How to improve pharmacy services by integrating trauma-informed care

As pharmacists continue to evolve from their traditional dispensing role into holistic healthcare providers, understanding and responding to the psychological and emotional needs of people who visit pharmacies has become increasingly important. 

The terms trauma-informed care (TIC) or trauma-informed practice (TIP) and psychologically-informed environments (PIE) or trauma-informed environments (TIE) are new to many people working in a pharmacy setting^​1–3​. In recent years, the importance of integrating TIC and PIE within all settings where services interface with the public has been recognised across the four UK nations^​1,4​.

This article explores what TIC and PIE are and how their implementation can improve pharmacy services in the UK.

What is TIC?

TIC is an approach to health and social care that acknowledges the wide-ranging impact of trauma on individuals. Within a pharmacy setting, it means providing a supportive and safe environment for those who work in or visit a pharmacy. TIC is based on the principle that trauma can affect an individual’s mental, emotional and physical wellbeing, and recognising that this may have an impact on their healthcare experiences^​1​. By integrating TIC into pharmacy services, pharmacy staff can help people feel better understood, more respected and involved in their care — thereby, improving the outcomes they receive. The definitions used in this article are used by the UK Office for Health Improvement and Disparities (OHID) and aligned with the US Substance Abuse and Mental Health Services Administration (SAMHSA) principles, which are the internationally recognised definitions in this area^​2,4​.

TIC involves five important principles:

• Safety: Creating a space where people feel physically and emotionally safe. It involves the use of supportive, non-confrontational language, making the person feel that they are being listened to and believed;
• Trustworthiness: Being open and honest in delivering care, setting boundaries and building mutual trust. It involves not making promises that can’t be kept and being clear around confidentiality and the circumstances in which information may be shared;
• Choice: Giving people choices, even if by exercising these choices it may expose them to a risk of harm and involving them in the decision-making processes around their care. Exercising choice allows a person to express a preference over the person that supports them;
• Collaboration: Working alongside people in a therapeutic partnership that emphasises mutual respect, acknowledging where opposing views exist and creating shared treatment goals;
• Empowerment: Encouraging people to take an active role in their own recovery journey, not making decisions for them and supporting them by providing information, skills development and confidence building^​1,4​.

The role of TIC in pharmacy

Pharmacies are often the first point of healthcare contact for individuals. Staff may not always be aware if a person has experienced a traumatic event, such as gender-based violence or adverse childhood experiences^​3,5,6​. Many people may not share their trauma histories; however, their behaviours, attitudes and healthcare needs may provide important clues. Some examples are hypervigilance even in safe situations, lack of trust in services, substance use and self-harm as coping mechanisms, risky behaviours and accessing emergency contraception following sexual assault.

For example, trauma-informed pharmacy practices could involve:

• Ensuring pharmacy staff are trained to recognise signs of trauma, understanding the emotional needs of people and how to respond with empathy, sensitivity and respect — for example, checking with people by asking: ‘Are you OK to talk here or is there somewhere else that you would prefer to talk?’
• Adapting the delivery of prescription and medication counselling to allow the recipient time to process information and ask questions without feeling rushed. This method also supports other patient groups, such as those who have difficulty processing information.
• Creating written materials that explain complex medication instructions in plain English, in a clear and supportive manner, considering any cognitive or cultural issues. This method supports other patient groups, such as those who do not use English as a first language or may have challenges with literacy.
• Normalising enquiries about trauma, such as asking about sexual assault every time when undertaking an emergency contraception consultation, as outlined in training, such as the Scottish NES TURAS pack ‘Responding to a disclosure of rape or sexual assault’^​7​ or the eLearning for Healthcare training on ‘Identifying and responding to sexual assault and abuse’^​8​ — for example, saying: ‘We know that some people requesting emergency contraception have been sexually assaulted, so it is now our policy to ask all our patients if their sexual encounter was entirely consensual…’

Incorporating TIC in pharmacy services is about adapting not only the approach to interactions but also the physical and psychological environment within the pharmacy itself. By understanding the impact of trauma, pharmacy staff can create an environment where people feel more comfortable discussing sensitive issues, such as mental health, substance use or gender-based violence.

