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Why trauma-informed care for people with learning disabilities is so important right now

The pandemic has put more vulnerable people at risk of experiencing trauma

Learning disability nurse Julie Calveley on different approaches to person-centred care and maintaining mental well-being

COVID-19 has caused a catastrophic cascade of effects distress, loneliness and an increase in mental health conditions such as anxiety and depression.

Government and mental health organisations have advised us to adopt self-care strategies, such as keeping active, mindfulness, connecting with loved ones and friends through technology and talking with others about our feelings. But what about people whose disability prevents them from being able to use self-care strategies and who are not able to use words to communicate?

People with severe and profound learning disabilities are at particular risk of experiencing mental health problems, and even more so as a result of the COVID-19 pandemic. This group are

Learning disability nurse Julie Calveley on different approaches to person-centred care and maintaining mental well-being

The pandemic has put more vulnerable people at risk of experiencing trauma
Picture: iStock

COVID-19 has caused a catastrophic cascade of effects – distress, loneliness and an increase in mental health conditions such as anxiety and depression.

Government and mental health organisations have advised us to adopt self-care strategies, such as keeping active, mindfulness, connecting with loved ones and friends through technology and talking with others about our feelings. But what about people whose disability prevents them from being able to use self-care strategies and who are not able to use words to communicate?

People with severe and profound learning disabilities are at particular risk of experiencing mental health problems, and even more so as a result of the COVID-19 pandemic. This group are more likely to have experienced loss, change, disruption to routines and isolation.

Trauma can occur when an event or experience overwhelms our ability to cope

By definition, they have impairments in cognition and communication, and therefore may be less able to process, make sense of, and share what they are going through with others. These factors make it more likely that a person with severe or profound learning disabilities may experience trauma as a consequence of the pandemic.

Trauma can occur when an event or experience overwhelms our ability to cope. An experience is more likely to be traumatic for a person who feels helpless, does not know what to do or feels unable to escape.

An experience such as loss is more likely to be traumatic for a person who is unable to understand and make sense of their loss, recognise their feelings and talk to others for support and to make sense of what is happening and how they are feeling.

How trauma can affect people

Current approaches to trauma are generally underpinned by an understanding of the bidirectional link between the body and the brain and the role of the nervous system in sending messages between the body and brain.

Trauma affects people in different ways and can affect physical and mental health and well-being, including:

  • Fear, anxiety, sadness, grief, distress, ‘behaviour that challenges’
  • Withdrawal: appearing distant or vacant
  • Increase in clinginess and compulsive behaviours such as hoarding
  • Stomach tightening or churning, changes in bowel activity
  • Excessive sweating, trembling, shaking, cold sweats, unexplained aches and pains
  • Rapid or difficult breathing, pounding heart, chest pains and dizziness
  • Restlessness and pacing
  • Difficulties with attention and concentration, memory problems and confusion
  • Changes in sleeping patterns, insomnia and nightmares
  • Loss of or increase in appetite

Effective strategies for supporting healing from trauma must take into account all physical, psychological and emotional effects.

One reason I was drawn to learning disability nursing was that I saw holistic care as being at the heart of the profession.

Appreciating that the body, brain, mind and emotions are not separate entities but part of an integrated and interdependent system allows learning disability nurses to avoid assessing or treating parts of the person in isolation. A holistic approach provides the best possibility of optimum quality of life being realised.

Talking with others about our feelings is one self-care strategy
Picture: iStock

Trauma has been shown to have a devastating effect on a sense of safety and security. People who have experienced trauma can become stuck in the fear state that accompanied the trauma and continue living in a state of heightened alert or shutdown, as if the cause of the trauma was still present.

Tips on spotting the signs of trauma and what to do about it

  1. Become aware of the causes and effects of trauma and the effects it can have physically and psychologically as well as on learning, development and behaviour
  2. If you are concerned that a person is experiencing trauma seek specialist, professional help and advice
  3. Relationships are key to supporting emotional well-being
  4. People have different responses to trauma – what works to support one person’s well-being may be different for another person
  5. Understanding and interpreting non-verbal communication is crucial when offering well-being experiences

Approaches that can be engaged in without the need for cognition and language skills

Science shows that there is a wealth of natural, non-invasive approaches that involve interactions, the senses and the body to help restore this sense of safety, benefit our mental well-being and assist in healing from trauma.

Many of these approaches can be engaged in without the need for cognition and language skills, and can therefore be adapted for people with severe and profound learning disabilities.

What works for one person or on one day may be different for another person or on another day. Evidence indicates that rather than taking a one-size-fits-all stance, various approaches can be tried, allowing us to develop person-centred care plans around an individual’s needs, preferences and observations of what works for them.

Non-Verbal Affective Care – offering practical approaches for nurses

My work explores evidence-informed strategies for supporting emotional well-being, and how these can be adapted for people with severe and profound learning disabilities.

I am running a workshop for healthcare professionals, parents, carers and educators on 20 March exploring practical ways of safely supporting someone who is experiencing the effects of trauma. This workshop will examine a variety of approaches, including using voice, facial expressions, touch, sensory experiences and strategies for making life feel more predictable.

My not-for-profit community interest company Non-Verbal Affective Care (NAC) is dedicated to the emotional and mental well-being of people with severe and profound learning disabilities. NAC offers guidance on well-being experiences designed for those who do not use words to communicate.

In February, NAC hosted a seminar, a video of which can be seen online, on supporting the emotional well-being of people with learning disabilities.


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