First-step for Developing Trauma-informed Care: Patients’ Report of Traumatic Experience and Posttraumatic Stress Related to the Psychiatric Setting

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Authors (including presenting author) :
Kitty K WU, Jamie P CHENG, Joey LEUNG, L P CHOW, Chi-Chui LEE
Affiliation :
Kwai Chung Hospital
Introduction :
Previous research found that persons with severe mental illness (SMI) who had received services in public mental health clinics showed high prevalence rates of trauma victimization (51-98%) and posttraumatic stress disorder (PTSD) (up to 43%) (Cusack, Frueh, & Brady, 2004; Mueser et al., 1998). Evidence indicated that users of psychiatric services reported high prevalence rates of experience of in-situational measures of last resort which included seclusion (59%), restraint (34%) and take-down (29%) (Frueh et al., 2005). Other traumatic experiences (TE) that might occur in psychiatric settings included witnessing aggression (57%) (Fagen-Pryor et al., 2003) or witnessing traumatic events (63%) (Frueh et al., 2005). According to the National Centre for Trauma-Informed Care (NCTIC) of the Substance Abuse and Mental Health Services Administration (SAMHSA), the recovery model and trauma-informed care (TIC) are important concepts in the treatment of persons with SMI. To provide adequate TIC, all members of an organization must understand that every interaction concurs with the recovery process and there is the possibility of re-traumatization during the treatment process. This study aimed at enriching the literature for TIC in Hong Kong by examining patients’ reports of TE after receiving in-patient psychiatric services.
Objectives :
Based on self-report of psychiatric service users with SMI, we studied the prevalence and relationship among the following factors: 1) lifetime TE; 2) traumatic or harmful events during the course of their mental health care in psychiatric setting (TE-PS); 3) features of PTSD, anxiety and depression.
Methodology :
Participants included 129 persons who have received inpatient psychiatric services in Kwai Chung Hospital. TE were examined by the Life Event Checklist (LEC) and Psychiatric Experiences Questionnaire (PEQ). The occurrences of features related to posttraumatic stress disorder (PTSD), anxiety, depression were examined by the Impact of Event Scale-Revised (IES-R); Hospital Anxiety and Depression Scale (HADS).
Result & Outcome :
TE were common with a prevalence of 84.5% according to LEC and PEQ. The most common TE within psychiatric setting (TE-PS) were: 1) witnessing another patient being taken down (61.2%); 2) being put in restraints of any kind (41.1%); 3) witnessing another patient being physically assaulted by another patient (36.4%). Some TE-PS were associated with high prevalence of severe or extreme distress, these included: 1) being forced to take medication against their will (52.2%); 2) being threatened with physical violence (52.2%); 3) experienced a physical assault (50.0%). Symptoms of PTSD, anxiety and depression were reported by 13-27% of the participants. Symptom severity was associated with TE. Present findings provide empirical support on service users' report of TE within psychiatric setting in Hong Kong. To facilitate development of TIC, it is important to start with acknowledging the presence of adversities within psychiatric service. Physical and psychological safety are pivotal for TIC and empowering psychiatric service users to rebuild sense of control.

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