How to include the trauma history in the diagnosis and treatment of psychiatric inpatients.

Although the high prevalence of significant psychological trauma among populations of patients with serious and persistent mental illness is well-known, and is duly recorded in initial psychiatric histories, such trauma rarely is reflected in the primary (or secondary) diagnosis, and thus, rarely becomes the focus of treatment. There are many complex reasons why the traumatic etiology of many presenting symptoms goes unrecognized. Failure to recognize it leads to prolonged hospitalization and to exclusion from participation in PTSD treatments in community settings, where they are more readily available. The author suggests some practical, general systems changes which might lead to more effective treatment and earlier recovery for patients with trauma-related symptoms.