Can Do Healthcare - Thinking Differently Together About Trauma Informed Care

is that the more ACEs you experience as a child, the more likely you are to develop things like heart disease, diabetes, poor academic outcomes, and substance misuse. Whilst the ACEs model can give us early indicators, we must exercise caution about how and where it is used and what the context is so it is used in a balanced way, because much of the current narrative ignores the limitation of the evidence base from which it comes, and not everyone who has an ACE score will live out the ‘predictors’ such as being in prison or having an early death, and ‘dooms’ them to a certain life or pathway. The model can fail to recognise scales of resilience in those who experience trauma. Trauma is a huge subject: it elicits such different emotions in all of us. It can be most simply defined as any experience we have had that has overwhelmed our ability to cope - whether it happened today, yesterday or thirty years ago. There is no scale or benchmark to trauma, and maybe as a system that is what we struggle to cope with. The sheer volume of variables that trauma encompasses challenges our system in its current set-up. The core experiences of psychological trauma are disempowerment and disconnection – when deconstructed, trauma plays havoc with systems of care, protection and meaning that support in our communities and it is the harder option to exercise. For most people who have experienced trauma it remains largely unresolved: it tends to be deconstructed and is pathologised into individual symptoms, because currently, that is how our system is set up to work – it’s no one's fault, it is just the way that it has always been, but that doesn’t mean it has to be the way that it is always going to be. We know loads more now about how trauma impacts us physically, mentally, and emotionally, but our system breaks things up into manageable symptoms like PTSD, anxiety, depression, eating disorders, substance misuse, disordered personalities, behaviours etc. Unfortunately, this means that the preferred approach is a sticking plaster approach, which isn’t effective or efficient and certainly doesn’t have the trauma survivor at the core of it. It often means that trauma survivors get caught in a revolving door of many, many services and have to tell their stories in the context of whichever service they are coming into contact with. Trauma is pervasive, and it finds parts of us as humans to live in, that sometimes we didn’t know we had. This can be lived out through physical pain, unexplained illnesses, emotional pain, distress, self-harm, guilt, shame, dissociation, and grief, to name but a few. Every symptom of trauma has a purpose. Every symptom is a piece of a bigger puzzle – these symptoms contain intelligence and are telling us the story – the whole story, not just the bits we are comfortable with hearing. At the moment we are treating symptoms as problems, rather than purposes or insights across our system, and this needs to change. We have come to place such an emphasis on the traumatic event itself that we have forgotten to look at the impact that it has had on an individual, and individual responses and reactions, including their inbuilt resilience and strength are often discounted as solutions. To reconstruct trauma in our system and for our service users and communities we could validate and recognise its pervasive nature across our communities. • The World Mental Health Survey Consortium reports that over 70% of adults have reported a traumatic event since the age of 18; 30% of those have been exposed to four or more traumatic events in their adult life – at least 20% of those will go on to develop PTSD as a result (N.B. this doesn’t take into account childhood trauma). • We know that 7.5% of our population have experienced sexual abuse before the age of 18, and that 20% of women and 4% of men have experienced some type of sexual assault since the aged of 16. Thinking Differently Together | 2