Why Being Trauma Informed Matters...
/“Trying to implement trauma specific practices without first implementing trauma informed organisational culture change is like throwing seeds on dry land “ Sandra Bloom
Serving on the frontline within a military context may damage people and create scars that are naked to the eye. One thing the last year has shown us all is that the term ‘front line’ is no longer restricted to just a military environment. We are more than a year into a global pandemic that has turned the lives of millions upside down. This has led to a ‘collective trauma’ the like of which we havent seen since WW2. This type of trauma can affect societies, populations of any size, nations, and even has a worldwide reach. One of the unique challenges of addressing Covid related trauma is gaining an understanding of the degree to which it has impacted on lives. There is a concern about contracting Covid, a concern about losing connection with friends and family, a fear of dying and having to be hypervigilant all of the time.
Movie producers over the years have taken the opportunity to make millions out of ‘ war porn movies’ such as ‘ Full Metal Jacket’ ‘ 1917’ and ‘The Deer Hunter’. There are so many movies made about war and soldiers suffering from mental health problems that when you hear the words PTSD your mind can’t help but lead you to think about those that have served in the military. But trauma is far reaching and the impact is devastating. Trauma affects billions of people worldwide every year, In the 2014 Adult Psychiatric Morbidity Survey, 3.7% of men and 5.1% of women screened positive for PTSD. Women aged 16-24 were most likely to screen positive (12.6%). & between the ages of 55-64 it transpires that this was the only age category where men were more likely to screen positive than women.
The definition of trauma is anything that is ‘deeply distressing or disturbing. The definition of trauma is broad because trauma is defined by a person’s subjective experience of it rather than the trauma itself.
Psychological trauma is unique to the person who experiences the event and specifically how overwhelmed they are in terms of their ability to integrate their traumatic experience.
Therefore, a traumatic situation causes psychological trauma when an individual feels psychologically, physically, and emotionally overwhelmed. That “event” can be almost anything: ranging from involvement in a car crash, the death of a relative, childhood bullying, a house fire and/or involvement in war.
The real problem is making sure that everyone can access good quality care when they need it most. Mental Health & Psychological therapies can do more harm than good if they are of poor quality or the wrong type. With long NHS waiting lists, the obvious place for sufferers to turn to is the 3rd sector, which on the whole are usually helpful to people who are distressed, but in a minority of cases when it goes wrong it can leave vulnerable people more unwell than when they first sought help.
Recently I spent over a week trying to organise a care coordination meeting for a Veteran. The details of the case are not what matters here, it is necessarily vague to protect confidentiality.
However, it is fair to say that the end result was a severe deterioration in the mental health of the client with an increased risk to others and self. The client did not trust mental health services , but I felt that the risk issues were so acute that it required a multi disciplinary meeting to share information and pool resources as well as look at statutory involvement. Various professionals were already involved from the health, social care and criminal justice sectors, numerous initial assessments had identified various complex needs however, no one had been allocated to undertake the work, so although it was an open case there had been no service provision for several months.In the mean time my client was trying to actively end their life every other day.
I’m not sure that my involvement did any good at all for the veteran in the end, my client was clinging to life and still waiting for a service to meet their needs. Despite spending hours and hours on the phone and writing emails, it did raise an important question, what if I wasn’t there? What if there wasn’t someone with a title, qualifications and a comprehensive understanding of NICE guidelines to advocate on their behalf to try and get services to do the right thing?
If this is a struggle for the veteran community, then it must be a struggle for society too — yet, we can put and end to this, simply by working together.
It starts with the simple act of changing the narratives of trauma. Trauma affects everyone, not just veterans. When veterans see their trauma as being relatable to the wider civilian population, it will reassure them that they are worthy of equitable help and access to services. When civilians see their trauma as being worthy of treatment alongside veterans, it will encourage all trauma survivors to speak up and that can only be a good thing.
In recent years the number of Veterans Charities has steadily increased, in 2019 there were 1,519 registered military charities in the UK, fast forward two years and there are now over 2000. Most Veterans Charities are designed for all adults, age 18 and older, both men and women. This broad-based, support-for-everyone approach might not be as effective as a utilising a trauma informed approach.
For Veterans with PTSD, it is extremely common for their memories to be triggered by sights, sounds, smells or even feelings that they experience. These triggers can bring back memories of the trauma and cause intense emotional and physical reactions, such as increased heart rate, sweating and muscle tension. For a veteran who has been re-traumatised multiple times, either by accident or not, they often report that their trauma-related symptoms get much worse. This creates a barrier to seeking help and support.
This is why veteran specific trauma-informed care needs to be taken seriously. The goal is to help PTSD sufferers in any way possible, not make things worse. This requires a sensitive, and above all, flexible approach to some very real, very serious problems. No one person experiences PTSD the same way, so a cookie-cutter approach will never work.
Trauma-informed care is different in that it does not have any specific rules. The nature of PTSD is so diverse that no one approach will be applicable to two different people suffering from it. Instead, there are six guiding principles that can be adapted and interpreted in ways that make for a better use in the specific setting it’s being employed, and for the individual that needs the help.
Trauma-informed care is based on the understanding that:
A significant number of people living with mental health conditions have experienced trauma in their lives.
People are doing the best that they can.
Trauma may be a factor for people in distress.
The impact of trauma may be lifelong.
Trauma can impact the person, their emotions, and relationships with others.
“Trauma is defined by the impact that an experience has had on the individual… rather than by the event itself.”
Core trauma-informed principles:
Safety – emotional as well as physical e.g. is the environment welcoming?
Trust – is the service sensitive to a veterans needs?
Choice – do you provide opportunity for choice?
Collaboration – do you communicate a sense of ‘doing with’ rather than ‘doing to’?
Empowerment – is empowering a key Veteran focus?
Respect for Diversity – do you respect diversity in all its forms?
To provide trauma-informed services, all staff, from the receptionist, therapists, project workers and support workers, to Trustees and Directors, must understand how trauma impacts the lives of the people using the service, so that every interaction is consistent with the recovery process and reduces the possibility of re traumatisation.
Never understimate the importance of collaborative care and if you nothing else this year do your very best to ensure timely access to high quality, efficiently delivered health care. It is a moral and economic imperative. Promotion of health, prevention of illness and early intervention are needed now more than ever. Veterans charities will continue to play a central, and increasing role in efforts to improve veteran health and wellbeing in the post C-19 months and years that follow.
Paula Edwards
Mental Health Therapist
Salute Her UK Project Lead.
