What being trauma informed means to me personally as well as our Trust.

As someone who has lived experience of adverse childhood experiences and violent trauma, I can personally appreciate the impact that traumatic experiences can have on your life. I am fortunate enough to have worked through my various traumas in a way that enables me to manage triggers, and focus my lived experience through a lens of enablement. My experiences have shaped my values, and in turn they have helped to shape my ability to empathise with others. These experiences have led me to dedicating my career and time to help other people, and to actively confront social injustice. Being trauma informed isn’t just about understanding, or aligning to good intent. It is about a fundamental underlying value of respect, compassion and understanding the unique experiences that people live through. TIC is not just about interpersonal communication skills. It is about fundamentally questioning the premise upon which we provide care to others – focusing on what they have experienced, and how it impacts their lives, rather than trying to compartmentalise and define what “is wrong” with people. This is the challenge for us at EPUT.

How I feel trauma informed care (TIC) affects our service users and our staff and the importance of creating a trauma informed environment.

Our staff, our policies and procedures, our leadership, the way we engage and support staff, and the way we provide services are all needing scrutiny and transformation toward aligning, as far as we can possibly manage, with these values. TIC is not just about identifying trauma experiences and their triggers; it is about recognising that adverse experiences can have a lasting effect on shaping our experiences – and that is true for staff, service users and their families. It is understanding why some people are able to be resilient, whilst others are vulnerable, and the limits of these. It is about respecting experiences as unique, not making assumptions, and ultimately being able to respond to contextual personal needs rather than defining human experiences as “illness.”

How we are working towards being a trauma informed Trust.

There is an overwhelming desire for change across the board. Staff and service providers generally are doing their jobs because this work aligns with their values, and are trying to find a way to manage the challenges that threaten to overwhelm their ability to do this. Being trauma informed, and adopting changes that support their efforts to do this will end in better care for our patients, and more fulfilled and satisfied health care workers. The Trust has committed to becoming a trauma informed care provider. There is a strategic plan to enable this, and so far the engagement and start to change practices and procedures has been excellent. We are in a process of trying to use a standardised way to identify what we do well, and where the gaps are, so we can assist the many projects and changes around our services to develop into a meaningful transformation. This takes time if done properly, and well. We envisage that we will see fundamental changes over the next couple of years. Positively, our system partners – commissioners, VCSEs and other Trusts – are also keen on making these changes across Essex. The 45+ organisations across the social care, voluntary and charitable and statutory health landscape that constitute the South East Essex Trauma Alliance is evidence of this.

What trauma informed care (TIC) means to me, both personally and within the South East Essex Trauma Alliance.

I feel compelled to begin with a concern, which I hope can also be protective of what TIC aims to represent. TIC is a phrase that a few years ago was rarely heard. Currently it has become the practice that more and more people know is helpful, perhaps not always with the awareness and understanding needed to realise its potential. TIC is not a trend, so it should not become a go to phrase to veneer any practice or environment or experience. TIC is integral to good care, and arguably life-saving let alone life-changing. But TIC also poses a challenge in that it is something felt and shared that people know when they connect with it. It’s therefore not formulaic or easy to define. But when we achieve trauma responsive care it’s a potent enabler for incredible things.

Some years ago I personally experienced a damaging trauma inducing series of interactions from a healthcare professional. At a time when I was vulnerable, in a potentially life threatening situation, I experienced stigma and professional shaming. Now, when I reflect on that time I most saliently recall how awful I felt given the professionals  attitude and behaviours. That’s become my reference point of that time, and not the actual situation I was in. I find that both incredible (for all the wrong reasons) and insightful. A professional caused me harm, probably unintentionally,  and this then impacted on my willingness to receive further care, which could have caused even further damage. I now use those experiences as my source navigator to drive authentic TIC growth because I so readily remember the impact and influence we can all have, for better or worse. I am grateful that my role enables me a platform from which to influence at a community level alongside others. I hold a deeply felt sense of responsibility to do something meaningful with that privilege.

TIC is something much needed by all, that has to be woven around people in a principles driven way. It requires a willingness to be authentic and humanising in everything we do. I enjoy the challenge of that. My involvement with TIC at a community level, as part of a local alliance, emerged from rich and lively conversations with people accessing services, colleagues and people with a shared sense that service offers can end up making things worse, even when our intention is to help. I have repeatedly felt tensions in knowing that so many people can’t even reach the front door or remain in services because of significant trauma loading and he respond (or fail to respond) to that. My journey in advancing place based TIC continues to be one of the most inspiring and valuable experiences of my career.

How I feel trauma informed care (TIC) affects our service users and our staff and the importance of creating a trauma informed environment.

To be human is to know pain and suffering through traumatic experiences. The nature of these will be very different for everyone, but the experience of feeling unsafe and vulnerable is universal. Layers of trauma create patterns of engagement, for both people accessing services and people delivering them. Being brave enough to grow awareness of this is essential, and needs a community of allegiance to steer with momentum. When TIC is wrapped around trauma soaked worlds it enables people to keep going and cultivate hope for change. It’s possible to retain hopefulness in spite of adversity, with ever more empowered outcomes becoming available. Bearing witness to this is remarkable. And when we get TIC well matched to staff needs our workforce becomes safer, more compassionate and more motivated to be the very best we can be. TIC is the synergy of pain and growth. Its arguably our greatest asset in being the best we can be through constant learning.

How we are working towards being a trauma informed Trust.

