'We're Not Mental Health': Perspectives of Emergency Department Clinicians on Trauma-Informed Care.

Exposure to potentially psychologically traumatic events is extremely common, impacting both physical and mental health. Trauma-exposed people are more likely to access emergency care than their non-trauma-exposed counterparts, and they risk symptom exacerbation and re-traumatisation during the care process. Trauma-informed care (TIC) practices may provide better experiences for these patients. However, TIC understanding and implementation in emergency settings remains limited. Therefore, the current study aimed to explore how emergency clinicians perceive, conceptualise and enact TIC in their practice. Twenty emergency clinicians (2 doctors, 18 nurses) from one metropolitan hospital participated in semi-structured interviews about their understanding and use of TIC. Reflexive thematic analysis of this qualitative data generated three themes: (1) 'treat the person not the problem', (2) 'we're not mental health' and (3) 'systemic factors that we can't fix'. When brought together, these themes suggested that emergency clinicians perceived TIC to be a holistic, person-centred practice designed to treat psychological trauma. This therefore displaced the responsibility for TIC from emergency clinicians onto others. Adoption of TIC practices was further impeded by perceived systemic barriers like competing priorities and working conditions fostering burnout. The findings suggest that systemic changes and TIC education for emergency clinicians are needed to support TIC implementation, which may in turn produce better patient experiences and outcomes.