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The possibility of trauma in the lives of people accessing services should be a central organising principle of care, practice and service provision. Many people who have experienced trauma have adopted extreme coping strategies in order to manage the impacts of overwhelming traumatic stress, including suicidality, substance use and addictions, self-harming behaviours such as cutting and burning, dissociation, and re-enactments such as abusive relationships. Although awareness and treatment of trauma may be pivotal to the process of recovery, in many mental health settings trauma is seldom fully identified or addressed.

Implications for practice and service delivery

A trauma-informed recovery-oriented service: commits to and acts upon the core organising principles of safety, trustworthiness, choice, collaboration and empowerment considers and evaluates all parts of the system in the light of a basic understanding of the role that violence and abuse play in the lives of people seeking mental health and drug and alcohol services applies this understanding to the design of service systems that accommodate the vulnerabilities of trauma survivors, that deliver services in a way that avoids retraumatising people and facilitates people's participation in their treatment trains staff in trauma-informed care and practice develops collaborative relationships with practitioners experienced in traumatology wherever possible (Fallot & Harris 2009). Trauma survivors still experience stigma and discrimination and unempathetic systems of care. Clinicians and mental health workers need to be well informed about current understanding of trauma and trauma-informed interventions. Professor Louise Newman in Practice guidelines for treatment of complex trauma and trauma informed care and service delivery (Kezelman & Stavropoulos 2012).

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