I increasingly notice investments in TIC throughout EPUT. At an organisational level we are thinking differently. We’re more prepared to be brutally open about what needs to change as well as making space to notice examples of fantastic practice. I think EPUT is increasingly holding itself accountable and committing to changes that can effect trauma reducing experiences. Some services are significantly investing in shaping their delivery around trauma informed values. And the Trauma Alliance has welcomed invitations to share our learning, both nationally and internationally, in relation to TIC and systems based culture shifts. I am assured that we are not seeking training alone to be the agent of change in this work, given the need to weave reflective practice and thinking minds through TIC development. I identify a seriousness and commitment to harness TIC throughout EPUT. I witness a willingness to pause and infuse TIC in so many areas such as the language we use, how we strive to make sense of experiences and seeking compassion to foster safer spaces. We have a long journey ahead and I respect the appreciation of this. What we continue to invest in together, everyone both delivering and receiving services, will define how we become a trauma informed Trust. I’m excited and grateful to be part of our journeying towards TIC defining EPUT provision.

These two images (A Treasure Box for Creating Trauma Informed Organisations, Dr Karen Treisman, 2021, Jessica Kingsley Publishers) represent so much of what I consider TIC to be. They’re both loaded with our inherent responsibility to invest in TIC, both for the people we work with, for our colleagues and for ourselves.  They represent a call to action in doing things differently, and when we move ever more towards TIC being infused throughout EPUT culture well have cultivated enabling and transformative organisational change.

What trauma informed care (TIC) means to me personally as well as professionally as part of the Crisis response service?

To me, trauma informed care is about understanding that trauma can impact a whole person, their mind, their body and the way they interact with the world. It is about professionals creating a service that is accessible and where a person feels safe, one that recognises the signs and effects of trauma, promotes psychological and physical safety and takes steps to avoid re-traumatisation.

Trauma informed care uses the knowledge that most mental health service users have experienced trauma in their lifetime to develop effective relationships and service delivery, so that everyone can be active participants in their recovery rather than passive recipients of care.

To be trauma informed or trauma sensitive is about working with people and empowering them to make choices. It is about asking me ‘what do you need right now’ rather than ‘what is wrong with you’; looking past my behaviour or my risk and seeing the person beneath. When I am unwell, my behaviours may seem dangerous, unexplainable or destructive, but actually, they are responses to distress; my way of coping in that moment to try and stop me from becoming completely overwhelmed.

It is about recognising that mental health services are typically viewed as physically and emotionally unsafe settings for a survivor of trauma. This could be because of the power dynamic between the person requiring or seeking support and the person that is giving it, particularly for someone that has experienced abuses of power.

Approaches to distress, though on occasion unavoidable, can be re-traumatising. Re-traumatisation involves the re-emergence of symptoms previously experienced because of trauma even though the event itself may not be traumatic. For me, things that can be re-traumatising include groups of staff approaching me when I am in distress, having males on my observations, hearing or seeing emergency services and having unexpected knocks on the door at home. It is vital that when restrictive practices are used, I am given as much voice and choice as possible and offered an opportunity to reflect and debrief.

What has worked well for me.

For me what has been helpful as a patient is feeling heard and being able to have a sense of control. This has included during periods where I have required extra support, being able to have female only observations, particularly in my bed area. This meant that although something very restrictive was being used, I could at least have a part in the decision making. Although it has had to involve a whole MDT discussion and disclosing my trauma, I have also been able to have my Oxevision, vision based patient monitoring system (VBPMS) turned off in my room, this promoted a sense of safety and privacy.

The stand out intervention was during my last inpatient admission where I was able to, with the support and encouragement of the ward management team, create a template that was in the office and on my bedroom wall. This served as an opportunity to engage in something that distracted me, but also empowered me to have a degree of control as to how staff worked with me and how I worked with them.

The sheets included things about me as a person beyond a patient, ways to help de-escalate me, calming strategies and behaviours of the staff working with me that would make me feel powerless. It listed some of my triggers; for example, "feeling restricted or trapped. Feeling that I am not being given choices" and identified particular phrases e.g "Why do you do that to yourself" and "calm down". I also recognised that I display 'high risk and challenging behaviours' but asked staff to try and not be nervous around me, as when they convey that they cannot support me to stay safe I feel I cannot support myself." This was respected by all of the staff that worked with me and was a  ‘live document’.

How I feel trauma informed care (TIC) affects our service users and our staff and the importance of creating a trauma informed environment.

Trauma informed care is vital for us to work together as partners. It affects service users and staff outcomes as we start to reframe the ‘unexplainable’ ‘dangerous’ and ‘risky’ as coping strategies used by a person to manage difficult thoughts, feelings and memories.

If we create trauma informed environments, everyone is able to participate. Outcomes are improved, because we do not just focus on the person’s ‘presenting problem’, but on promoting physical, psychological and emotional safety. It lets us work together to identify needs and goals and make choices about treatment.

Recognising a person’s life experiences promotes engagement, treatment adherence and attainment of the person’s goals. As many as 70% of people will experience trauma in their life time, we know that that those that come to the attention of mental health services have an even greater likelihood of experiencing it, but staff themselves also come with their own histories and vulnerabilities; ultimately trauma informed care is better for the wellbeing of everyone, staff and patients and society.

Final thoughts.

I think Trauma Buddy is a great approach that will allow us all to work together, staff and patients as well as those like me who fit into both categories; there is no us and them! I particularly like the passport, as it’s vital that people are given the opportunity to disclose ‘what happened to them’ and to feel safe to, if they wish to, that decision should ultimately be up to them. What matters most is that they are supported to identify things that bring back trauma symptoms and that staff recognise this and avoid practicing in a way that can do more harm than help.