PIEs in pharmacy

In a PIE, the principles of TIC are applied to the physical environment of a pharmacy^​3​. Some of the most common ways involve considering the layout of the pharmacy, the way staff talk and act with people, and ensuring the delivery of services with psychological wellbeing in mind^​9​.

In pharmacies, this could mean:

• Providing a calm and private consultation space where people can discuss sensitive health matters. An important aspect of using this space is checking that people are comfortable in it. Someone with a history of trauma as a result of being locked in a room may not feel comfortable in enclosed or small spaces;
• Reviewing the design of pharmacy spaces to be welcoming and calming, minimising loud noises, bright lights or overwhelming visual stimuli that could trigger stress responses in trauma survivors. This may also benefit those with neurodiversity who may more easily feel overwhelmed or retraumatised in a pharmacy environment;
• Supporting the retention of people in treatment by building trusting relationships with pharmacy staff over time. This can help people using the pharmacy feel more welcome and safer, and less likely to experience anxiety or stress during their visits. Through an improved understanding of how a person behaves, it can then be easier to pick up verbal or non-verbal signs, which may provide a clue to changes in a person’s physical or mental wellbeing^​9​.

PIE has benefits for employers and employees as they can make the pharmacy a better place to work by reducing the risk of burnout and stress among staff and nurturing a more supportive working environment. This in turn has positive effects on person-centred care, as a motivated and psychologically supported workforce is better equipped to meet the needs of people in a trauma-sensitive manner^​3​.

Implementing TIC and PIE in pharmacy environments

Across the UK, trauma-informed and psychologically informed care are being adopted within health and social care, justice services and our emergency services^​10​. For example: 

• Sussex Health and Care Partnership have developed a trauma-informed framework^​11​, which is based on its trauma-informed community of practice, comprising around 300 members from 70 organisations, including people with lived experience, frontline staff, service leads and system leaders;
• England’s prison and probation service uses psychologically informed planned environments (PIPEs) in approved premises to support rehabilitation^​12​. These environments are aimed at reducing reoffending by fostering positive relationships and addressing trauma-related behaviours.

However, there are still significant barriers to fully integrating these approaches within pharmacy settings. The biggest challenge to overcome is the need for staff training and education^​13​. Pharmacists and their teams must be equipped with the knowledge and skills to recognise trauma responses and how to adapt their communication style with people who may be struggling with mental health or emotional issues. For a list of trauma-related training programmes available in the UK, see Box.

Confidentiality is another important consideration. Trauma survivors often feel stigmatised, judged or not believed when they are disclosing their experiences, which can prevent them from seeking help or openly discussing their needs^​17​. Pharmacy teams must ensure that their policies and practices encourage trust, confidentiality and respect for people’s privacy. One way to do this is clearly display your pharmacy privacy policy in the pharmacy and online, explaining how you use any personal information collected when they use pharmacy services. This can also be done verbally, where appropriate — for example, when patients are dispensed medication that a break in treatment may cause a return of symptoms or require re-titration and the prescriber will be contacted to ensure follow-up.

Ultimately, funding and resources play an essential role in the successful implementation of these frameworks^​18​. Governments and commissioners must prioritise the integration of TIC and PIE in pharmacy services, ensuring that pharmacies receive the necessary support to develop trauma-sensitive care environments. This could include funding for staff training, development of person-centred resources and funding for the design of more accessible and emotionally supportive spaces.

Conclusion

Adopting the principles of TIC and PIE into pharmacy services is not only the right thing to do but is also an effective strategy for improving care across the UK and reducing harm from substance use. As pharmacy services change to meet the growing needs of the population, adapting our approach will provide more compassionate, effective and supportive care. With the right training, resources and commitment, UK pharmacy teams can become leading proponents of trauma-sensitive healthcare, offering people more holistic care^​19​.