Trauma-informed care practices in psychiatric wards: a comprehensive review of strategies for reducing restraint useand enhancing patient trust

Abstract

Trauma is highly prevalent among individuals admitted to psychiatric inpatient facilities, with a substantial proportion of patients reporting histories of childhood adversity, interpersonal violence, neglect, sexual abuse, military combat, forced displacement, or other psychologically distressing experiences. These traumatic exposures frequently influence emotional regulation, interpersonal relationships, treatment adherence, and behavioural responses during psychiatric hospitalization. Conventional inpatient practices, including coercive interventions such as physical restraint, mechanical restraint, seclusion, and involuntary medication administration, may unintentionally reactivate traumatic memories, intensify psychological distress, and compromise therapeutic engagement. Consequently, trauma-informed care (TIC) has emerged as a transformative framework that seeks to recognise the widespread impact of trauma while fostering safety, dignity, collaboration, empowerment, and recovery-oriented psychiatric services (Substance Abuse and Mental Health Services Administration et al., 2014). Trauma-informed care extends beyond individual clinical interventions and represents an organisational philosophy integrated into policies, workforce education, environmental modifications, communication strategies, and multidisciplinary clinical decision-making. Rather than asking "What is wrong with the patient?", trauma-informed approaches encourage healthcare professionals to consider "What has happened to the patient?", thereby shifting psychiatric care from symptom control toward understanding behavioural responses within the context of traumatic life experiences (Sweeney et al., 2018). This paradigm has gained increasing international recognition because evidence suggests that trauma-informed inpatient services are associated with reductions in restraint use, decreased seclusion episodes, fewer aggressive incidents, improved staff confidence, enhanced patient satisfaction, and stronger therapeutic alliances (Azeem et al., 2015). The implementation of trauma-informed care is particularly relevant in psychiatric wards where patients often experience heightened emotional vulnerability, impaired coping mechanisms, severe mental illness, and acute behavioural disturbances. Restrictive practices intended to maintain safety may inadvertently reinforce fear, mistrust, and psychological harm, thereby delaying recovery and increasing the likelihood of repeated crises. Trauma-informed strategies emphasise de-escalation techniques, collaborative safety planning, respectful communication, shared decision-making, sensory modulation, peer support, and environmental adaptations that reduce perceived threats while preserving patient autonomy whenever clinically feasible (Isobel et al., 2021). Such interventions contribute not only to immediate crisis prevention but also to long-term improvements in patient engagement, trust, and treatment adherence. This review synthesises current evidence regarding trauma-informed care practices implemented within psychiatric inpatient settings, with particular emphasis on their effectiveness in reducing restraint utilisation and strengthening patient trust. The review discusses the epidemiology of trauma among psychiatric populations, theoretical foundations of trauma-informed care, mechanisms underlying trauma-related behavioural responses, evidence supporting Volume-4|| Issue-2|| July-Dec||2026 ISSN: 3107-9245; SJNS Smita et al., Scienxt Journal of Nursing Studies Scienxt Center of Excellence P Ltd ||2|| organisational transformation, barriers to implementation, staff education, leadership responsibilities, policy implications, and future research priorities. Collectively, available literature indicates that trauma-informed psychiatric services can substantially improve both patient-centred outcomes and workplace culture when supported by comprehensive organisational commitment, continuous professional development, and evidence-based clinical practice (Bryson et al., 2017; Wilson et al., 2017)