Blog

When Grievances Move Past Filing

From Christy da Rosa, PhD, MSW, LCSW, Professor of Practice, Trauma Informed Oregon

I have a friend who works in community mental health doing intakes for clients transitioning from an adult inpatient unit to outpatient services. Part of that work includes asking people about their experience on the unit. Most shared concerns: Conflicts with staff. Feeling talked down to. Unsafe interactions with other clients. These weren’t dramatic accusations; they were attempts to make sense of an environment where power, choice, and voice were severely limited. But over time, my friend realized they were hearing the same story told by different voices.

I had a similar experience as a member of the same team. I assisted clients to file grievances on their behalf, but only could file if they were willing. Sometimes they worried about getting someone in trouble. Sometimes they felt their experience was horrible, but they had been shut down too many times to bother filing.

Over time, we began to see a pattern that extended beyond any individual concern –and not just with the issues clients brought to our attention. Each grievance was treated as its own isolated event, like an incident report to log away. I had come to believe there was no point in following up with grievances I helped file. Most often, the grievance was dismissed. The client was “bad,” “difficult,” or “just upset.”

The grievances existed on paper. But they didn’t lead to reflection, accountability, or system change.

When Systems Protect Themselves

Trauma informed care helps me understand why grievance processes can undermine rather than enforce accountability. In our experience, two common issues arose. First, individualization was precisely why our grievance policy failed so frequently. When complaints are not examined cumulatively, the organization can’t zoom out to broadly examine problems in policy, training, staffing, or organizational culture even when the same issues surface again and again.

Stigma compounded our problem. Trauma responses (e.g., anger, mistrust, outbursts) are often misread as behavior flaws rather than signals of distress. Power differentials mean clients are perceived as more credible when they’re “good clients.” Others are labeled “difficult,” “manipulative,” or “noncompliant.”

When grievances are filtered through stigma and examined one at a time, patterns can’t be tracked. What could have been understood as a systemic issue becomes a series of “problem clients.” In this way, our grievance policy was designed in ways that obscured organizational culpability and enforced existing power structures.

What the Grievances Were Trying to Tell Us

When I asked my friend about the most common grievances they hear from clients in adult inpatient units, they reported:

1. “They don’t listen to me when I don’t want to take medication.”

For clients experiencing psychosis, forced medication can be perceived as being poisoned. That fear response is real, especially if clients feel negative side effects with medications. My friend reported that even clients without psychosis raised concerns about medication like weight gain, sedation, and emotional blunting which were dismissed as necessary sacrifices for their “safety.”

When similar medication-related grievances appear again and again, they’re not individual resistance. They’re warning signals about consent, communication, and power that are being systematically ignored. Some might argue that in inpatient settings, these things are already compromised for safety. But it’s precisely because clients have such limited access to autonomy that safety, transparency, and choice become even more critical and must be restored as much as possible.

2. “I don’t like the way staff talk to me.”

In inpatient settings, power is already profoundly uneven. Clients have limited control over their bodies, schedules, and choices. When staff communicate in ways that feel dismissive or authoritarian, they undermine client safety and trust. Examined individually, staff-client interpersonal conflicts are easy to note as personality disputes. Examined cumulatively, they point to trauma activating hotspots in work culture, burnout, and protocols that are creating harm.

3. “I don’t understand why I was secluded or restrained.”

Seclusion and restraint are often framed as safety measures. But frequent grievances about these experiences (especially when clients report receiving no explanation or follow-up) suggest deeper systemic issues: activated staff, lack of collaborative protocols, or insufficient debriefing after critical incidents.

The Parallel Process

Across many of these grievances ran a familiar refrain: It felt like being in jail.

This isn’t incidental. Inpatient units can unintentionally recreate institutional trauma—loss of voice, lack of transparency, diminished autonomy –even when staff are trying their best.

In our Foundations of Trauma Informed Care training, we reference the parallel process developed by Dr. Sandy Bloom to better understand trauma organized systems. In trauma organized systems, the way staff are treated by leadership mirrors how staff are expected to treat clients and vice versa, creating positive or negative patterns across the organization. Trauma organized systems can develop patterns such as hypercontrol, mistrust, and disempowerment that mirror the traumatic experiences of their clients.

When staff feel unsafe, overwhelmed, or unsupported, those stress responses impact what clients experience. Policies get created in stress activation, resulting in defensive or aggressive policies against perceived harmful parties (e.g., clients). The system becomes rigid in response to its own distress.

What Trauma informed Care Actually Requires

Grievances, when examined cumulatively, become one of the clearest ways to see where this parallel process is occurring and where the system is failing everyone within it. They can be a powerful resource for trauma informed care.

Trauma informed care calls us to recognize, realize, respond to, and resist retraumatization. For feedback processes, this means examining grievances cumulatively to identify organizational patterns—not just adjudicating individual complaints.

This shift moves us from asking Is this complaint legitimate? to asking:

• In what ways did systemic trauma occur here?
• What conditions are repeatedly creating harm?
• What is this feedback telling us about our policies and culture?
• How is the organization’s distress showing up in client experiences?

If grievance policies are meant to create accountability and safety, trauma informed care suggests several essential shifts:

• Grievances must be reviewed collectively over time
• Patterns should be expected and actively sought
• Organizations must engage with feedback with a growth-mindset perspective
• Clients need protection from retaliation and dismissal and to also be seen as legitimate sources of feedback
• Grievances must be treated as data about system health, not disruptions to workflow

From Policy to Practice

A grievance policy isn’t trauma informed simply because it exists. It becomes trauma informed when feedback is safe to give, supported to receive, and powerful enough to change systems.

I think back to those intake sessions, to the clients who trusted me with their stories of feeling unheard, disrespected, frightened. I filed their grievances. I documented their concerns. But I often wondered if anyone could connect the dots, if anyone had the authority, time, and energy in our busy community mental health system to step back far enough to see the picture those dots were forming.

When organizations listen for patterns, feedback becomes what it was always meant to be: not a threat to the system, but a pathway toward safer, more humane care for everyone. The question isn’t whether grievances will arise. In any system where power is unevenly distributed, they will. The question is what action we take when we receive them.

Back to Blog