This document discusses whether trauma-informed practice is possible in public mental health services. It begins by providing context about the presenter and their organization which advocates for mental health consumer rights.
The presenter then outlines three main reasons why trauma-informed practice is not currently possible in public mental health services: 1) it is being co-opted and misunderstood, 2) the scale of change needed is huge, and 3) many current practices directly contradict trauma-informed principles. Some specific examples of how services violate human rights and replicate traumatic experiences are provided.
Finally, the presenter suggests some steps that can be taken to move towards greater trauma-informed practice, such as learning from consumer/survivor advocates
Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA A single counseling CEU course is available at https://www.allceus.com/member/cart/index/product/id/393/c/ or the complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member
This document discusses trauma-informed care and trauma awareness. It defines different types of trauma including individual, group, community/cultural, and mass trauma. It also discusses how trauma can be caused by nature or humans, intentionally or unintentionally. The document outlines factors that influence how individuals respond to trauma, such as characteristics of the trauma itself, cultural and personal characteristics, and whether the trauma was expected. It emphasizes that treatment needs to avoid retraumatizing clients and nurture resilience.
This document provides an overview of trauma and trauma-informed care. It defines trauma as experiences that overwhelm an individual's ability to cope, such as abuse, violence, loss or disasters. Trauma has widespread impacts on physical, emotional and cognitive functioning. High rates of trauma are seen in populations experiencing homelessness, addiction and mental illness. The core principles of trauma-informed care emphasize safety, trust, choice and empowerment. Trauma-informed practices view behaviors as adaptations to past trauma and focus on building safety and resilience. Implementing trauma-informed care requires organizational changes and self-care to prevent burnout among providers from secondary traumatic stress.
The document discusses intergenerational trauma and its impacts. It notes that trauma can be passed down from generation to generation if not resolved. Cultural trauma impacts entire societies by attacking the fabric of the community. The concept of an "invisible backpack" is introduced, which refers to how our culture, experiences and beliefs unconsciously influence our interactions. The cycle of pain, trauma and harm can be addressed through restoring balance, though harm reduction and focusing on wellness and resilience rather than disease models of health. The theory of the "wounded healer" is presented, where those who have experienced and processed trauma can develop greater empathy and understanding to help others.
This document discusses the rationale for developing trauma-informed service systems. It begins by defining psychological trauma and reviewing research showing high rates of trauma in vulnerable populations. Trauma affects brain development and can cause lasting negative impacts. The document advocates for a universal precautions approach and trauma-informed care across organizations, rather than just trauma-specific treatment. It outlines 12 criteria for building trauma-informed mental health systems, such as having trauma-focused policies, training staff, and involving trauma survivors. The goal is to minimize re-traumatization and promote healing.
Deliberate Self Harm Among Children And Adolescentsgaz12000
This document provides a summary of a research briefing on deliberate self-harm among children and adolescents. It defines self-harm and notes that it most often involves overdoses and cutting. Repeated self-harm is associated with increased suicide risk. Girls self-harm more than boys up to age 16. Factors that increase self-harm risk include mental health issues, a history of self-harm, an abusive home life, poor parent communication, and living in care. Common triggers are stressful life events like abuse. Self-harm is often considered a coping strategy and way to relieve pain or communicate distress.
Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA A single counseling CEU course is available at https://www.allceus.com/member/cart/index/product/id/393/c/ or the complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member
This document discusses trauma-informed care and trauma awareness. It defines different types of trauma including individual, group, community/cultural, and mass trauma. It also discusses how trauma can be caused by nature or humans, intentionally or unintentionally. The document outlines factors that influence how individuals respond to trauma, such as characteristics of the trauma itself, cultural and personal characteristics, and whether the trauma was expected. It emphasizes that treatment needs to avoid retraumatizing clients and nurture resilience.
This document provides an overview of trauma and trauma-informed care. It defines trauma as experiences that overwhelm an individual's ability to cope, such as abuse, violence, loss or disasters. Trauma has widespread impacts on physical, emotional and cognitive functioning. High rates of trauma are seen in populations experiencing homelessness, addiction and mental illness. The core principles of trauma-informed care emphasize safety, trust, choice and empowerment. Trauma-informed practices view behaviors as adaptations to past trauma and focus on building safety and resilience. Implementing trauma-informed care requires organizational changes and self-care to prevent burnout among providers from secondary traumatic stress.
The document discusses intergenerational trauma and its impacts. It notes that trauma can be passed down from generation to generation if not resolved. Cultural trauma impacts entire societies by attacking the fabric of the community. The concept of an "invisible backpack" is introduced, which refers to how our culture, experiences and beliefs unconsciously influence our interactions. The cycle of pain, trauma and harm can be addressed through restoring balance, though harm reduction and focusing on wellness and resilience rather than disease models of health. The theory of the "wounded healer" is presented, where those who have experienced and processed trauma can develop greater empathy and understanding to help others.
This document discusses the rationale for developing trauma-informed service systems. It begins by defining psychological trauma and reviewing research showing high rates of trauma in vulnerable populations. Trauma affects brain development and can cause lasting negative impacts. The document advocates for a universal precautions approach and trauma-informed care across organizations, rather than just trauma-specific treatment. It outlines 12 criteria for building trauma-informed mental health systems, such as having trauma-focused policies, training staff, and involving trauma survivors. The goal is to minimize re-traumatization and promote healing.
Deliberate Self Harm Among Children And Adolescentsgaz12000
This document provides a summary of a research briefing on deliberate self-harm among children and adolescents. It defines self-harm and notes that it most often involves overdoses and cutting. Repeated self-harm is associated with increased suicide risk. Girls self-harm more than boys up to age 16. Factors that increase self-harm risk include mental health issues, a history of self-harm, an abusive home life, poor parent communication, and living in care. Common triggers are stressful life events like abuse. Self-harm is often considered a coping strategy and way to relieve pain or communicate distress.
This document provides information from a webinar presented by Griswold International, LLC on managing dementia symptoms. The webinar aims to empower caregivers to understand and manage dementia symptoms and improve quality of life through education, support and advocacy. It covers common symptoms such as repetitive behaviors, wandering, aggression, hallucinations, sundowning, sleep problems, and communication challenges. Potential causes of symptoms and management strategies are discussed. The importance of surrounding oneself with a dementia care team is emphasized. [END SUMMARY]
This document provides information on self-injury (also called non-suicidal self-injury or NSSI). It defines different types of self-injury and reviews prevalence rates among adolescents. Studies show that 15-30% of adolescents engage in NSSI. There is evidence that rates are rising. The document also discusses biological and neurological factors that may contribute to NSSI, such as low endorphin levels and altered pain sensitivity. Treatment approaches covered include assessment of motivations and functions of self-injury, psychoeducation, and motivational enhancement techniques.
