Building Trauma Informed Institutions in Ghana: A Framework for Healing Centered Care
Introduction
Trauma is not only about dramatic events such as war and disasters. It also includes chronic experiences of poverty, violence, stigma, neglect and loss. In Ghana, many people live with the emotional impact of childhood adversity, intimate partner violence, unsafe school environments, stigma around mental illness, and stressful encounters with health and justice systems. Yet, most institutions are not designed with these invisible wounds in mind. A trauma informed approach asks a simple but powerful question. Instead of saying “What is wrong with you?” we ask “What happened to you?” and “What has helped you survive until now?” This article explores how Ghanaian institutions can become more trauma informed and outlines a practical framework for healing centered care.
Understanding trauma and trauma informed care
Psychological trauma can be described as the emotional and physiological response to events that overwhelm a person’s ability to cope and feel safe. It can result from single incidents such as accidents, assaults, or sudden losses, as well as repeated experiences such as ongoing abuse, bullying, discrimination, or growing up in a home with violence or addiction (Substance Abuse and Mental Health Services Administration, 2014). Trauma affects how people think, feel, relate to others, and respond to stress. People may appear “difficult,” “lazy,” “aggressive,” or “uncooperative,” when in fact they are struggling with survival responses such as fight, flight or freeze.
Trauma informed care is not a specific therapy but an overall way of organising services so that they recognise the widespread impact of trauma, understand paths to recovery, and actively avoid doing further harm (SAMHSA, 2014). Key ideas include safety, trust, collaboration, respect, and empowerment. A trauma informed institution understands that many staff and service users have lived through adversity. It seeks to create spaces where people feel physically and emotionally safe, where power is shared more fairly, and where policies do not unintentionally repeat patterns of abuse, humiliation, or neglect.
Why trauma informed institutions matter in Ghana
Ghana has made important progress in areas such as education, child protection, and mental health policy, including the Mental Health Act of 2012. At the same time, evidence suggests that many Ghanaians are exposed to significant stress and adversity. Studies in sub Saharan Africa indicate high rates of intimate partner violence, child abuse, road traffic accidents, and exposure to community violence, which are all risk factors for trauma related distress and mental health problems (World Health Organization, 2013). In Ghana, research has also shown high levels of psychological distress among students, health workers, and people living with chronic illness, often linked to stressful environments and limited support (Ofori Atta et al., 2010).
Institutions such as schools, hospitals, churches, social welfare services, and prisons are often the first places where people affected by trauma seek help. Unfortunately, these same institutions can unknowingly repeat patterns that feel unsafe. Examples include harsh language, public shaming of students, long waits with no explanation in hospitals, the use of physical punishment, lack of privacy during consultations, or insensitive handling of survivors of sexual and gender based violence. When people who have already been hurt encounter such environments, they may withdraw, become angry, or mistrust services. This undermines health, learning, and social cohesion.
Moving towards trauma informed institutions in Ghana is therefore not a luxury or a purely psychological agenda. It is a practical strategy for improving service quality, promoting mental health, and supporting national development goals that depend on a healthy, educated, and emotionally resilient population.
From trauma informed to healing centered care
In recent years, some scholars and practitioners have argued that trauma informed approaches should go further and adopt what is called healing centered engagement or healing centered care. This perspective, developed for example by Ginwright (2018), emphasises strengths, culture, community, and collective wellbeing, not only individual wounds. Instead of defining people mainly by their trauma, healing centered care asks what gives them hope, what cultural and spiritual resources they draw on, and how communities can be part of the healing journey.
In Ghana, where extended family, community ties, faith, and traditional practices remain central to life, a healing centered approach may be especially relevant. It invites institutions to recognise not only the pain that people carry, but also the resilience, humour, faith, and solidarity that help them survive. Healing centered care therefore combines the safety and sensitivity of trauma informed practice with an asset based, culturally grounded vision of wellbeing.
A framework for trauma informed and healing centered institutions in Ghana
Building trauma informed institutions in Ghana will look different in each setting. However, several core components can guide schools, hospitals, community organisations, and other systems. The following framework brings together international principles and Ghanaian realities.
1. Creating safety and trust
The first task is to ensure that people feel safe, both physically and emotionally. This can include simple changes. Staff greet service users respectfully. Procedures are explained in clear language. Waiting areas are arranged in a way that protects privacy. Doors to consultation rooms can be closed, but people also know how to call for help if they feel unsafe. Signs, posters, and staff behaviour all send a message that abuse, harassment, and discrimination are not tolerated.
Trust is built when institutions keep their promises, maintain confidentiality, and admit mistakes. In a Ghanaian hospital, this might mean explaining delays, seeking consent before examinations, and avoiding harsh or blaming language when patients struggle to follow instructions. In schools, it might involve replacing public humiliation and corporal punishment with fair and consistent discipline strategies, in line with existing child protection policies.
2. Recognising trauma and its effects
Staff in trauma informed institutions do not need to be expert therapists, but they do need basic knowledge about trauma. Training can help them understand common reactions such as anxiety, irritability, numbness, or difficulty concentrating. Staff can learn to notice signs that someone may be overwhelmed and to respond calmly rather than with anger or judgement.
