Why We Need Trauma-informed Care in Mental Health Services – Highlights from RCPsychIC 2019
This article is based on the talk by Ms Jemima Olchawski at RCPsychIC 2019. Jemima is the Chief Executive of Agenda, the alliance for women and girls at risk.
1. More than 50% of women with a mental health problem have experienced violence and abuse, and for those using mental health services, trauma is the norm. AGENDA is an alliance service for women and girls at risk, who campaign for services and systems to be transformed, raise awareness, and ensure that the right support and protection is provided to those in need. [Agenda]
2. Within the professional services, it is important to recognise differences in the experiences of both women and men to respond appropriately, and traumatic events are experienced more frequently by individuals in marginalised groups.
3. Statistics from the Adult Psychiatric Morbidity Survey (APMS) reveal that one in five women has a common mental disorder, and one in five women and girls admitted to mental health units is physically restrained. Importantly, the rates of restraint vary widely.
4. In children’s services, girls are more likely to be restrained than boys, and more likely to be restrained face down. This practice has the potential to re-traumatise women who have suffered violence and abuse, causing humiliation and instilling fear. Often, the restraining is done by men, and for women and girls who have been harmed by men, this may be especially re-traumatising. Alternative de-escalation techniques working in a trauma-informed way are necessary, and successful policy change has resulted in increased accountability and transparency in the use of restraint.
5. To deliver effective support, practitioners need an awareness and understanding of the history behind a woman’s experience of trauma and abuse. A survey showed that only 13 of 35 mental health trusts who responded had a policy on routine enquiry – a requirement of NICE guidelines to ensure trained staff ask people about domestic violence and abuse.
6. However, the support to back up disclosures by women is lacking, leading to routine enquiry not being carried out, and ultimately, no information on which to base an appropriate response.
7. Recognising the prevalence of trauma should encourage trained staff to ask the question appropriately and then help provide the support needed. As women’s trauma histories are unknown, a trauma-informed overarching approach should be adopted, which assumes that all those in mental health services are likely to have experienced trauma. This approach is unlikely to cause harm to those who have not experienced trauma but could have real benefits for those who have.
8. There are concerns around UK legislation which may be putting women at risk, for example, where a perpetrator of abuse is classified as the ‘nearest relative’ allowing an abuser to obtain information on the location of an abused woman. This lack of consideration of women’s needs can have devastating consequences, and a review of the Mental Health Act has called for alternatives to the ‘nearest relative model.’
AGENDA Alliance for Women and Girls at Risk. Available at: https://weareagenda.org/. Accessed 31 July 2019.
Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. NHS digital website. Published 29 September 2016. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014. Accessed 31 July 2019.