Foundations of mental health practice

The following foundations of mental health practice provide a lens through which all aspects of care and support are understood and applied. These guiding principles shape every interaction, assessment, and intervention, ensuring a holistic and person-centred approach. Together, these elements form the overarching framework that underpins effective and compassionate mental health practice.

Social determinants of mental health

Social determinants are non-medical factors that can contribute to marginalisation and, in turn, influence a person’s mental health and wellbeing. These include the conditions into which a person is born, grows, lives, and works, as well as broader influences such as economic policies, social norms, and political systems. Examples include:

• income and social protection
• education
• unemployment and job insecurity
• working conditions
• food insecurity
• housing, basic amenities and the environment
• early childhood development
• social inclusion and non-discrimination
• structural discrimination, conflict and displacement of peoples
• access to affordable quality health services.

These social determinants can contribute significantly to health inequities, unfair and avoidable health differences based on social and economic conditions where lower socioeconomic status correlates with poorer health outcomes. Research shows these may be more influential on a person’s health than healthcare or genetics (World Health Organisation (b)). (Refer to The model of social and emotional wellbeing.)

Trauma-informed

A trauma-informed approach adopts the principles of safety, trust, choice, collaboration, and respect for diversity. This approach aims to avoid re-traumatising or blaming people for their efforts to manage their trauma (Kezelman).  

Adopting a trauma-informed approach involves:

• being sensitive to how a parent’s presentation and needs can be understood within the context of their trauma history
• integrating the parent’s needs and strengths into assessment, formulation, and the planning, delivery, review, and transfer of care
• providing care in ways that promote physical and psychological safety for children, parents, their families, and staff
• delivering services in a manner that actively works to prevent re-traumatisation (Queensland Health (d)).

Trauma significantly impacts how a child and parent think, feel, behave, and form relationships. It often manifests as survival responses rather than defiance. Trauma and mental health are closely linked, with an individual who has experienced trauma often presenting with conditions such as anxiety, depression, PTSD, dissociation, or behavioural challenges.

To adopt a trauma-informed approach, remain curious rather than judgmental, reframing the question from ‘What’s wrong with this person?’ to ‘What’s happened to this person?’

A trauma-informed lens focuses on key elements that support healing and recovery. These include:

• predictability and safety in interactions
• providing choice and voice for the individual
• respecting their pace and their story
• fostering connection with family and culture.

Culture and trauma

Colonisation, along with disconnection from Country, kin, and culture, is a form of trauma. Cultural identity and connection are protective factors, making the embedding of culture in healing processes essential.

To ensure culturally safe and effective responses, consult ATSICCOs, community members, family, and Elders. This ensures that cultural protocols are respected and that healing approaches are both family and community led and defined.

Complex developmental trauma

The term complex developmental trauma describes the impact of repeated and prolonged experiences of abuse, neglect, or other forms of harm that happen within a young person’s important relationships, usually during early childhood (Evolve (b)). 

Trauma impacts for brain development

The development of the child’s brain begins in utero, continues after birth with the first 4 years understood to be a critical development period. The experiences in utero are already influencing and adapting development to suit the environmental experiences it expects are required to survive after birth (Evolve (b)). 

The brain develops ‘bottom up’, beginning with the brain stem which controls basic functioning (which includes the survival responses of flight, fight and freeze), progressing to the mid-brain and limbic – the areas responsible for attachment and emotional development) and finally to the neocortex which controls one’s ability to concentrate, learn, think and reflect, reason and problem solve (Evolve (b)). 

Exposure to chronic stress and traumas in utero can cause structural changes in the brain architecture resulting in long-lasting effects on a person's psychological and emotional wellbeing. It can also impact their relationships and overall quality of life (Evolve (b)).

Considerations for assessment and support

Care must be taken to ensure we don’t assume children are simply making ‘bad choices’ or being ‘manipulative’ when they may be unable to respond to stressful situations in ways we would hope they can. (Refer to Trauma-informed.) 

Attachment

Attachment theory examines the dynamic interaction between nature and nurture in shaping a child’s development and relationships. It offers a framework for understanding how early bonds with caregivers influence emotional, social, and behavioural patterns throughout life. 

