By Blue Knot Review editor Jane Macnaught

This article has been edited for Blue Knot Review, you can read the full version here:
http://onlinelibrary.wiley.com/wol1/doi/10.1111/inm.12344/full

“Paternalistic-driven interventions stemming from the dominant biomedical model cultures in Australian mental health services (Lakeman 2013) are seemingly incompatible with TIC principles (Elliot et al.  2005). Consequently, a key barrier to embedding TIC into inpatient units is that the adoption of recovery into these settings is incomplete. While MHN widely understand the features and principles of recovery, within the context of inpatient care, most see it as commencing at the point of discharge from the unit into a community setting (Cleary et al.  2013). Thus, nursing interventions and cultures are focussed on preparing the consumer for recovery through more biomedical model-style interventions, such as medications (Cleary et al.  2013). Embedding recovery, choice, and control has traditionally been identified as ‘too risky’ by clinicians within the context of acute mental health settings (Harris & Fallot 2001). A lack of alternative interventions or workforce capability to deliver alternative interventions, and an unsatisfactory understanding of the impact of trauma has meant that staff members have traditionally adhered strictly to protocols to ensure their safety (Chandler 2008). However, mental health services do a disservice to themselves by failing to provide trauma survivors with the opportunity to maximize their choices and control their treatment goals (Elliot et al. 2005).” p.14-15

 

Abstract

“Trauma-informed care (TIC) is increasingly recognized as an approach to improving consumers’ experience of, and outcomes from, mental health services. Deriving consensus on the definition, successful approaches, and consumer experiences of TIC is yet to be attained. In the present study, we sought to clarify the challenges experienced by mental health nurses in embedding TIC into acute inpatient settings within Australia. A systematic search of electronic databases was undertaken to identify primary research conducted on the topic of TIC. A narrative review and synthesis of the 11 manuscripts retained from the search was performed. The main findings from the review indicate that there are very few studies focussing on TIC in the Australian context of acute mental health care. The review demonstrates that TIC can support a positive organizational culture and improve consumer experiences of care. The present review highlights that there is an urgency for mental health nurses to identify their role in delivering and evaluating TIC, inclusive of undertaking training and clinical supervision, and to engage in systemic efforts to change service cultures.” “They found that interpersonal processes were integral to consumers’ perceptions of MHN care, with the therapeutic relationship the single most important predictor of consumers’ satisfaction (Clark et al.  2008).” p.3

“The themes from the present review suggest that while being distinct constructs, both TIC and recovery need to be adopted by MHN for either to be fully effective for consumers.” p.14

“Service policy that enables this passing of control and enhancement of consumer choice, and supports staff to do so, will of itself change the very culture of the services, with service culture and caring practices being mutually embedded (Lakeman 2013). As Chandler (2008) noted, passing control to consumers is part of the service’s transitional journey under TIC. The key differentiation between TIC and that of recovery or person-centred care is that TIC requires staff to look for and understand the connection between childhood trauma and adult psychopathology as a means of understanding consumer behaviours. (Elliot et al.  2005). The findings from this review indicate that TIC education and training can be an effective mechanism by which to embed TIC and promote recovery-based therapeutic relationships with consumers. TIC education offers an explanatory model for consumer behaviour that can manifest in the daily working life of acute inpatient MHN.” p.15

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