Is Trauma-Informed Care Really Possible? A Human Rights Issue
Blog Author: Corinne Henderson, Mental Health Coordinating Council, NSW
Speaker: Indigo Daya, Human Rights Advisor, Victorian Mental Illness Awareness Council (VMIAC)
Indigo challenges the audience to consider how being trauma-informed is still the “elephant in the room,” a “wicked problem” that requires significant change as to how services are provided and how practitioners engage with people with lived experience. She suggests that speaking to people “like her” is challenging, portraying herself as frequently being that elephant in the room. Providing a picture of her trajectory towards recovery and healing, she portrays the development of her passion to make a difference as fuelled by a sense of outrage. Quoting Dean Burnett, a Neuroscientist who said that “ saying all mental health problems are the fault of the brain is like saying injuries from falls are the fault of gravity: technically correct, but of no use whatsoever”, she proposes that what practitioners saw and what she felt were two entirely different perspectives. Rarely did those attempting to support her see that the layer beneath her symptoms was the trauma.
Indigo likens trauma-informed care and practice to the Emperor’s New Clothes – “lots of intent but still naked.” Reflecting on some progress that has been made in community sector, she proposes that public services often co-opt the language, but do not understand or reflect the principles and simply “get it wrong”.
Describing what she received from services as opposed to what she needed is clear evidence of the major cultural shift urgently needed to ensure that people are no longer traumatised and re-traumatised by a system that seeks to support them. “People with mental illness lose their rights and are in the double bind of submitting or fighting back,” neither options lead to good recovery outcomes.
Indigo encourages us all to consider the words of Maya Angelou: “do the best you can until you know better, then when you know better, do better.”
Despite the great work being discussed at this forum and the commitment clearly demonstrated by the presenters and audience alike, we all face a challenge to move our endeavours at a pace and ensure that this trauma-informed care and practice approach is fully understood and embedded across service settings and systems.
Developmental implications of Complex Trauma – Infancy, Parenting and the Legacy of Abuse
Speaker: Louise Newman, Director, Centre for Women’s Mental Health, Royal Women’s Hospital & Professor of Psychiatry, University of Melbourne
Approximately 70% of adult mental health inpatients report an early history of trauma, and this puts people at risk of ongoing trauma and re-victimisation. In describing her particular area of work which is women’s mental health, Louise says that characteristically, her clients disclose a wide range of trauma experiences that severely challenge them at a particularly stressful period of their life, especially when new to parenting. Mental health services are not looking at where the gaps are, and Louise reports that we are a long way from embedding a trauma-informed approach, or developing trauma-informed ways of working that are gender and culturally appropriate.
Understanding the social context of women’s experiences, the impact of systemic discrimination and gender-based human rights violations on mental health is vital. Likewise, awareness of the growth of child sexual abuse and DV in a global context, increased rates of exposure to violence, poverty and exploitation as well as the implications for development and mental health understanding is essential.
Services need to develop gender related trauma –informed responses. The challenge for clinicians is to understand the developmental framework. Louise suggests that often strategies like universal screening are implemented when services don’t know what to do with the information. She urges implementation of a whole of system approach; this includes creating a system where people feel safe to disclose, where staff are appropriately trained and supported and where people are not re-traumatised. Such experiences scar people for life, the dysregulation can affect people across the life-span.
The call for action is for all of us to advocate for services with skilled practitioners able to offer an empathic response, where diagnosis is avoided and where people with complex trauma are not labelled because they have experienced a multiplicity of traumas over extended periods of time. Louise suggests that often government policy is ahead of what the system can provide – “we are still at the stage of needing a framework underpinned by evidence.”
These are the challenges for us all working in the sector to bring about practice change across the whole system. We need changes that build safety and enable people to have the right to receive care that is compassionate, that listens to lived experience and that doesn’t throw a range of superficial techniques at clients thinking that this will then tick the ‘we are trauma-informed’ box.