Strand 7. Developing a trauma-informed workforce

Trauma-informed care recognises the impact of trauma on an individual’s health, social and emotional wellbeing. Within the context of mental health care, it aims to deliver care services that will minimise the risk of further trauma. The core principles of trauma-informed care are choice, collaboration, trust, empowerment and safety.

Individuals who have a trauma background may experience:

• emotional dysregulation - difficulty communicating, recognising, managing and expressing their emotions in an adaptive way
• difficulty in communicating, and in recognising, managing and expressing their emotions
• poor peer relationships, social isolation, feeling stigmatised, difficulty in trusting others
• disconnection from others and feelings of disempowerment
• anxiety, hypervigilance and hyperarousal
• difficulty in thinking clearly, concentrating, interpreting the world and other people’s intentions accurately
• cognitive distortions
• physical health comorbidity
• increased risk of self-harm or suicide

In response to this, trauma-informed culture and practice in services should focus on being:

• patient-led rather than service-led
• flexible rather than rules-led
• non-stigmatising and protective of human rights
• cognisant of individual’s past events and the impact these may have on current interactions with staff
• about interactions and interventions that promote engagement and recovery
• non-coercive and without overt displays of authority or power

Evidence suggests that the impact of trauma on mental health (including psychosis, personality disorder and depression) can put individuals who have experienced trauma under further stress if subjected to restrictive, coercive or inflexible practices in hospital. Arming nursing staff and allied health professionals with a range of clinical, interpersonal and therapeutic interventions can help to facilitate both early identification and appropriate intervention, personalised to the needs, risks and strengths of each patient.

Putting guidance into practice

Patient-facing staff should receive education and training on trauma-informed care and practice, in collaboration with every NHS Scotland Health Board’s psychology colleagues. Local health boards are responsible for organising this and for benchmarking practice and culture change.

Ward staff should

• ensure that only core or regular, familiar staff with trauma-informed skills carry out personalised psychotherapeutic interventions as indicated within the patient’s care, treatment and safety plan – this includes unregistered nursing staff and peer support workers who may have these skills, as well as allied health professionals such as occupational therapists or psychologists, and is particularly important when:
• the patient’s clinical needs are complex
• there is the presence or risk of harm or deterioration
• the patient requires personalised interventions or interventions targeted at specific issues such as self-harm
• structure ward activity and/or shift patterns to maximise staff visibility, interaction, therapeutic milieu and continuity of care within the clinical environment
• plan workforces in terms of the resources, staffing, activities and skills required to deliver preventative, early intervention-focused care, treatment and safety to a patient group with increasing complexity and often multiple morbidities
• explore continental (short-day) shift patterns in line with emerging information about the ease of use for core nursing staff, visibility of nursing staff and continuity of relationships, care, treatment and safety planning

For more information, please refer to our From Observation to Intervention (PDF) guidance document.