Health and wellness in the workplace - interactive white paperSteven Fidgeon
Employers will play an increasingly important role in addressing employee health issues as chronic disease shifts to affect younger workers and costs rise. While challenges exist, opportunities do as well - employers can use health analytics to understand risks and drive strategy. New technologies also allow greater engagement with employees to promote healthy behaviors in the workplace. A focus on prevention and wellness can help achieve sustainable healthcare costs versus just treating illness.
The document discusses health and spirituality. It begins by clarifying the differences and similarities between religion, spirituality, and faith. While these terms are often used interchangeably, spirituality is generally used as a broad term to describe a person's religious or faith beliefs without specifying a particular tradition. The document then discusses how thinking about health in terms of presence of well-being rather than just absence of sickness affects perspectives on the relationship between health and religious/spiritual factors. It suggests clinical care should include spiritual assessment and ensure availability of spiritual care aligned with a patient's beliefs.
Ethics are important in counseling to protect clients and set standards for counselors' behavior. There are five main ethical principles in counseling: beneficence, which means acting in the client's best interest; autonomy, which means respecting a client's right to make their own decisions; fidelity, which involves keeping commitments and being loyal and honest; justice, which is about treating all people fairly; and veracity, which means being honest. Counselors have a duty of care for clients and must act ethically to promote client welfare, rights, and goals.
Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA The complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member
Stress is a natural feeling of not being able to cope with specific demands and events. However, It’s natural and normal to be stressed sometimes but long-term stress can cause physical symptoms, emotional symptoms and unhealthy behaviors.
Mental illness has been recognized for over 4,000 years. Early attempts to treat it were often cruel, such as chaining or torturing patients due to beliefs that mental illness was caused by demonic possession. In the late 1800s, some doctors experimented with methods to influence blood flow to the brain like tranquilizer chairs and spinning chairs, but these provided no lasting benefits. Through the 1900s, many mentally ill individuals were institutionalized in asylum conditions that were often deplorable. Lobotomies and electroshock therapy were introduced in the mid-20th century as treatments but often had negative effects and did not cure illness. Understanding and treatment of mental illness has significantly improved since these early attempts.
Listen to this presentation on Counselor Toolbox Podcast, available on any podcast app. Earn CEUs for this at https://www.allceus.com/member/cart/index/product/id/392/c/
Self care involves actions to improve one's own health and involves physical, emotional, social, and spiritual dimensions. The document discusses tips for self care and defines well being as a sense of health, vitality, happiness, and purpose that comes from thoughts, emotions, actions, and experiences. It provides dimensions and tips for well being as well as links to related videos.
The document discusses the importance of self-care for managing stress, burnout, and maintaining well-being, noting that poor self-care can lead to disengagement, emotional exhaustion, and losing one's passion. It outlines five core components of wellness - sleep, exercise, nutrition, relaxation, and connection - and provides examples of practices to improve each of these areas. The document emphasizes finding self-care practices that work for the individual and seeking help if one's current strategies are not effective.
Post-traumatic stress disorder (PTSD) is a psychological reaction that occurs after experiencing a traumatic or stressful event such as combat, violence, accidents, or natural disasters. It is characterized by symptoms like reliving the event through flashbacks or nightmares, avoiding reminders of the trauma, and feeling constantly on edge or distressed. Children may exhibit PTSD through stomach aches, headaches, or refusal to socialize. Treatment involves therapy, medication, or both and aims to help patients manage distressing thoughts and feelings about the trauma to reduce symptoms over 6-12 weeks. Family therapy programs bring relatives together to strengthen relationships and support the person with PTSD.
This document discusses stress, its causes, types, and management techniques. It covers two types of stress: eustress (positive stress) and distress (negative stress). Distress can be short-term acute stress or long-term chronic stress. Chronic stress can negatively impact physical and mental health through increased risk of conditions like depression, anxiety, heart disease, and cancer. The document then discusses factors that influence the stress response like cognitive appraisal and coping styles. It provides an overview of cognitive-behavioral stress management techniques like reappraisal of stressors and developing effective coping skills.
Mental illness stigma ppt slides - cultural infoJoe Tinkham
This document discusses mental illness stigma in several non-Western cultures. It finds that most cultures exhibit somatization of emotional distress and idioms of distress that are culturally specific. Treatment often focuses on pharmacotherapy due to stigma, and families prefer to keep mental illness private. While biomedical views are more common in urban areas, traditional beliefs involving spirit possession or witchcraft remain influential, especially rurally. Integrating biomedical and traditional views into mental healthcare may help reduce stigma.
ACT aims to increase psychological flexibility through six core processes: acceptance, defusion, contact with the present moment, self-as-context, values, and committed action. It does not aim to control or eliminate private experiences like thoughts and feelings, but to create distance from them and enable values-based action. ACT uses metaphors, exercises and other experiential techniques grounded in functional contextualism and relational frame theory to undermine cognitive fusion and enhance flexibility. The goal is for language to serve values rather than dominate experience.
This document discusses defense mechanisms and coping skills. It differentiates between defenses, which protect individuals from threats until they can be addressed, and coping skills, which help change situations or reactions to situations. The document provides examples of common defenses like denial, avoidance, and projection. It also outlines cognitive, physical, environmental and interpersonal coping skills like mindfulness, encouragement, and changing beliefs. Activities are suggested to help clients identify defenses and coping skills, understand their purpose, and prevent issues from building up over time through journaling and mindfulness.
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Unlimited Counseling CEUs for $59 https://www.allceus.com/
Specialty Certificate tracks starting at $89 https://www.allceus.com/certificate-tracks/
Live Webinars $5/hour https://www.allceus.com/live-interactive-webinars/
CEs can be earned for this presentation at https://www.allceus.com/member/cart/index/search?q=family+dynamics
Pinterest: drsnipes
YouTUBE: https://www.youtube.com/user/allceuseducation
Nurses, addiction and mental health counselors, social workers and marriage and family therapists can earn continuing education credits (CEs) for this and other course at:
View the New Harbinger Catalog and get your 25% discount on their products by entering coupon code: 1168SNIPES at check out
AllCEUs has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6261. Programs that do not qualify for NBCC Credit are clearly identified. AllCEUs is solely responsible for all aspects of the programs.
AllCEUs is also approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions. Our courses are accepted in most states through those approvals.
Family Dynamics of Addiction
Objectives
Define the Family
Examine how addiction impacts the family
Emotionally
Socially
Physically
Spiritually
Why I Care/How It Impacts Recovery
The identified patient does not exist in isolation
As the IPs behaviors/problems developed, the family’s behaviors changed to try and maintain stability
When the IP begins to change in recovery, that disrupts the balance.
