Please cite this paper as follows: Mental Health Coordinating Council (MHCC) 2013, Trauma-Informed Care and Practice: Towards a cultural shift in policy reform across mental health and human services in Australia, A National Strategic Direction, Position Paper and Recommendations of the National Trauma-Informed Care and Practice Advisory Working Group, Authors: Bateman, J & Henderson, C (MHCC) Kezelman, C (Adults Surviving Child Abuse, ASCA) © Mental Health Coordinating Council 2013 Authors: Jenna Bateman, Corinne Henderson and Dr Cathy Kezelman For any further information please contact: Jenna Bateman Chief Executive Officer, MHCC E: [email protected] T: (02) 9555 8388 # 102 Corinne Henderson Senior Policy Advisor, MHCC E: [email protected] T: (02) 9555 8388 # 101 Dr Cathy Kezelman President, Adults Surviving Child Abuse (ASCA) Board member MHCC E: [email protected] T: (02) 8920 3611 Mental Health Coordinating Council Building 125, Corner of Church & Glover Streets Lilyfield NSW 2040 PO Box 668 Rozelle NSW 2039 Website: www.mhcc.org.au ii Contents Trauma-Informed Care and Practice: towards a cultural shift in policy reform in mental health and human services in Australia Purpose ..................................................................................................................... 2 Position Paper Recommendations: A National Strategic Direction ................................ 3 Section 1 ............................................................................................................................................... 4 Executive Summary ............................................................................................................................. 4 Trauma-Informed Care and Practice ..................................................................................... 4 Evolution of the national agenda in Australia ....................................................................... 5 National Trauma-Informed Care and Practice Advisory Working Group (NTICP AWG) ........................................................................................................................... 7 Section 2 ............................................................................................................................................... 8 Language – Understanding Trauma.................................................................................................. 8 Definitions .................................................................................................................................. 8 Principles of Trauma-Informed Care & Practice ............................................................... 10 Section 3 ............................................................................................................................................. 14 International Evidence: The Literature ............................................................................................ 14 a. Defining trauma .....................................................................................................14 b. Prevalence .......................................................................................................................... 14 c. Re-victimisation .................................................................................................................. 15 d. Populations at risk ............................................................................................................. 15 e. Presentation ........................................................................................................................ 17 f. Mental health impacts ........................................................................................................ 18 g. Other health impacts ......................................................................................................... 19 i. Resilience ............................................................................................................................. 20 j. Economic cost ..................................................................................................................... 23 Section 4 ............................................................................................................................................. 24 Systems ............................................................................................................................................... 24 1. Current systems’ responses ............................................................................................. 24 2. Re-traumatisation in services ........................................................................................... 25 3. System failures ................................................................................................................... 27 4. Requisites for implementing Trauma-Informed Care and Practice across service settings ....................................................................................................................... 27 5. Benefits of introducing TICP – International Evidence................................................. 28 6. Rationale for embedding TICP into Australian service systems ................................. 29 7. A Trauma-Informed Recovery-Oriented approach ....................................................... 30 8. Why we need to change cultures and systems: ............................................................ 31 iii Section 5 ............................................................................................................................................. 33 TICP in Australia – A National Strategic Direction ........................................................................ 33 Scope of reform .................................................................................................................................. 34 a) Mental health in Australia: current policy and workforce challenges ......................... 34 b) Costs of retaining the status quo: health utilisation, burden of cost – to individuals and communities .................................................................................................................... 35 c) Systems for change – broader implementation............................................................. 38 d) Current developments in Australian TICP reform ......................................................... 42 Innovation .................................................................................................................................... 44 a) Policy ................................................................................................................................... 44 b) Policy and Practice ............................................................................................................ 44 c) Practice/Practice Guidelines ............................................................................................ 45 Translation ................................................................................................................................... 46 a) Workforce development and training .............................................................................. 46 b) Workforce capacity building ............................................................................................. 46 c) Research into practice ...................................................................................................... 48 Dissemination ............................................................................................................................. 53 TICP in Australia – a national strategic direction................................................................... 53 Implementation ........................................................................................................................... 55 a. Role of the National TICP Advisory Working Group ..................................................... 55 b. MHCC and ASCA activities supporting and promoting TICP nationally.................... 56 c. NTICP AWG ongoing activities ........................................................................................ 56 d. Priority activities for the NTICP AWG ............................................................................. 56 Section 6 ............................................................................................................................................. 57 Measurable Cultural Change .................................................................................................... 57 Position Paper Recommendations ..................................................................................... 57 Consultation ........................................................................................................................... 58 Appendicies ....................................................................................................................................... 59 Appendix 1 – NTICP AWG Terms of Reference ........................................................................... 60 Appendix 2 – MHCC Policy Template: General Integration of a TICP Approach .................... 63 Appendix 3 – ASCA Practice Guidelines Endorsement Listing .................................................. 73 Appendix 4 – TICP Activities 2006-2013 .......................................................................................