Creating a safe environment relates to creating an environment in which clients and staff have a sense of both physical and psychological safety. As such, it pertains to the services’ physical surroundings, as well as practitioner approaches, programs, procedures, and policies that have been described earlier in this chapter, that can be modified to create a space that is safe and welcoming, and where the likelihood of re-traumatisation is minimised.
Many clients who have experienced trauma will feel on guard, fearing violence at the hands of another client, or other forms of unwanted attention. They may also fear that they will not be able to escape a situation in which they feel threatened, particularly if they are in secure or locked wards. These settings can be reminiscent of other times in their life when they have not been able to escape unsafe environments. It is important to pay attention to the physical environment, ensuring that there is [384, 392, 397]:
- Adequate lighting and common areas are well-lit.
- Sufficient space for comfort and privacy.
- Clear pathways to building entrances and exits.
- Sufficient staffing to monitor the behaviour of others that may be perceived as intrusive or harassing.
- No groups of people loitering at the entrances and exits.
- An absence of exposure to violent, sexual, or offensive material in common areas (e.g., magazines left in the waiting area; television programs, films or music that may be playing).
- Welcoming language is used on signage.
The ideal safe environment is one that is free from the risk of harm; however, it is unlikely that all potential environmental triggers can be completely eliminated. Triggers are highly variable and unique to individuals and their experiences, but they can be minimised and clients supported to use coping skills in the event that they are triggered [392].
A safe environment is also one in which clients feel that they are able, should they wish to, talk about their trauma, and their reactions to it, without judgement. If a client does become triggered or distressed by trauma symptoms, it is important that avoidance or suppression of thoughts or feelings is not encouraged, as avoidance symptoms, rather than re-experiencing symptoms, have been associated with the perpetuation of trauma-related symptoms [398]. Similarly, avoidance or suppression may also intensify feelings of guilt and shame. For those who have experienced abuse, it may closely re-enact the experience of being told to keep quiet about it [384]. This does not mean that clients should be pushed to revisit events or disclose information if they are not ready to do so. Rather, it means that it is understandable that the person may be upset by thoughts and feelings that may arise, and that they should be allowed to engage with them in order to help process the trauma emotionally. Ideally, clients will have developed good self-care skills, and will have skills to regulate their emotions, before they delve into their own traumatic experiences, or are exposed to the stories of others; however, choice and control should be left to the client [384]. Notwithstanding, even in the absence of details of a client’s trauma, AOD workers can help to reinforce a sense of safety by assisting clients in the use of anxiety management techniques such as breathing retraining, progressive muscle relaxation, and grounding techniques, to help manage their symptoms. These techniques are described in detail in Appendix CC.