When the IP did _____ the family members always reacted with ____
Example:
When John was late coming home from work….
When Sally started sleeping late and going to bed early…
When Jane starts cleaning a lot and getting irritable…
The family needs to
Understand the impact of the IPs behavior on the family
What the function of the IPs behavior was
How to examine old behaviors in a new context
The document discusses stress management for students. It defines stress and explains that moderate stress can improve performance while too much leads to issues. It identifies common stressors for students like academics, relationships, finances and lifestyle changes. Symptoms of stress are described including physical, emotional, behavioral and cognitive impacts. The document provides tools to manage stress such as maintaining a healthy lifestyle, building social support, relaxation techniques, challenging negative thoughts, and developing a positive attitude.
View the video here: https://youtu.be/RtJdZ7xfCHQ
Earn counseling CEUs: https://www.allceus.com/member/cart/index/product/id/519/c/
ACT is a useful tool to help people evaluate the thoughts and feelings underlying their reactions, step back and evaluate whether those behaviors, thoughts and feelings are helping them move toward their goals and commit to thoughts and actions that will improve their happiness and help them move closer to those things which are important to them
Reflecting on mental health consumer-survivor-expatient movementIndigo Daya
The document provides a summary of a presentation on reflections from the consumer-survivor-ex-patient movement. It discusses the diversity of experiences within the movement, including different views on treatment experiences and priorities. It also reflects on challenges such as a lack of influence, barriers faced by consumer workers within the mental health system, and how to build unity while embracing diversity. The presentation considers strategies for enacting change both from inside and outside the system, as well as strengthening the movement.
This document provides information from a webinar presented by Griswold International, LLC on managing dementia symptoms. The webinar aims to empower caregivers to understand and manage dementia symptoms and improve quality of life through education, support and advocacy. It covers common symptoms such as repetitive behaviors, wandering, aggression, hallucinations, sundowning, sleep problems, and communication challenges. Potential causes of symptoms and management strategies are discussed. The importance of surrounding oneself with a dementia care team is emphasized. [END SUMMARY]
This document provides information on self-injury (also called non-suicidal self-injury or NSSI). It defines different types of self-injury and reviews prevalence rates among adolescents. Studies show that 15-30% of adolescents engage in NSSI. There is evidence that rates are rising. The document also discusses biological and neurological factors that may contribute to NSSI, such as low endorphin levels and altered pain sensitivity. Treatment approaches covered include assessment of motivations and functions of self-injury, psychoeducation, and motivational enhancement techniques.
Health and wellness in the workplace - interactive white paperSteven Fidgeon
Employers will play an increasingly important role in addressing employee health issues as chronic disease shifts to affect younger workers and costs rise. While challenges exist, opportunities do as well - employers can use health analytics to understand risks and drive strategy. New technologies also allow greater engagement with employees to promote healthy behaviors in the workplace. A focus on prevention and wellness can help achieve sustainable healthcare costs versus just treating illness.
The document discusses health and spirituality. It begins by clarifying the differences and similarities between religion, spirituality, and faith. While these terms are often used interchangeably, spirituality is generally used as a broad term to describe a person's religious or faith beliefs without specifying a particular tradition. The document then discusses how thinking about health in terms of presence of well-being rather than just absence of sickness affects perspectives on the relationship between health and religious/spiritual factors. It suggests clinical care should include spiritual assessment and ensure availability of spiritual care aligned with a patient's beliefs.
Ethics are important in counseling to protect clients and set standards for counselors' behavior. There are five main ethical principles in counseling: beneficence, which means acting in the client's best interest; autonomy, which means respecting a client's right to make their own decisions; fidelity, which involves keeping commitments and being loyal and honest; justice, which is about treating all people fairly; and veracity, which means being honest. Counselors have a duty of care for clients and must act ethically to promote client welfare, rights, and goals.
Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA The complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member
Stress is a natural feeling of not being able to cope with specific demands and events. However, It’s natural and normal to be stressed sometimes but long-term stress can cause physical symptoms, emotional symptoms and unhealthy behaviors.
Mental illness has been recognized for over 4,000 years. Early attempts to treat it were often cruel, such as chaining or torturing patients due to beliefs that mental illness was caused by demonic possession. In the late 1800s, some doctors experimented with methods to influence blood flow to the brain like tranquilizer chairs and spinning chairs, but these provided no lasting benefits. Through the 1900s, many mentally ill individuals were institutionalized in asylum conditions that were often deplorable. Lobotomies and electroshock therapy were introduced in the mid-20th century as treatments but often had negative effects and did not cure illness. Understanding and treatment of mental illness has significantly improved since these early attempts.
Listen to this presentation on Counselor Toolbox Podcast, available on any podcast app. Earn CEUs for this at https://www.allceus.com/member/cart/index/product/id/392/c/
Self care involves actions to improve one's own health and involves physical, emotional, social, and spiritual dimensions. The document discusses tips for self care and defines well being as a sense of health, vitality, happiness, and purpose that comes from thoughts, emotions, actions, and experiences. It provides dimensions and tips for well being as well as links to related videos.
The document discusses the importance of self-care for managing stress, burnout, and maintaining well-being, noting that poor self-care can lead to disengagement, emotional exhaustion, and losing one's passion. It outlines five core components of wellness - sleep, exercise, nutrition, relaxation, and connection - and provides examples of practices to improve each of these areas. The document emphasizes finding self-care practices that work for the individual and seeking help if one's current strategies are not effective.
Post-traumatic stress disorder (PTSD) is a psychological reaction that occurs after experiencing a traumatic or stressful event such as combat, violence, accidents, or natural disasters. It is characterized by symptoms like reliving the event through flashbacks or nightmares, avoiding reminders of the trauma, and feeling constantly on edge or distressed. Children may exhibit PTSD through stomach aches, headaches, or refusal to socialize. Treatment involves therapy, medication, or both and aims to help patients manage distressing thoughts and feelings about the trauma to reduce symptoms over 6-12 weeks. Family therapy programs bring relatives together to strengthen relationships and support the person with PTSD.
This document discusses stress, its causes, types, and management techniques. It covers two types of stress: eustress (positive stress) and distress (negative stress). Distress can be short-term acute stress or long-term chronic stress. Chronic stress can negatively impact physical and mental health through increased risk of conditions like depression, anxiety, heart disease, and cancer. The document then discusses factors that influence the stress response like cognitive appraisal and coping styles. It provides an overview of cognitive-behavioral stress management techniques like reappraisal of stressors and developing effective coping skills.