In Ghana, where open discussion of mental health is still limited and stigma is common, such training can challenge myths that trauma survivors are “weak” or “mad.” It can also highlight how trauma interacts with poverty, gender inequality, disability, and other social factors. For example, a girl who frequently misses school may be caring for a sick parent or avoiding harassment on her way to class, rather than simply being lazy.
3. Involving service users and communities
Trauma informed institutions involve the people they serve in decision making. This can include feedback boxes, suggestion meetings, and community advisory groups. Listening to service users helps institutions notice practices that feel unsafe or humiliating. It also builds a sense of shared ownership.
In Ghana, chiefs, opinion leaders, religious leaders, youth groups, and parent teacher associations are powerful partners. Involving them early can help address cultural practices that may harm children or vulnerable adults, such as certain forms of shaming or harmful forms of punishment, while also drawing on positive traditions of care, storytelling, and communal support. Community engagement can also reduce stigma by promoting open conversations about mental health and trauma in churches, mosques, and community gatherings.
4. Supporting staff wellbeing
Staff in hospitals, schools, social services, and correctional facilities are often exposed to the suffering of others. Many also carry their own painful experiences. Without support, they may become exhausted, emotionally numb, or reactive. A trauma informed institution therefore pays attention to staff wellbeing. This includes reasonable workloads, opportunities for debriefing, supportive supervision, and access to counselling or peer support when needed.
In Ghana, where resources are limited, creative approaches can be used. For example, peer support circles for nurses, reflective meetings for teachers, or partnerships with faith based organisations and professional counsellors. When staff feel valued and supported, they are more likely to treat service users with patience and respect. Staff wellbeing is therefore not separate from trauma informed care; it is one of its foundations.
5. Reviewing policies and procedures
Many institutional policies were created without considering trauma. Conduct codes, disciplinary procedures, admission protocols, and complaint mechanisms may unintentionally reproduce power imbalances and fear. A trauma informed review looks at these policies through the eyes of someone who has been hurt in the past.
For example, if a school rule allows teachers to shout at or insult students, it should be revised. If a hospital protocol permits non urgent procedures without consent or explanation, it should be updated. Systems for reporting abuse should protect whistle blowers and survivors from retaliation. The goal is not to remove all rules, but to ensure that they are fair, transparent, and respectful.
Challenges and opportunities in the Ghanaian context
Implementing trauma informed and healing centered care in Ghana faces several challenges. Resources are already stretched, especially in public health and education. Staff may feel overwhelmed by daily demands and see trauma informed practice as “extra work.” Cultural norms that emphasise respect for authority may make it difficult for students, patients, or junior staff to question harmful practices. Stigma around mental health and sexual violence can also silence survivors.
Despite these obstacles, there are many opportunities. Ghana has a strong foundation of community solidarity, religious engagement, and respect for human dignity. Existing initiatives in mental health, child protection, and gender based violence prevention provide entry points for introducing trauma informed principles. Universities and training institutions can integrate trauma awareness into curricula for teachers, nurses, social workers, clergy, and police officers. Professional bodies can develop guidelines and codes of conduct that reflect trauma informed values. Donors and government agencies can include trauma informed indicators in funding and monitoring frameworks.
Practical first steps
Institutions in Ghana that want to move towards trauma informed and healing centered care can begin with small but meaningful steps. Leadership can publicly commit to becoming more trauma informed. A small team can be formed to lead the process. Staff can receive introductory training on trauma and healing centered principles. One or two policies or practices that clearly cause distress can be identified and changed. Simple tools for gathering feedback from service users can be established.
Over time, these small steps can grow into a wider culture change. Trauma informed practice is not a one time project but an ongoing journey. It requires humility, willingness to learn, and openness to the voices of those who have been hurt.
Conclusion
Building trauma informed institutions in Ghana is both a moral and a practical task. It is about recognising that many people who come into contact with schools, hospitals, social services, churches, and prisons carry invisible wounds. It is also about understanding that institutions can either deepen these wounds or become places of safety and healing. A framework for healing centered care invites Ghanaian institutions to combine awareness of trauma with a focus on strengths, culture, and community.
By creating safety and trust, recognising trauma and its effects, involving service users and communities, supporting staff wellbeing, and reviewing policies through a trauma informed lens, Ghana can move towards institutions that not only deliver services, but also help people recover their dignity, hope, and sense of belonging. In doing so, trauma informed and healing centered care becomes part of the broader project of national development and social justice.
References
Ginwright, S. (2018). The future of healing: Shifting from trauma informed care to healing centered engagement. Occasional Paper, 25, 1–8.
Ofori Atta, A. L., Read, U. M., & Lund, C. (2010). A situation analysis of mental health services and legislation in Ghana: Challenges for transformation. African Journal of Psychiatry, 13(2), 99–108. https://doi.org/10.4314/ajpsy.v13i2.54357
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma informed approach (HHS Publication No. SMA 14 4884). Author.
World Health Organization. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non partner sexual violence. Author.