This leading-edge approach to client interactions extends to all of our programs, including the Forensic Psychiatric Hospital, the Burnaby Centre for Mental Health and Addiction, the Heartwood Centre for Women, Correctional Health Services and others. It is also informing the care model and many of the design choices for the new B.C. Centre for Mental Health and Addiction, scheduled to open in summer 2021.
Many BC Mental Health and Substance Use Services clients have experienced trauma. At some of our facilities, including the Forensic Psychiatric Hospital, nearly all clients have histories of trauma. This can have a significant impact on substance use, mental health and behaviours. Trauma-informed practise (TIP) takes all of this into account.
“Patients are more responsive because it’s an acknowledgement of what’s happened to them,” says Barb Langlois, the director of inter-professional practice at the Forensic Psychiatric Hospital. “The approach is more collaborative and more patient-centred. Care is guided by thoughtful questions, thinking about what the clients have gone through, and giving them choice.”
“TIP provides organizations with aspirational goals for clients as well as staff,” says Terri-Lee Seeley, the clinical services manager at the Heartwood Centre for Women. An in-patient substance use and mental health treatment program located at BC Women’s Hospital, Heartwood cares for women, including trans women, 19 years and over from across B.C.
The women live with severe and concurrent substance use and mental health disorders such as depression, anxiety, bipolar disorder and schizophrenia, and often other chronic diseases. “TIP influences how we work with everyone—clients as well as colleagues—including physicians, nurses, allied health professionals, housekeeping staff and security staff,” says Seeley.
TIP is guided by six principles:
- Trust and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice and choice
- The importance of cultural, historical and gender issues
“We expect all staff members to be trauma-informed in how they interact with our clients,” says Jane Sun, the director of inter-professional practice at Burnaby Centre and Heartwood.
Treatment is not trauma-specific. Rather, administrators and health care workers work to provide a strengths-based safe place for growth and healing that focuses on recovery and resiliency.
Under the direction of Susan Good, BC Mental Health and Substance Use Services' executive director of inter-professional practice and patient experience, the program is now advancing an organizational strategy that will enhance and embed TIP in all services. Current TIP-related practices include San’yas Indigenous Cultural Safety Training
, therapeutic and relational security
, policies and procedures that recognize TIP, evaluating programs through a TIP lens, and creating TIP-informed client tools.
Comfort plans are a good example of a trauma-informed client tool.
"Clients fill out a worksheet that helps them recognize and respond to low, medium, and highly distressing states, like green, yellow, and red lights of a stoplight." Sun explains. "The tool, created when the client is feeling well, acts as an anchor to help the client through strong negative emotions, as it can be hard to remember coping skills during periods of distress."
In the comfort plan, the client identifies what grounding strategies they can use, and can also invite ideas from caregivers, family and friends.
Other tools coming soon include comfort kits and passports. A kit is made up of personal items that help a client feel grounded, such as essential oils, toys or a blanket. A passport is a portable version of the kit for day and weekend passes.
The idea is to balance creative solutions with evidence-based practice, Sun says. “We strive to make TIP more than just a buzzword on posters. We want to make it concrete.”
At Heartwood, Seeley has found that a majority of clients want to talk about their trauma and its causes, which include child sexual abuse, sex trade work, intimate partner violence, emotional abuse, stigma from others who don't recognize their mental health condition, and racism.
“We may be challenged by clients’ behaviours when they arrive, and we re-frame the behavior by looking at the root cause. We see that it is rooted in trauma, and we teach clients new coping skills while at the same time recognizing their strengths and positive coping skills,” Seeley says. “We hear clients saying that this is the first time they really feel like they’ve been heard.”
Leaders at the upcoming B.C. Centre for Mental Health and Addiction have taken trauma-informed practice into consideration in every aspect of the building design, says Amir Rasheed, the director of clinical planning and capital projects for BC Mental Health and Substance Use Services.
All client bedrooms in the purpose-built, 105-bed residential treatment facility will be private single rooms with ensuite bathrooms. Each client will be able to control the natural light and temperature in their own room.
“Residents stay here six to nine months, so their room becomes their home. We want to create a personal sense of home for them and give them a safe, personal space in recognition of the trauma they have come from,” says Rasheed.
Other design features, including furniture, fixtures, textures and colours, will maximize client comfort and safety by providing a calm, healing environment. Exam rooms, counselling rooms, admission areas and other spaces will have two ways of entering and leaving.
Additionally, the new centre will be the first building of its kind in the Lower Mainland with lighting that adjusts throughout the day to mimic natural light patterns.
Due to past trauma and addictions, clients often don’t have normal sleep cycles, explains Rasheed. Additionally, anti-psychotic medication has a tendency to affect sleep patterns. In response to both patient needs and evidence-based research, lighting in the public areas will adjust as natural sun patterns do during the day. This dosage of light early in the morning activates the brain’s circadian rhythm to find a natural sleep pattern, and reduces need for medical intervention.