These attachment experiences play a pivotal role in mental health, affecting both the quality of interpersonal relationships and the potential development of psychological, emotional and behavioural difficulties. (Refer to the Permanency practice kit, Attachment.)

The following 2-minute video explains the basics of how and why a person can modify their way of being in the world, as a response to the kind of caregiving received in childhood. The names used are merely categories to reflect common patterns, of the ways a person may adapt their behaviour to protect themselves if needs were not reliably met in infancy. 

When applying attachment theory for Aboriginal and Torres Strait Islander families, it is important to exercise caution, as the theory was developed within a Western framework and does not inherently account for cultural differences, such as the collective caregiving practices and kinship systems central to many communities (Yeo). As such this can lead to a misunderstanding of non-western parenting practices.

However, attachment theory can still be useful to recognise the strengths of these cultural practices, such as the role of extended family in providing stability and emotional security for children, and by ensuring interventions are culturally safe and respectful of community values. 

Additionally, attachment theory can help practitioners understand why a child might be behaving in a particular way. For example, behaviours such as withdrawal, anxiety, or difficulty trusting others may reflect disruptions in their attachment relationships, and this understanding can guide trauma-informed and culturally sensitive responses to support the child’s emotional, relational and overall mental health needs.

Grief and loss

Grief and loss are profound experiences that can significantly impact a child or adult’s mental health and wellbeing, particularly in the context of child protection. For children and families with child protection experiences, grief and loss often extend beyond the death of a loved one to include the loss of family connections, cultural identity, stability, or a sense of safety. These experiences can manifest in complex ways, influencing a child’s emotional, behavioural, and psychological development (Bergh). 

Loss 

Loss is an event and can be ‘ambiguous’ whereby the loss event remains unclear, is without a resolution and as such the person feels simply stuck and without ‘closure’. No-one can decide what constitutes loss for another person (Bergh).  

People often feel the pain of loss but may lack the language or coping skills to express it, instead showing their feelings through their behaviour. These expressions can be cyclical, may be hidden and may re-surface at times of development, transitions or other personal triggering times or events (Bergh).   

Grief 

Grief is the reaction and response to a loss and can include: 

• anticipatory grief where there’s a reaction to losses which have not yet occurred
• disenfranchised grief where the loss cannot be openly acknowledged or is not recognised or valued by society (Bergh). 

Unresolved or unsupported grief can contribute to mental health challenges such as anxiety, depression, or trauma responses (Bergh). 

This 12-minute award-winning video, both powerful and confronting, shows a 10-year-old girl navigating her way through the foster care system after being removed from her home and separated from her younger brother. This demonstrates the varied and ongoing losses which may be experienced by a child engaged with child protection. 

A child’s experiences of grief and loss can often be misunderstood, potentially manifesting as mental health issues that lead to seeking psychiatric diagnosis and treatment. 

Strengths based practice

As described in the Strengthening families Protecting children Framework for practice values shape every part of our work including how we respond to the families we work with and one another, how we structure our activities, set goals, form relationships, gather information, assess, plan and facilitate change. 
One core value is to recognise and utilise the strengths those we work with have and draw on these to facilitate change. (Refer to Foundational elements.)

A strengths-based approach to child protection intervention involving mental health is vital to ensure we do not become solely focused on behaviours, diagnoses, or challenges, losing sight of a child’s inherent strengths and their capacity for recovery, growth, and healing.

Even in the most complex and difficult circumstances, maintaining a focus on strengths helps to balance the narrative, foster hope, and align with the principles of the practice framework to support positive outcomes.
 

Cultural humility

Cultural humility is a lifelong practice of self-reflection and learning. It is applied by recognising our own biases, understanding power imbalances, and respecting families as experts in their cultural identities and experiences. 

It also involves understanding how culture shapes mental health, wellbeing and help-seeking behaviours. Practising cultural humility supports culturally safe, equitable, and collaborative decisions that promote the safety and mental wellbeing of children, young people and families. (Refer to Safe care and connection practice kit.)