How Trauma-Informed Care Is Changing Psychiatry

Several months ago, I reported on a groundbreaking study that has the potential to transform inpatient mental health care. The lead researchers (Consultant Clinical Psychologist Dr. Faye Nikopaschos and Gail Burrell, Borough Director and Trust-Wide Perinatal Lead) helped staff and patients undertake a paradigm shift in how we think about mental illness.

Specifically, they encouraged staff and patients to think about mental health problems as understandable reactions to crisis – rather than as a symptom of a disorder. Trauma‑informed approaches view mental health problems like depression, anxiety, and psychosis as meaningful responses to traumatic experiences.

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Consider depression. In the 1980s, psychiatrists commonly understood depression as little more than a chemical imbalance in the brain. In contrast, an emerging framework sees depression as your mind’s designed signal that something in your life is going wrong and needs to change.

Or consider the traits associated with borderline personality disorder (BPD), including volatile interpersonal relationships, impulsiveness, and self-harm. Although some psychiatrists see BPD in terms of executive dysfunction, a growing number of psychologists understand it as a survival strategy prompted by trauma.

We can even extend this conceptual shift to thinking about symptoms associated with schizophrenia, such as delusions or hearing voices. Many mental health professionals now consider delusions to be coping mechanisms for stress, and hearing voices as the mind’s attempt to navigate trauma.

But how might such a conceptual shift actually help patients on the ground?

Why did it work?

Over a four-year period, in two mental health units in London, researchers held a series of training sessions with staff members on trauma-informed care.

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Among other things, they taught them the Power Threat Meaning Framework (PTMF). PTMF was developed collaboratively by psychologists and former patients. It views mental health problems as responses to power and context, rather than diseases or disorders.

They also held a series of teaching sessions with patients on psychological stabilizing techniques such as mindfulness.

The introduction of these new perspectives had surprising and positive results. These included:

• A significant drop in the need for restraints and seclusion
• Improved relationships between patients and staff
• A decrease in self-harm among patients

Since then, the lead researchers conducted a follow-up study. They wanted to go beyond merely showing that the perspective shift worked, to how.

The follow‑up study explored this question through interviews with staff and patients. Their accounts shed tremendous light on the real motor behind the change.

For staff, several themes stood out. These included:

• A new framework linking trauma and distress: Staff began to connect patients’ current struggles with past experiences. One nurse reflected, “You focus on what they’re feeling rather than on symptoms and diagnosis … the [PTMF] framework helps to understand them as individuals and address what’s behind the diagnosis.”
• Distress as a threat response: Staff began to see behaviors not as ‘symptoms’ but as survival strategies. As one participant put it, “You might look at something as challenging behavior, but when you…tie it in with all their experiences throughout their life, it makes so much more sense.”
• Changes in practice and engagement: With this new lens, staff reported greater compassion for patients and a greater ability to de-escalate conflict. They also became more aware of how ward routines, like seclusion, could re‑traumatize patients.
• Talking about the past: staff felt more empowered to ask patients about their past, rather than medicate and manage them. This went hand in hand with the idea, common in trauma medicine, that instead of asking “what’s wrong with you?” we should ask “what happened to you?”

For patients, two themes emerged:

• The benefits of stabilization techniques: Patients described learning practical skills, such as breathing, mindfulness, and self‑compassion, that helped them manage distress.
• Trauma‑informed care aided recovery: Patients felt their stories were heard and their experiences were validated. One said simply, “I felt like an individual not a tick on a sheet.”

Together, these accounts suggest that the success of trauma‑informed care was not just about improved methods. It was about improved ideas. Staff and patients alike began to see distress as meaningful, rooted in life experience, and worthy of compassion.

Beyond the disease model

The introduction of the PTMF and trauma‑informed counseling isn’t just another method added to psychiatry’s toolkit. It heralds a major conceptual change in how we understand and respond to mental suffering.

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Since the 1980s, psychiatry has been dominated by what we might call a ‘disease‑entity’ model of mental health problems. In this model, depression, anxiety, hearing voices, panic attacks, and so on, are symptoms of a malfunctioning brain or a hypothetical chemical imbalance.

While this medical perspective has brought some relief to suffering patients, it also carries downsides: increased stigma, debilitating side effects of medications, and a tendency to see people as broken rather than responding to life’s challenges.

The results of these studies suggest another path. Help can be offered without treating problems as diseases. Instead, distress can be understood as a meaningful response to power, threat, and context.

As I argue in my forthcoming book, this shift invites us to move beyond diagnosis to stories, and beyond management toward compassion.