The Culture of Care – Learning From Trauma Informed and Autism Informed Environment Reviews

Synopsis

The Culture of Care (CofC) Programme is a major landmark in UK Mental health service delivery. It was codeveloped to reimagine the model of care across NHS-funded mental health, learning disability and autism inpatient settings. This NCCMH led programme is delivered in partnership with Neurodiverse Connection, Black Thrive Global and NCISH. It is based on four key interventions that aim to support wards to provide safe, trauma informed (TI), therapeutic and equity-focused care; working organisationally both at ‘ward’ and ‘Board level’, providing leadership support and personalising the approach to risk.

A key consideration of the programme is the role of the physical environment in providing safe and therapeutic care. Effective implementation of a Trauma Informed Approach (TIA) in inpatient settings, must include embedding TI environments (i.e. environments that promote healing rather than further harm) for those accessing services, as well as for staff1 . In-patient services must also be deigned to meet the needs of neurodivergent people. This includes particular attention to sensory needs with acknowledgment of key elements of the built environment that can contribute to sensory overload or ‘sensory shut down’2. Guidance on design of mental health settings is starting to acknowledge the importance of, and opportunities to, balance elements of more mechanistic safety (e.g. infection control) in the built environment with the need to create therapeutic and psychologically safe environments (e.g. ‘soft furnishings’, and ‘acoustics’)3, 4.

Neurodiverse Connection and ‘TI’ leads for the CofC Programme are working across 10 wards to provide trauma and autism informed environment reviews. Learning will be collated and shared. Aligned with the principles of the programme, this element of work has mixed lived experience and professional experience leadership. The presentation will aim to identifying key principles of ‘best practice’ for autism and trauma informed environments and share learning from the CofC Programme. We will share good practice examples from the work to date, consider current challenges and system-wide solutions.

1. Substance Abuse and Mental Health Services Administration. ‘SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach’ Administration. SAMHSA 2014
2. Design for the Mind – Neurodiversity and the Built Environment Guide. The British Standards Institution PAS6463 2022
3. ‘Its’ Not Rocket Science’. Considering and meeting the sensory needs of autistic children and young people in CAMHS inpatient service. National Development Team for Inclusion, 2020.
4. National Minimum Standards for Psychiatric Intensive Care in General Adult Services. NAPICU, 2014