Mental illness stigma ppt slides - cultural infoJoe Tinkham
This document discusses mental illness stigma in several non-Western cultures. It finds that most cultures exhibit somatization of emotional distress and idioms of distress that are culturally specific. Treatment often focuses on pharmacotherapy due to stigma, and families prefer to keep mental illness private. While biomedical views are more common in urban areas, traditional beliefs involving spirit possession or witchcraft remain influential, especially rurally. Integrating biomedical and traditional views into mental healthcare may help reduce stigma.
ACT aims to increase psychological flexibility through six core processes: acceptance, defusion, contact with the present moment, self-as-context, values, and committed action. It does not aim to control or eliminate private experiences like thoughts and feelings, but to create distance from them and enable values-based action. ACT uses metaphors, exercises and other experiential techniques grounded in functional contextualism and relational frame theory to undermine cognitive fusion and enhance flexibility. The goal is for language to serve values rather than dominate experience.
This document discusses defense mechanisms and coping skills. It differentiates between defenses, which protect individuals from threats until they can be addressed, and coping skills, which help change situations or reactions to situations. The document provides examples of common defenses like denial, avoidance, and projection. It also outlines cognitive, physical, environmental and interpersonal coping skills like mindfulness, encouragement, and changing beliefs. Activities are suggested to help clients identify defenses and coping skills, understand their purpose, and prevent issues from building up over time through journaling and mindfulness.
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Unlimited Counseling CEUs for $59 https://www.allceus.com/
Specialty Certificate tracks starting at $89 https://www.allceus.com/certificate-tracks/
Live Webinars $5/hour https://www.allceus.com/live-interactive-webinars/
CEs can be earned for this presentation at https://www.allceus.com/member/cart/index/search?q=family+dynamics
Pinterest: drsnipes
YouTUBE: https://www.youtube.com/user/allceuseducation
Nurses, addiction and mental health counselors, social workers and marriage and family therapists can earn continuing education credits (CEs) for this and other course at:
View the New Harbinger Catalog and get your 25% discount on their products by entering coupon code: 1168SNIPES at check out
AllCEUs has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6261. Programs that do not qualify for NBCC Credit are clearly identified. AllCEUs is solely responsible for all aspects of the programs.
AllCEUs is also approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions. Our courses are accepted in most states through those approvals.
Family Dynamics of Addiction
Objectives
Define the Family
Examine how addiction impacts the family
Emotionally
Socially
Physically
Spiritually
Why I Care/How It Impacts Recovery
The identified patient does not exist in isolation
As the IPs behaviors/problems developed, the family’s behaviors changed to try and maintain stability
When the IP begins to change in recovery, that disrupts the balance.
When the IP did _____ the family members always reacted with ____
Example:
When John was late coming home from work….
When Sally started sleeping late and going to bed early…
When Jane starts cleaning a lot and getting irritable…
The family needs to
Understand the impact of the IPs behavior on the family
What the function of the IPs behavior was
How to examine old behaviors in a new context
The document discusses stress management for students. It defines stress and explains that moderate stress can improve performance while too much leads to issues. It identifies common stressors for students like academics, relationships, finances and lifestyle changes. Symptoms of stress are described including physical, emotional, behavioral and cognitive impacts. The document provides tools to manage stress such as maintaining a healthy lifestyle, building social support, relaxation techniques, challenging negative thoughts, and developing a positive attitude.
View the video here: https://youtu.be/RtJdZ7xfCHQ
Earn counseling CEUs: https://www.allceus.com/member/cart/index/product/id/519/c/
ACT is a useful tool to help people evaluate the thoughts and feelings underlying their reactions, step back and evaluate whether those behaviors, thoughts and feelings are helping them move toward their goals and commit to thoughts and actions that will improve their happiness and help them move closer to those things which are important to them
Reflecting on mental health consumer-survivor-expatient movementIndigo Daya
The document provides a summary of a presentation on reflections from the consumer-survivor-ex-patient movement. It discusses the diversity of experiences within the movement, including different views on treatment experiences and priorities. It also reflects on challenges such as a lack of influence, barriers faced by consumer workers within the mental health system, and how to build unity while embracing diversity. The presentation considers strategies for enacting change both from inside and outside the system, as well as strengthening the movement.
Human rights and citizenship in community mental healthVMIAC
The document discusses human rights and citizenship in community mental health. It makes four key points:
1) Human rights are not separate from quality and safety in mental health services. Limiting rights is emotionally harmful.
2) Thinking must evolve to view mental health experiences as meaningful reactions rather than just symptoms, and give consumers leadership roles.
3) Only services that support personal recovery through diverse bio-psycho-social options and are led by consumers should be funded.
4) Achieving equality, by addressing violence, discrimination and disadvantages consumers face, is important for mental health and rights.
This document discusses harm reduction approaches for working with criminalized communities like sex workers and substance users. It defines harm reduction as addressing risky behaviors in a public health framework that prioritizes individual choice and mitigating harm. It presents concepts like viewing sex work as legitimate work, distinguishing between substance use and abuse, and considering how multiple forms of oppression intersect. It advocates applying these frameworks in practice through affirming language, ongoing education, knowing applicable laws and policies, and meeting people where they are at with strengths-based models. The goal is mitigating the harms of criminalization in contexts like HIV treatment and care.
Post-abortion syndrome is a condition experienced by some women after having an abortion. While not officially recognized by the APA, it can cause emotional and psychological distress. Women may experience depression, grief, and trauma from terminating a pregnancy. More awareness and support services are needed to help women reconcile their actions and heal from any trauma. Counseling before and after an abortion could help reduce incidents of post-abortion syndrome.
iCAAD London 2019 - Clarinda Cuppage and Lou Lebentz - NUMBING THE PAIN: CHI...iCAADEvents
Childhood sexual abuse (CSA) has seemed at the forefront of many news items recently and increasingly out there in the public domain. The statistics quoted in the UK are 1 in 4 women and 1 in 6 men are survivors, higher in other countries such as the USA. Indeed, most of our addiction clients tend to present with underlying trauma, many as a result of CSA. So as clinicians and treatment providers how do we deal with this epidemic in terms of numbers and the resultant increased disclosures and presentations?
This document provides an introduction to healthcare ethics, discussing key concepts like ethical issues, principles of biomedical ethics, and broad philosophical theories of ethics. It defines an ethical issue as when one has to judge right from wrong in making difficult choices between options. Some major ethical issues in healthcare discussed are respecting patient autonomy, beneficence, non-maleficence, justice, and distributing scarce resources fairly. It also outlines four key ethical principles - autonomy, beneficence, non-maleficence, and justice - and four ethical rules - veracity, privacy, confidentiality, and fidelity. Utilitarianism and deontology are presented as two broad philosophical approaches to ethics.
