(Mis)understanding trauma informed approaches in mental health

The Journal of Mental Health has a history of publishing articles that explore the ways traumatic experiences lead to mental distress, and the experiences of trauma survivors (Cooke, 2016; Harper, Stalker, Palmer, & Gadbois, 2008; Karatzias, Ferguson, Gullone, & Cosgrove, 2016; Kucharska, 2017; Mueser & Rosenberg, 2003; Salter & Richters 2012; Xie, Jiuping, & Zhibin, 2017). These articles join other evi- dence demonstrating that large numbers of people in con- tact with mental health services have experienced traumatic events (Khalifeh et al., 2015), that these experiences are causal in the development of mental distress (Felitti et al., 1998; Morrison, Frame, & Larkin, 2003) and that there is a relationship between the severity, frequency and range of adverse experiences, and the subsequent impact on mental health (Dillon, Johnstone, & Longden, 2012). For instance, there is evidence of a strong link between childhood trauma and adulthood psychosis (Varese et al., 2012), and intimate partner violence and depression (Devries et al., 2013). It is also argued that social factors such as poverty and racism can be considered forms of trauma and that traumatic expe- riences are more common within ethnic minority and socially disadvantaged groups (Hatch & Dohrenwend, 2007; Paradies, 2006). This, coupled with evidence of iatrogenic harm in psychiatric services, has led to the development of trauma-informed approaches. Despite growing international interest, trauma-informed approaches can seem fuzzy, complex, something that service providers already do, or a theorised call for practitioners to “be nicer.” However, writing as trauma survivors and aca- demics/clinician, the more we learn about trauma-informed approaches, the more we argue that these approaches have the potential to lead to a fundamental shift in how mental health services are organised and delivered, meaning that they are better able to meet the needs of service users. In this editorial, we will explore the central drivers for trauma- informed approaches, outline the key principles of the approach, discuss some common misconceptions and high- light some of the dangers associated with trauma-informed practices. We conclude by arguing for the need for survivor organisations to have a key role in shaping the agenda.