by Charlotte Riches, Stuart Mitchell, Amy Ashton

This book offers practical suggestions for how to grow a trauma informed approach and culture within acute mental health services. It starts by building a compassionate understanding of the challenges faced by people receiving, and delivering, care in inpatient settings. It considers the (understandable) ways in which individuals and services have adapted to cope, and what this means for patient care and staff wellbeing. It then offers suggestions relevant to individual clinicians, teams and organizations, aiming to help all readers feel more hopeful, empowered, and equipped.

The clinical focus is crisis and inpatient care for people with 'complex emotional needs', where there is a need to build (multidimensional) safety for all involved - patients, but also those caring for them. Some systemic challenges are recognized and discussed, including fear of blame, task focus, fast pace, and increasing clinical acuity. The book makes links between trauma informed care and workforce capacity and wellbeing, organizational culture, mentalizing, and compassion.

The book covers all stages of an acute care pathway, including safety planning, crisis care, hospital admission, ward-based intervention, and discharge, with an overarching focus on realistic expectations, attachment-focused interventions, and emotion-regulation skills building. Several therapeutic models, including Dialectical Behavior Therapy (DBT), Compassion-Focused Therapy (CFT), and Mentalization-Based Therapy (MBT) are drawn upon and applied to clinical examples, to help readers integrate understandings and ideas into their everyday clinical practice. The book incorporates lived experience comments from patients and clinicians, and brings the material to life for busy readers through core concept boxes, clinical scenarios, and bullet point summaries.