This document discusses trauma-informed care for forensic clients at Fulton State Hospital. It provides information on the hospital's clients, which include those deemed incompetent to stand trial or not guilty by reason of insanity. It also describes the hospital's security levels and treatment programs. The document discusses how trauma is prevalent among clients, especially those with disabilities or mental illness, and explains the neurological and social effects of trauma. It emphasizes the importance of trauma-informed care and providing a safe environment to avoid re-traumatization. It recommends treating trauma as a universal precaution, developing specific trauma treatment plans, and training staff to engage compassionately with clients.
Why do some individuals develop addictive disorders while others don’t? The relationship between trauma and addiction can provide valuable insight. The adverse childhood experiences (ACES) study helped define and shape our understanding of this complex issue and research demonstrates that higher ACE scores are linked with higher rates of future substance use. It is critical that the health care workforce understand the impact of trauma on addiction and how this relationship impacts treatment and recovery. Explore what it means to be trauma-informed and how providers can integrate trauma-informed care into recovery services and other work with individuals who experience addictive disorders.
The document provides information about a workshop on drug use, stigma, stereotypes and harm reduction. It outlines the goals of gaining understanding of the negative effects of stigma on people who use drugs and examining ways to reduce stigma and improve well-being. It establishes group guidelines for the workshop, including maintaining confidentiality and respecting different experiences. It then considers stereotypes related to drug use through pictures and a survey. Key aspects of drug-related stigma from individuals, institutions, internally and by association are examined. The implications of stigma for access to services, risk behaviors, self-worth and relationships are discussed. Factors influencing drug use including the continuum of use and drug, set and setting are briefly covered.
Professor David Sweanor - E-Cigarette Summit 2014Neil Mclaren
- The document discusses the legal and ethical responsibilities of public health organizations, particularly regarding providing accurate consumer information on potentially less harmful alternatives to cigarettes.
- It notes public health groups can be sued and lose reputation if they do not meet an acceptable standard of providing evidence-based information to consumers.
- The document argues public health groups should give people enough information to make informed decisions and the ability to act on that information, rather than blame people for decisions made without proper information.
This document summarizes a digital storytelling project called Story Gleaners that engaged 12 participants who use drugs. The project aimed to document their experiences with drug policy and support harm reduction. Participants created 8 stories through storytelling circles and editing sessions. The stories highlighted themes of lack of safe spaces, self-medication to cope with pain, criminalization despite health issues, and strength in peer communities. Recommendations included acknowledging self-medication, adopting harm reduction in services, increasing social support, and creating safe consumption sites to reduce harms of drug use and drug policy.
This document introduces some key concepts in medical ethics, including the four main ethical principles of autonomy, beneficence, non-maleficence, and justice. It discusses ethical issues that clinicians may face in healthcare, from big issues like determining what constitutes life to smaller interpersonal issues like treating patients with dignity and respecting their choices. The document also outlines two main philosophical approaches to ethics - consequentialism, which considers the consequences of actions, and deontology, which focuses on adhering to principles of duty. It provides examples of how these principles and theories can guide decision-making around ethical dilemmas in clinical practice.
Did you know that our brains are naturally biased? Let's explore the functions of unconscious bias together and navigate their impact on our decision-making processes. We will examine our own background and identities so we can interact more authentically with colleagues, consumers, and the community at large.
This document discusses stigma faced by forensic clients with mental illness who commit crimes. It begins by defining forensic clients as those found not criminally responsible due to mental illness. It describes how stigma develops in society and is especially strong for forensic clients due to a double stigma of mental illness and criminality. The document outlines how stigma impacts recovery and community reintegration for forensic clients and their families by decreasing treatment adherence and social engagement. It recommends promoting recovery-oriented practices, education to decrease ignorance, and support for families to help reduce this stigma.
Session 1 introduction to ethics convertedsherkamalshah
This document provides an introduction to nursing ethics. It defines key terms like morals, ethics, values, beliefs, and attitudes. It discusses important ethical concepts like ethical dilemmas, principles of autonomy, beneficence, non-maleficence, and justice. It also identifies common nursing ethics dilemmas and discusses the importance and role of ethics in nursing practice.
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Presenters:
Dr. Jakov Shlik, Clinical Director, Operational Stress Injury Clinic and Anxiety program, The Royal
Michelle Antwi, Operational Stress Injury Clinic, The Royal
Katie Bendell, Operational Stress Injury Clinic, The Royal
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CHI's Lunchtime Learning is open to all researchers, decision-makers, clinicians, patients and members of the public who want to learn more about the theory and practice of meaningful, inclusive, and safe patient and public engagement.
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2. www.vmiac.org.au
VMIAC envisions a world where
all mental health consumers stand proud,
live a life with choices honoured,
rights upheld,
and these principles are embedded
in all aspects of society
3. Is trauma
the elephant
in the room
of mental
health?
Does
trauma-informed
practice feel huge
& overwhelming?
4. Perhaps we can
sit with the
discomfort of
major change…
And even very
different
perspectives…
6. Peeling back
layers of an
onion*
* Concept by Ron Coleman, Working to Recovery, Scotland
Our madness
experiences often have
many layers.
We can’t know what lies
beneath without
working beyond the
superficial.
The deeper layers are
where the trauma is.
10. Not in public
mental health
services.
Well, not yet,
anyway.
Andersen, Hans Christian. Fairy Tales by Hans Andersen. Arthur
Rackham, illustrator. London: George G. Harrap, 1932.
11. Why Trauma-Informed Practice
isn’t possible (yet)
1. Trauma-informed
practice is already being
co-opted
2. The scale of change
needed is huge
3. There are many contra-
indications to trauma-
informed practiceAndersen, Hans Christian. Fairy Tales by Hans Andersen.
Arthur Rackham, illustrator. London: George G. Harrap,
1932.
12. (1) Ways that services are
getting trauma-informed
practice wrong… co-opting
• ‘It’s just about not causing trauma’
• ‘It’s about new trauma screening tools’
• ‘It’s about screening for trauma,
referring on to specialist services for
that, then business as usual for us’
• ‘It’s about diagnosing comorbid trauma
disorders, like PTSD’
• Not addressing conflicting interests &
risks in family inclusive practice
13. (2) The scale of change
A trauma informed approach 1…
• Realizes the widespread impact of trauma and
understands potential paths for recovery;
• Recognizes the signs and symptoms of trauma in
clients, families, staff, and others involved with the
system;
• Responds by fully integrating knowledge about trauma
into policies, procedures, and practices; and
• Seeks to actively resist re-traumatization.
