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“We’re Working in a Trauma Avoidant Culture”: A Qualitative Study Exploring Assertive Community Treatment Providers’ Perspectives on Working with Trauma and PTSD in People with Severe Mental Illness

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Abstract

Assertive Community Treatment (ACT) is the most widely used evidence-based community mental health intervention for people with severe mental illness (SMI). Despite research showing that the vast majority of those with SMI have traumatic histories, the ACT service model does not have consistent guidelines on how to address trauma in their client population. This study employed thematic-analysis through interviewing ACT providers to better understand their perspectives on working with trauma in clients. Five overarching themes with 21 sub-themes emerged: the role and scope of ACT teams and model regarding trauma, discussions of trauma with clients, current treatment of trauma, barriers to working with trauma, and recommendations for enabling trauma discussions and treatment. Some examples for recommendations were: a need for more training regarding trauma, increasing resources like including a psychologist and trauma specialized professionals on the team, more support from leadership, and a cultural change from medicalization. Implications of the barriers and suggestions are discussed.

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Authors and Affiliations

  1. School of Psychology, University of Ottawa, Vanier Hall, Ottawa, ON, Canada

    Noor Sharif

  2. Department of Psychology, Carleton University, Ottawa, ON, Canada

    Vasileia Karasavva & Helen Thai

  3. The Royal Ottawa Health Care Group, Ottawa, ON, Canada

    Susan Farrell

Authors
  1. Noor Sharif
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  2. Vasileia Karasavva
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  3. Helen Thai
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  4. Susan Farrell
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Correspondence to Noor Sharif.

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Appendix

Appendix

Interview questions

1. What are your roles and duties in the ACT team?

2. What are the intake procedures when a client is first reviewed and accepted into the team?

3. How often does trauma come up as a topic with clients? Follow up: How likely are you to ask about trauma and PTSD?

4. How comfortable are you with discussing traumatic events or PTSD symptoms that your clients may have experienced once they are brought up? Follow up: How comfortable are you with your knowledge of trauma and PTSD?

5. When it comes to light that the client has experienced traumatic event(s) and is or likely is experiencing trauma-related symptoms, how does your role and team respond? Follow up: Are you providing treatment for PTSD or trauma and if so what treatment are you providing?

6. When a client describes traumatic experiences, do you wonder about the accuracy of what they are describing to you (e.g. if it really happened, or how accurate is what they are saying)? Why or why not? Follow up: If so, how does this impact providing treatment?

7. What is the possibility that symptoms observed in clients (e.g., psychotic, manic, depressive, substance use, etc.) may be responses to trauma they experienced in the past? Follow up: How come?

8. How important is treating possible trauma-related symptoms in a client’s overall progress and well-being? Follow up: How much do you feel concerned that talking about traumatic events, trauma-related or PTSD symptoms will negatively affect your clients?

9. What do you think are the greatest barriers to discussing, assessing, and treating PTSD and other trauma-related problems in clients on this ACT team?

10. What do you think are the greatest facilitators to discussing, assessing, and treating trauma and PTSD with clients?

11. What do you think would be helpful in further facilitating being able to discuss trauma and PTSD with clients?

12. Do you think it’s the role of the ACT team to work with trauma and PTSD?

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Sharif, N., Karasavva, V., Thai, H. et al. “We’re Working in a Trauma Avoidant Culture”: A Qualitative Study Exploring Assertive Community Treatment Providers’ Perspectives on Working with Trauma and PTSD in People with Severe Mental Illness. Community Ment Health J 57, 1478–1488 (2021). https://doi.org/10.1007/s10597-020-00764-8

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  • DOI: https://doi.org/10.1007/s10597-020-00764-8

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