Mental Health Staff's Understandings of the Barriers and Facilitators to ‘Trauma Informed Services’

Background: The concept of trauma-informed services has been developed over the past twenty years and is growing in popularity. Trauma-informed approaches to service-delivery work on the understanding that a large proportion of the population have experienced trauma. There is substantial literature outlining the benefits of trauma-informed services to both clients and clinicians. Several authors and organisations have produced literature outlining how services can become trauma-informed. Much of the literature emphasises that trauma-informed changes must be led from the top-down. However, as not all services have made the ‘shift’ to become trauma-informed there are many staff who work to advocate for trauma-informed changes in, currently, trauma uninformed services. The barriers that they have encountered in advocating for trauma-informed services have not previously been studied.
Aims: This research explores the perceptions of staff who are advocating for trauma-informed changes. It aims to explore how these staff perceive traumainformed services and their perceptions of the barriers and facilitators to their development.
Methods: Semi-structured interviews were carried out with fifteen mental-health staff working in NHS and non-NHS services. A range of services and professional
orientations are represented in this study. Interviews were analysed using Thematic Analysis. A non-standardised questionnaire about the barriers to trauma-informed services was also completed by participants to provide supplementary descriptive information.
Results: Four main themes were generated, ‘Defining qualities of traumainformed services’, ‘Individual-level factors’, ‘System-level factors’ and ‘Advice for change advocates’. Sixteen sub-themes were categorised under these themes.
Conclusions: The themes extracted from interviews highlight the personal investment that participants have made in their efforts to develop traumainformed services. The barriers and facilitators to trauma-informed services were often seen as interacting and overlapping. The work of these participants was facilitated by individual-level factors such as participants’ persistence, passion for the work and the inspiration gained from clients. Connections with allies both inside and outside of services were also perceived to be a facilitator. Managers were perceived as both barriers and facilitators but gaining management buy-in is suggested to be an important role of change-advocates. Additionally, sharing research with managers and colleagues was perceived to be a helpful strategy.
Perceived barriers included the prevalence of the medical model, misunderstandings about what the trauma-informed model is and staff burnout. Participants shared advice and encouragement for individuals wishing to make trauma-informed changes to their services. This advice can be summarised by eight points: 1- Don’t give up, 2- Look after yourself, 3- Get management on board 4- Stay connected to allies, 5- Be patient, 6- Be tolerant of different opinions, 7- Make use of research, 8- Be strategic.