1 Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Trauma-Informed
Approach and Trauma-Specific Interventions. Retrieved from:
https://www.samhsa.gov/nctic/trauma-interventions
14. … yet this requires genuine reform
To support this approach, we would need…
• Recovery orientation – yet this has largely failed in the
clinical sector
• Substantially more face-to-face time in a pressured
system
• Fundamental changes to practice by all staff: this is not
an ‘add-on’, it’s a game changer
• Shifting away from existing diagnostic frameworks
• Substantial increases in knowledge & skill, including a
diversified workforce
• Revisiting mental health legislation and built
environments
15. (3) Contraindications to trauma-
informed practice
Much of what happens in
clinical mental health
services is contraindicated
in the context of trauma:
• Human rights breaches
• Double-binds
• Incompatibilities with
principles of trauma-
informed practice
16. Human Rights (Victorian Charter of Human Rights, 2006)
Right to
recognition &
equality before
the law
Protection from
torture & cruel,
inhuman or
degrading
treatment
Right to life
Freedom
from forced
work
Freedom of
movement
Freedom of
thought,
conscience,
religion &
belief
Privacy &
reputation
Freedom of
expression
Peaceful
assembly
and freedom
of
association
Protection
of families
and
children
Humane
treatment
when
deprived of
liberty
Taking part
in public
life
Cultural
rights
Property
rights
Right to
liberty &
security of
person
Rights of
children in
the criminal
process
Rights in
criminal
proceedings
Right to a
fair hearing
Right not to
be tried or
punished
more than
once
Retrospective
criminal laws
17. Human rights breaches that happen in
mental health services
Right to
recognition &
equality before
the law
Protection from
torture & cruel,
inhuman or
degrading
treatment
Right to life
Freedom
from forced
work
Freedom of
movement
Freedom of
thought,
conscience,
religion &
belief
Privacy &
reputation
Freedom of
expression
Peaceful
assembly
and freedom
of
association
Protection
of families
and
children
Humane
treatment
when deprived
of liberty
Taking part
in public
life
Cultural
rights
Property
rights
Right to
liberty &
security of
person
Rights of
children in
the criminal
process
Rights in
criminal
proceedings
Right to a
fair hearing
Right not to
be tried or
punished
more than
once
Retrospective
criminal laws
18. The double bind faced by consumers
Submit
To treatment I
don’t want, that
doesn’t help,
that harms me
Fight back
Defend my rights
and risk worse
coercion and
harms
20. Principles of Trauma-Informed
Practice*
• Safety
• Trustworthiness & transparency
• Peer support
• Collaboration & mutuality
• Empowerment, voice & choice
• Cultural, Historical, and Gender Issues
1 Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Trauma-Informed
Approach and Trauma-Specific Interventions. Retrieved from:
https://www.samhsa.gov/nctic/trauma-interventions
21. Trauma Informed Practice
…what’s in the way
Principles of trauma-
informed practice (SAMHSA)
Common contraindications in public
mental health services
Safety
Seclusion, restraint, sexual assault,
psychological injury
Trustworthiness &
transparency
Privacy breaches, coercion, punitive measures,
unlawful practice
Peer support Some positive change, but…?
Collaboration & mutuality Substitute decision making, extreme boundaries
Empowerment, voice & choice
Compulsion, a lot that’s done about us without
us, rules & controls
Cultural, Historical, and
Gender Issues
Some positive change, but…?
22. “Do the best you can
until you know better.
Then when you know
better, do better.”
MAYA ANGELOU
23. Moving
towards
trauma-
informed
practice
1. Practice listening,
validation & non-
judgement
2. Call out any co-opting of
trauma informed practice
3. Provide information about
trauma
4. Develop therapeutic skills
5. Learn about trauma, &
emotion
6. Be an ally and challenge
harmful practice & rights
breaches
7. Introduce new support &
recovery options
26. Be an ally & challenge harmful
practice • Learn about & respect consumer
history & perspectives
• Invite us to work with you
• Don’t misuse your privilege
• Respect our experiences, beliefs,
choices & rights
• When you see injustice or harm,
stand with us & take action
• Support us to make complaints,
use advocates and legal services
(that’s not ‘being litigious’, it’s promoting rights
and empowerment)
• Do no harm
28. Read the work of consumer /
survivor leaders, writers & thinkers
Eleanor Longden
Tina Minkowitz
Shery Mead
Rachel Waddingham
Jacqui Dillon
Rufus May
Will Hall
Ron Coleman
Oryx Cohen
Judi Chamberlin
Patricia Deegan
Daniel Fisher
Mary O’Hagan
• Merinda Epstein
• Cath Roper
• Vrinda Edan
• Wanda Bennetts
• Flick Grey
• Amanda Waegli
• Louise Byrne
• Fay Jackson
• Neil Turton-Lane
• Stephanie Ewert
• Tim Heffernan
• Maybe me!
29. Read the work of critical professional
voices (allies with consumer movement)
Organisations:
• Mad in America (US)
• Critical Psychiatry Network (UK)
• Drop the Disorder (UK)
• Intervoice / International
Hearing Voices Movement
• Schizophrenia does not exist
(Netherlands)
• International Institute for
Psychiatric Drug Withdrawal
• ImROC (UK)
• Joanna Moncrieff
• Peter Breggin
• Lucy Johnstone
• John Read
• Pat Bracken
• Richard Bentall
• Jay Watts
• Sam Timimi
• Jeffrey Lacasse
• Bruce Levine
• Daniel Mackler
• David Cohen, UCLA
• Jo Watson
• Noel Hunter
• Dirk Corstens
• Judith Herman
• Mike Slade
30. Learn about genuinely trauma-informed
support, recovery & healing options
• Hearing Voices Approach
― Making sense of voices, listening to voices,
dialoguing with voices, profiling voices
(Maastricht interview)
• Alternatives to Suicide (Western Mass)
• Intentional Peer Support (Shery Mead)
• Narrative therapy
• eCPR (Daniel Fisher)
I am wondering how many people feel like that trauma elephant is just a bit like this? Huge, overwhelming, threatening?
I hope not, but I know that big change can feel this way, so I wanted to acknowledge that.
This is a hopeful elephant, hanging out with a dog. It’s here to remind us that it’s possible to sit alongside something big, and different, and tricky, and to be ok with that.
It’s even possible for people with really different experiences and views – like clinicians and consumers – to sit alongside each other and begin to listen.
I hope we can do that today… even if I do feel a bit like an enormous scary elephant.
