Trauma is often closely tied to substance use, mental illness, stigma, health care access barriers, and other challenges. Trauma-informed practice means recognizing this link, making sure that people feel safe and are not re-traumatized by their care.
We recognize the strong link between trauma and mental health and substance use challenges in patients and clients across BC Mental Health and Substance Use Services. Most of our patients and clients have experienced traumatic events — often more than one.
We also recognize the effects of trauma in the circumstances and challenges that bring people to us. Besides affecting mental wellness and substance use, trauma can also trigger reactions such as self-harm or aggression that may make someone's health challenges worse, deepen stigma, create barriers to health care and employment, and even contribute a conflict with the law.
In light of this, we have implemented trauma-informed practice principles across the organization. This means that our leaders, physicians, and clinical and support staff are all sensitive to the effects of trauma, and work to avoid re-traumatization and make sure that all of our clients and patients feel safe and supported. We also advocate for using trauma-informed practice principles in mental health and substance use treatment programs across British Columbia.
We follow trauma-informed practice principles as defined by the Substance Use and Mental Health Services Administration (SAMHSA), known as the Four R's:
- An organization-wide realization, or understanding, of how trauma affects people.
- The ability to recognize the signs of trauma.
- A system-wide response to trauma that informs all behaviours, language, programs, and policies.
- Resisting re-traumatization of patients, clients and staff. Organizations can unintentionally create conditions that will re-traumatize people.
More information and guidance about the Four R's and trauma-informed practice is available in the Substance Use and Mental Health Services Administration's trauma-informed practice manual, called SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach.
We also use and recommend these two resources:
While some of our clients' and patients' care plans include trauma-specific therapy, BC Mental Health and Substance Use Services' approach to trauma-informed care is much broader than individual treatment options. In all interactions with our clients and patients, our administrators and health care workers work to provide a strengths-based safe place for growth and healing that focuses on recovery and resiliency, regardless of the type of trauma a person has experienced.
This trauma-informed approach 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 also informs the care model and many of the design choices for the province's new Centre for Mental Health and Addiction, scheduled to open in summer 2021.
Our approach to trauma-informed practice 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
This approach, in which clinicians acknowledge what has happened, allows clients and patients to be more engaged in their care.
- To increase awareness among staff, physicians, clients and mental health practitioners across the province of the prevalence of trauma and the impact it has on mental and physical health and substance use.
- To increase knowledge of trauma-informed principles and practice among all mental health professionals within our programs, PHSA and other health authorities.
- To increase capacity among our mental health practitioners to better serve people affected by violence and trauma and improve outcomes for patients, clients and families.
- To create safer environments for our patients, clients, staff and physicians by enhancing physical safety in care settings and interpersonal safety through all interactions.
- To provide patients and clients opportunities to engage by giving them choices, chances to collaborate, and make safe connections with other patients and clients staff, physicians, loved ones and community members.
- To empower patients and clients by recognizing their strengths, fostering resilience and believing in their recovery.
Current trauma-informed practices at BC Mental Health and Substance Use Services include the following:
We have rolled out therapeutic and relational security at the Forensic Psychiatric Hospital, which is increasing awareness and understanding of patient triggers and how clinicians may respond, reducing patient reactivity and aggression. To learn more, visit our therapeutic and relational security page or download the See Think Act workbook, produced by the U.K.'s Royal College of Physicians. You can also watch this video:
All PHSA staff participate in San'yas Indigenous Cultural Safety Training to help them provide culturally safe care to Indigenous patients and clients, many of whom are struggling with historical and intergenerational trauma.
We use a number of trauma-informed policies and procedures to make sure our clients and patients feel safe and to avoid re-traumatization. For example, we use the least restraint necessary at the Forensic Psychiatric Hospital. Also, when clients at the Burnaby Centre for Mental Health and Addiction or the Heartwood Centre for Women return from a day pass, while we do search their belongings, we do not subject them to a full-body search.
When patients and clients arrive at the Burnaby Centre for Mental Health and Addiction or the Heartwood Centre for Women, we help them identify triggers and situations that may cause them to react. A resource called the Calm, Cool, Collected Tool identifies positive coping strategies for them to use during their treatment.
Following this, we help many of our patients and clients create comfort plans, which help them recognize and respond to distressing situations. We're also creating comfort kits, which are made up of personal items that help a client feel grounded, such as essential oils, toys or a blanket.
A comfort room at the Forensic Psychiatric Hospital is a place patients may visit when they are feeling triggered or upset. A calming sensory environment helps clients feel more relaxed, safe and secure.
As we build the B.C. Centre for Mental Health and Addiction, we're considering trauma-informed practice in every aspect of the building design. Examples include the following:
- 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.
- 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.
We share regular trauma-informed practice tips in staff and physician newsletters, recognizing those who have implemented trauma-informed care well.