Trauma can follow a single event, repeated abuse, exploitation, neglect, institutional treatment, frightening medical care, bereavement or years of living without safety or control. It may affect memory, sleep, trust, communication, pain, relationships and the nervous system. A person does not need a formal diagnosis, and does not have to disclose what happened, to receive careful and respectful support. Behaviour that looks angry, avoidant, resistant, detached or inconsistent may be an attempt to survive overwhelming threat. The useful question is not simply ‘What is wrong with this person?’ but ‘What may have happened, what does this person need, and what will help them feel safe now?’

Practice boundary Trauma-informed care is not trauma therapy. Carers should recognise distress, reduce avoidable triggers, support safety and choice, and help the person reach qualified services. They should not diagnose PTSD, force a person to recount traumatic events, conduct exposure work or promise secrecy when there is a safeguarding duty.

The Office for Health Improvement and Disparities describes six principles of trauma-informed practice: safety, trust, choice, collaboration, empowerment and cultural consideration. It also explains that trauma-informed practice should prevent re-traumatisation and remove barriers to using health and care services; specialist treatment remains the role of appropriately qualified practitioners. Official source: GOV.UK, Working definition of trauma-informed practice, 2 November 2022.

11A.1 Possible signs of trauma-related distress

Possible signs include nightmares, flashbacks, intrusive memories, panic, scanning for danger, a strong startle response, irritability, anger, sleep disturbance, avoidance, withdrawal, numbness, dissociation, difficulty remembering, loss of speech or communication under stress, unexplained pain, self-harm or suicidal distress. A person may freeze, flee, fight, submit or try to please others to stay safe. None of these signs proves trauma or PTSD. Pain, infection, medication effects, breathing problems, seizures, delirium and other physical causes must not be missed.

11A.2 Everyday trauma-informed care

Ask what helps the person feel safe. Record their preferred name, communication method, routines, privacy needs, known triggers, calming strategies and people they trust. Do not demand the story behind a preference.

Explain who you are, what you intend to do, why it is needed and what will happen next. Avoid surprises, unexplained staff changes and promises that cannot be kept.

Offer real choices wherever possible: timing, clothing, food, lighting, doors, positioning, music, which task happens first and which worker provides support. Small choices can restore control.

Ask permission before touching the person, their mobility equipment, assistance animal or possessions. Give time for an answer and use the person’s accessible communication system.

Use calm, concrete language. Do not crowd the person, block an exit, shout, threaten withdrawal of care, mock a fear or label distress as manipulation.

Provide continuity where possible. Predictable workers, routines and handovers can reduce repeated retelling and help trust grow, but the person retains the right to refuse a particular worker.

Respect culture, disability, religion, sex, gender identity, sexual orientation and previous experiences of discrimination. Ask rather than assume what safety and dignity mean to the individual.

11A.3 Personal and intimate care

Washing, dressing, toileting, continence care, catheter care, transfers and examinations can recreate powerlessness or trigger traumatic memories. Consent must be specific and ongoing: agreement to one task is not agreement to every task. Explain each step, ask before exposure or touch, preserve privacy, use the least intrusive method and stop or pause if consent is withdrawn. Where practicable, honour preferences about the worker’s gender, the presence of another person, positioning and the sequence of care. Never make essential care conditional on disclosing trauma, being compliant or tolerating an avoidable trigger. If the person may lack capacity for a particular decision, follow the Mental Capacity Act process for that decision; do not treat a trauma response as automatic proof of incapacity.

11A.4 Responding to a flashback, panic or shutdown

Step	Trauma-informed response
1. Check safety	Look for immediate danger and urgent physical causes. Follow the person’s emergency plan. Call 999 where there is a life-threatening emergency or immediate danger.
2. Reduce threat	Lower noise and stimulation, give space, keep an exit visible and reduce the number of people present. Do not restrain or touch unless lawfully necessary to prevent serious harm.
3. Orient gently	Say your name, where the person is and that they are with you now. Use short sentences and their chosen communication method. Do not argue about what they are experiencing.
4. Ask, do not impose	Ask what would help and offer simple choices. Use grounding, breathing, sensory objects, water, movement or a trusted person only if the individual has said these are helpful.
5. Allow recovery	Give time and privacy without abandoning the person. Do not interrogate them or require an immediate account.
6. Review	When the person is ready, record observable facts, what helped, what worsened distress and any change needed to the care plan. Seek clinical or safeguarding review where indicated.

11A.5 A personal trauma-support plan

Plan field	What to record with the person
Safety	What makes the environment feel safe or unsafe; preferred exits, lighting, doors, distance and staffing.
Communication	Words, signs, symbols, devices and processing time; phrases to use or avoid.
Triggers and early signs	Known sounds, smells, touch, people, dates, procedures or situations, plus early signs noticed by the person or carers.
Helpful responses	Grounding choices, sensory tools, routines, medication directions, trusted contacts and the person’s preferred level of company.
Personal care	Consent signals, touch and positioning preferences, privacy requirements and any gender or staffing preference.
Escalation	When to contact the GP, mental-health team, safeguarding lead, NHS urgent support or emergency services.
Aftercare and review	Rest, hydration, reassurance, follow-up, factual recording and when the plan will be reviewed.

11A.6 Treatment, safeguarding and urgent help

Carers support recovery but are not substitutes for clinicians. Encourage the person to speak with their GP or existing mental-health team and support access to NHS talking therapies where appropriate. NICE recommends evidence-based trauma-focused psychological treatments for PTSD, including trauma-focused cognitive behavioural therapy and EMDR in defined circumstances; these should be delivered by trained practitioners with appropriate supervision. Official sources: NICE guideline NG116, Post-traumatic stress disorder; NHS, PTSD (post-traumatic stress disorder).

If there is immediate danger, a life-threatening emergency or an immediate risk of serious harm, call 999. For an urgent mental-health crisis that is not an emergency, use the NHS urgent mental-health route, NHS 111 or the person’s local crisis team. Where abuse, neglect, exploitation or organisational practice may be causing the trauma or continuing the danger, follow safeguarding procedures without confronting a suspected abuser in a way that increases risk. Preserve the person’s words accurately, distinguish fact from opinion, and involve the person in decisions as far as possible.

Good trauma-informed care does not require accepting every explanation without assessment, and it does not remove lawful safeguarding responsibilities. It requires taking distress seriously, checking physical and psychological causes, preserving dignity and consent, sharing power wherever possible, and ensuring that the care system does not repeat the fear, coercion or loss of control that the person has already endured.