This is an onion. Ron Coleman, a man I count as a mentor and a friend, and a leader in the international hearing voices movement, talks about making sense of madness and trauma as being like peeling back the layers of an onion.
You work on the layer you can see, and when you peel it back, more than likely there will be another layer underneath. This was a really helpful concept for me.
These were the layers of ‘my onion’. The 3 layers on top were all that psychiatric services seemed to see or address. Every now and then, a clinician would see the top layer of emotions, but that was a rare thing.
And so, it was with my peers, and eventually with a sexual assault counsellor, that I was able to unpeel the remaining layers.
What I found was that all of the layers on the surface – the ‘illness’ – were actually just a profoundly painful reaction to shame from childhood abuse. And these were all things that I could heal from, with the right time, support and knowledge.
It we are to be trauma-informed, we need to understand that so much of our trauma is just sitting there, hidden beneath layers of psychiatric labelling and supposed risk.
Think about those things that I was experiencing, and then have a look at what I actually got from clinical services (on the left).
On the right are the things I eventually got, and that contributed to really healing – but I had to go and find these on my own, in different places. I had to lie to my psychiatrist and services as well.
What does this tell us about trauma-informed practice? How much work do we have to do?
Image from the old fairy tale, ‘The Emperor's New Clothes’.
I’ve seen lots of services who are trying to implement trauma informed practice, both here and overseas. And I’m afraid that it really reminds me of this old fairy tale. It feels like everyone is saying how wonderful this new policy is, and yet it’s not actually authentic in any way, kind of like the emperor’s clothes. So, as a consumer/survivor, I feel like that little girl in the crowd, the one who called out ‘but the emperor’s wearing no clothes’! This is often our role, as consumers, to say the uncomfortable truth that no-one else seems able or willing to say. To speak truth to power, if you like. But gosh, it would be really great if more people could join in.
Right now, I have yet to see a single clinical mental health service do anything that is even close to authentic trauma informed practice.
These are, I think, three big reasons why trauma informed practice is not yet possible in clinical mental health services. Each of them has some complexity, so let’s explore them. The next set of slides talks through each of these issues.
Services around Australia and overseas are ‘having a go’ at TIP. To date, I’ve not seen a single clinical service that’s gotten it right. Each of them is ‘co-opting’ or seriously misinterpreting, what this new kind of practice is supposed to be about. These are some of the most common ways that I have seen services getting it wrong:
Not causing trauma: Yes…’but’. People often think that TIP is about reducing restrictive practices. But you should never cause trauma anyway. You’re a health service, and your patients have a right to be safe. There’s also that Charter of healthcare rights, and international conventions, and that Hippocratic oath thing, that somehow seems to be less relevant in mental health. Not hurting people is not being trauma-informed. It’s called providing safe services, and it’s what every service should do regardless of trauma-informed practice. So while trauma informed practice will include an element to ensure this doesn’t happen – if this is all you do, then you have failed before you’ve begun.
New screening tools: If you just screen people with tools and forms, you have missed the point, and risk causing harm. Trauma is too complex and individual to leave to a form. Many people’s experience won’t fit on a form any way. And most of the relevant information about the trauma will come from understanding how it fits into the person’s life – past and present. Trauma disclosure should be supported through interpersonal sessions, following the establishment of rapport and trust. And, really, has ANY problem in health services ever been addressed with a new form??
Referrals then business as usual: If you do not have trauma expertise then you absolutely should refer to specialist services. However the experience of trauma should also influence all of your thinking about assessment, diagnosis and treatment. If it doesn’t change all of these things in a major way, then you haven’t got it. Trauma can be associated with almost any ‘mental health diagnosis’. Many people associate trauma with hearing voices, having unusual beliefs, with depression, anxiety, borderline personality disorder and mania – in fact, all of the common experiences that services might be working with. This must mean that we can’t continue ‘as usual’. For many people, it will mean that the primary treatment and support should come from a different service, and is likely to involve peer support and/or talking therapies.
Diagnosing comorbid PTSD: Using a trauma history to give us more labels and more treatments is missing the point very badly. It also means that you are most likely ignoring the way that trauma can be linked to any type of mental or emotional experience. Trauma is not an ‘add on’ experience – it’s at the heart of most of our experiences. Further, PTSD does not fit with everyone’s experience, it’s just one way of responding to trauma – but there are many ways.
Conflicts with family inclusive practice: Family inclusive practice matters, although family sensitive practice is probably more aligned with consumer perspectives. However, approaches to including families seem to exclude critical considerations for trauma informed practice. This is a major risk for the many consumers who have experienced trauma within a family, whether it’s partner violence or child abuse, and sometimes abuse into adulthood. Of course sometimes family are the best supporters we could possibly have, but sometimes they can also be the people who hurt us the most, and even at the root of our trauma. We can’t return to the old days of the ‘schizophrenogenic mother’, we have to be better than that, but it seems to have become not OK anymore to speak about uncomfortable realities – sometimes carers and family members are harmful to us, and so sometimes they are the last people who should be involved. What does it mean if an abusive husband can attend a case conference about the wife he beats up? What does it mean if a past perpetrator of child abuse is still having a say about our mental health treatment? And I know that of the many women I have sat with over the years who were sexually abused by their father, that the part of the experience that sent them over the edge was not that original abuse, but having told their mother and not being believed. And sometimes, that mother was the person’s carer. So if you’re thinking that you’re doing trauma-informed practice, and you haven’t thought about this, you have a problem.
Another barrier to trauma-informed practice is that it require some of the most substantial reforms we’ve ever seen in mental health. This is not a small thing. It is not something we can do with a framework document and a two-day course and a poster.
Think about these elements of a trauma informed approach. I include these because so often people only talk about the principles of trauma informed care. They’re really important, of course, but if you don’t know anything about trauma that they can seem a little vague and fluffy. The approach, on the other hand, is clearer about what should actually DO, rather than HOW we should do it.
Stop and really think about what it would mean to do all these things in mental health services, all the time.
The trauma informed approach from the previous slide requires lots of reform to become a reality. The things on this slide are necessary - and much more.
We’ve already seen the concept of ‘recovery’ get co-opted by the clinical sector. Almost everyone says that they are recovery oriented, but this is superficial at best. There are five core processes that underpin recovery: connectedness, hope, identity, meaning and empowerment. How do clinical services support these processes? In reality services are still just as focused on symptom remission as they have always been.
Shifting away from the DSM is massive – and we know that there is no other approach sitting there ready to replace it. Although, the Power Threat Meaning Framework, by the British Psychological Society, starts to open up this conversation.
