Our data support the presence and role of trauma in this population, and we see evidence of the need for trauma-informed care. Regardless of diagnosis, patients with serious mental illness and post-traumatic stress symptoms would likely experience benefit in both areas from trauma-informed care.
TRAUMA-INFORMED CARE does not mean only focusing on a specific traumatic incident; successful, trauma-informed care for patients with serious mental illness requires providers to do the following:
1) ASSESS TRAUMA: Recognition of a patient’s trauma can be achieved during the admission process via trauma screening. In fact, the current standards for accreditation by The Joint Commission (TJC) in behavioral health already require the use of such screeners. Current TJC estimates show roughly 95% of patients in accredited inpatient psychiatric programs are screened for trauma.3 Thus, many programs already collect these data, which should be made accessible and incorporated into treatment planning. In addition to admission screening, assessment of trauma and PTSD can easily be performed with the addition of a quick trauma screener, such as the PCL-C-6.
2) Acknowledge trauma: Once assessed, trauma can be addressed with patient psychoeducation and by entering diagnoses or progress notes into the medical record. If PTSD is present in a reduced form, a remission specifier or “not otherwise specified” may also be considered. Inclusion in the medical record provides a history of the patient’s experiences and encourages a clinical focus on all relevant issues. Moreover, noting PTSD in a chart allows the patient a record of his or her history, which encourages the continuation of trauma-informed care at follow-up once the patient leaves the current facility.4
3) Treat trauma: While PTSD can be a recurrent disorder that may not be fully treated in one inpatient stay, it is theorized that co-occurring PTSD and serious mental illness are best treated in conjunction. New evidence suggests popular treatments for PTSD can be used with patients with co-occurring serious mental illness, including psychosis.5,6 Unfortunately, many clinicians report not feeling equipped with the training they need to engage in trauma-specific treatment. Given the high incidence of trauma exposure and PTSD symptoms in the population of patients with serious mental illness, we believe continuing education and training in this area should be a core component of behavioral health care practice.
Ms Nowlin and Dr Brown are data analysts for Mental Health Outcomes, LLC., a subsidiary of Universal Health Services, Inc, Lewisville, TX.
The authors report no conflicts of interest concerning the subject matter of this article. The views expressed in this article are the authors’ own and do not represent the official position of Universal Health Services, Inc. or of its subsidiaries, whose funding supported the data collection and preparation of the article.
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