma and mental distress<br />Emphasise the need to be consumer driven and informed by lived experience knowledge<br />Recovery from the impact of experiences and the impact of treatments and systems.<br />Evidence base supports their emergence and growth<br />Involve fundamental shifts in thinking and practice<br />
Recovery Oriented Services<br />from<br /> “How do I treat this client?” <br />to <br />“What does this person need to live a meaningful and satisfying life?”<br />
Recovery Oriented Services<br />Address basic understanding and valuing of mental distress<br />Lived experience is a major contributor to our understandings<br />Use diverse explanatory frameworks and respond with a broad range of approaches, supports, resources, opportunities<br />Relationship (not treatments, models & systems) is the key to healing<br />
“Just because it is doesn’t mean it shouldbe … we need to keep thinking and challenging and evolving.”<br />NSWIOP Student, 2011<br />
Trauma Informed Care<br />from<br /> “What is wrong with this person ?” <br />to<br />“What has happened to this person?”<br />
Trauma Informed Care & Services<br />The extent and profound impact of trauma in the lives of people receiving MHS<br />Trauma has direct and tangible links to distress in the present <br />The impact of trauma is core business<br />Sometimes contact with services is traumatic and causes further harm<br />
“Reflecting on the amount of interpersonal trauma that people experience in their lives has been shocking and saddening”<br />Student, NSWIOP 2011<br />
For change to occur…<br />Service Culture<br />Leadership & Vision<br />Partnership<br />
‘Recovery’ opens a new door for recognising & responding to trauma…<br />
“Developing and implementing trauma-informed systems of care is one of the first steps to becoming recovery oriented.”<br />National Technical Assistance Centre<br />National Association of State Mental Health Program Directors<br />USA<br />