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Is trauma informed care really possible in mental health services?

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Keynote talk delivered at the 2018 Summer TheMHS Forum, in Sydney, Australia. Talk by our Human Rights Advisor, Indigo Daya.

While we know that trauma is a critical issue for most mental health consumers, we are also concerned that changes intending to implement trauma-informed practice are not always addressing the need. We highlight major issues to be resolved when considering the implementation of trauma-informed practice. This is too important to get it wrong.

Published in: Healthcare
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Is trauma informed care really possible in mental health services?

  1. 1. www.vmiac.org.au Is trauma-informed practice really possible? Indigo Daya Human Rights Advisor, VMIAC Adjunct Research Fellow, Swinburne University TheMHS Summer Forum 2018
  2. 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. 3. Is trauma the elephant in the room of mental health? Does trauma-informed practice feel huge & overwhelming?
  4. 4. Perhaps we can sit with the discomfort of major change… And even very different perspectives…
  5. 5. A bit of my story
  6. 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.
  7. 7. ‘Psychotic’, ‘Borderline personality disorder’ ‘At risk, lacking insight’ (hearing voices, suicidality) Terrified, despairing Shame Memories, triggers, overwhelm Self-judgement & self-blame Self-loathing Devalued core identity ‘I am evil’ ‘Mentally ill’ medicalemotionaltrauma
  8. 8. Containment Observation Diagnostic labels Force Pills Humiliation Seclusion Disability Poverty ‘Chemical imbalance’ myth Injections Punishment Shock treatment Memory loss Obesity Sedation Fear, mistrust, despair Compassion Comfort People like me Practical help Coping skills Respect Choice Empathic listening Courage Acknowledgment of trauma Therapeutic exploration Making sense of experience Finding myself innocent Safety, trust, hope Human rights
  9. 9. Is trauma informed practice possible?
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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
  19. 19. The double-bind created by mental health services often replicates our original traumas
  20. 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. 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. 22. “Do the best you can until you know better. Then when you know better, do better.” MAYA ANGELOU
  23. 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
  24. 24. www.vmiac.org.au Indigo Daya Human Rights Advisor Contact p 9380 3900 e indigo.daya@vmiac.org.au Indigo Daya @IndigoDaya Indigo Daya BLOG www.indigodaya.com
  25. 25. Further reading ‘The time is always right to do what is right’ Martin Luther King
  26. 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
  27. 27. Learn about our movement
  28. 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. 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. 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)
  31. 31. https://youtu.be/0nUjbFGOKNg WorkSafe Victoria video https://youtu.be/fMPr9rs2ooQ ConsumerSafe video Try to see it as we do…

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