But any one of these actions would require commitment by a brave government, willing to risk upsetting the status quo of power, to face public criticism, industrial unrest and many political problems. But genuine, deep reform, comes once a generation if we’re lucky, and I’m not sure we’ve ever seen it in mental health. Sure, there was deinstitutionalisation, but as Ron Coleman reminds us, all that really happened was that we got institutionalised in CTOs and poverty instead of big old buildings.
I don’t know how we make this happen, but I know it’s a huge ask.
Mental health consumers/survivors lose the right to bodily integrity, but that’s just one of many breaches of human rights.
There is much that happens in mental health services that is just the complete opposite of what a genuinely trauma-informed system would do.
Right now, we know that services are very often the cause of trauma – and so that’s can’t possible be trauma-informed.
Human rights breaches are common for mental health consumers. So, when we say our rights are breached, which rights do we mean?
These are from Victoria, but they are based on the International Covenant of Civil and Political Rights, which Australia has ratified – so they apply to everyone in this country, even if our laws have been slow to catch up.
Depending on our experience, around half of our rights can be breached.
Some of the most common ways that rights are breached include compulsory detention and compulsory treatment (which currently affects almost 60% of consumers) but there are many other practices that breach rights.
When we think about trauma-informed practice, we need to remember that inherent in most interpersonal trauma experiences (but not all), is a severe violation of human rights. This is part of why choice is a central principle of trauma informed practice. So how can we possibly be trauma informed when we breach so many basic human rights? We are not even in the situation yet where clinicians fully appreciate which rights they breach, and how.
We often hear clinicians and government say that these rights violations are justified by the right to health: yet this is a serious misuse of that right. The right to health, according to the United Nations, includes the right to informed consent. So forced treatment is not upholding the right to health – it’s breaching it. The right to health puts an obligation on governments to provide a healthy environment, society, and health services… but it is supposed to be up to the people whether or not they avail themselves of those services. The right to health is not a right to be healthy.
So often, for consumers with a trauma history, we are faced with an impossible choice:
We can submit to a service that is based in medical models of treatment, and which feels largely, even wholly, unsuited to help us, or
We can fight back
If we submit, we know that this will make us worse. We become more disempowered, we take on board disabling medication effects, like cognitive impairment that we may not be able to escape from. We lose our dignity and self-respect. But if we fight back, (or be ‘non-compliant’), we know that we’ll face restrictions and force that will be traumatising and make us worse.
These are impossible situations. The only way out is to escape and get free of services, which some of us do by faking compliance and lying our way to freedom. Is this trauma-informed? Is it possible that this kind of double-bind replicates the kind of ‘mad-making’ experiences of trauma?
So often, for consumers with a trauma history, we are faced with an impossible choice:
We can submit to a service that is based in medical models of treatment, and which feels largely, even wholly, unsuited to help us, or
We can fight back
If we submit, we know that this will make us worse. We become more disempowered, we take on board disabling medication effects, like cognitive impairment that we may not be able to escape from. We lose our dignity and self-respect. But if we fight back, (or be ‘non-compliant’), we know that we’ll face restrictions and force that will be traumatising and make us worse.
These are impossible situations. The only way out is to escape and get free of services, which some of us do by faking compliance and lying our way to freedom. Is this trauma-informed? Is it possible that this kind of double-bind replicates the kind of ‘mad-making’ experiences of trauma?
The principles of trauma informed practice are generally well accepted, but with slight variations. I show two versions here, and I prefer the one by SAMSHA because it includes peer support. Without peer support, I may well still be on the pension and heavily medicated and hating myself.
And these are the common contraindications to the principles that we see frequently in clinical mental health services. I cannot see a way that it is possible to embed these principles authentically until we eliminate all the contraindications in the right hand column.
I know this might feel confronting for you all to hear.
I know that you chose to become a mental health clinician in order to help people.
And what I’m saying may not sound very helpful at all.
I am not speaking today with the aim of making you feel bad. Don’t do that. Instead I am speaking with the aim of motivating you:
I have worked with too many clinicians not to know that for the vast majority of you, your intentions are good.
Like Maya Angelou said, do the best you can, until you know better.
So this is what I ask: Work with us, help us to have our say, so that, together, we can know better, and eventually, we can do better.
There are a whole lot of prerequisites before the clinical mental health sector can do trauma-informed practice. I am not sure if these prerequisites are even possible… many days I would much rather just see us create a trauma system to replace most of the mental health system. It would be entirely different: voluntary, in the community not health settings, the workforce would be entirely different, the services and assumptions and concepts would be different too.
But we also have to work with what we have today.
The things on this list are not a complete list. And doing them won’t bring us trauma-informed practice, but they will move us closer towards it. Closer to be being more helpful and less harmful. I have selected things that you can each do as individuals, rather than dramatic big things that governments must do. Because we also need to address discriminatory and harmful legislation, funding, workforce issues and much more.
If the only thing you can do is step 1, it could make an enormous positive impact on people’s lives
If you see the kinds of examples of co-opting that I shared today, or new ones, call it out. This is too important to get it wrong.
Providing information is one of the simplest changes you could make. Because so many of us have never even disclosed our history of trauma, there is a lot we don’t know about how trauma can impact us. I was 40 before I learned about grooming, and suddenly so much of my experience made sense. Think about how you can make information available to people, even if it’s just a brochure stand.
The lack of therapeutic skills is one of our biggest issues in the mental health workforce. We’ve become so medicalised it’s almost like we’ve forgotten why we're here. How can a clinical mental health service have less therapeutic skills than someone I can see in my community? We have to change this across the system – but you can also change this for yourself. Take a course, read up, get good supervision.
Learn everything you can about trauma and about emotions. These are the reasons most of us are at your services, so you should know this stuff.
Stand with consumers by being a genuine ally. Stand against harmful practice in your service, and model positive change.
Psychiatry might have a lack of ‘evidence-based’ approaches for trauma informed practice, but we survivors actually know quite a lot. So do some of those trauma specialists who work with us in different settings. We don’t have to start from scratch. Learn about approaches that people find helpful outside of your services, and think about ways to incorporate them.
But the bottom line is this: if you use compulsion or think you are acting in our best interests, then you have already hurt us. If consumers are not safe, both psychologically as well as physically, then you are not trauma informed.
There is more information about some of these ideas in the additional reading section.
Thank you for sitting with my challenges, and for welcoming me into this space. I hope we get many more opportunities to speak again.
If you worked in women’s health you would probably take a course in women’s studies or gender studies. If you worked in LGBTIQ health you would want to study queer theory. Yet almost no one in mental health even knows about Mad Studies, or takes time to understand the consumer movement. If you want to be helpful to us, then please, take time to get to know us. Out of your services, take time to read and enquire and learn. Most importantly, have conversations with us. The consumer movement is not going away.