Mental Health Caught in the Storm | Why We Need Trauma Informed Care

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I was lucky to attend a Jesuit college where one of our core values is cura personalis or care for the whole person-mind, body, and soul. Mental health was not ignored. We had a free counseling center on campus. Our student government brought in mental health advocates and therapy dogs frequented our library. Most professors would understand if I said I was approaching a breakdown and needed to skip class for a mental health day.

Now let’s compare this to the rest of the world. My family asks how I’m doing at Christmas and I smile and say “good” even though I’m barely functioning after existing on coffee, highlighter fumes, and the occasional slice of free pizza for three months. And my dad would have a heart attack if I ever told him I skipped class for a mental health day.

We don’t talk about mental health, it’s often ignored or forgotten. Especially in the aftermath of a natural disaster. We can see the physical damage-buildings that are destroyed and trees that are uprooted. But we can’t see the emotional damage and, as a result, often ignore it until it’s too late.

Puerto Rico’s Emotional Turmoil

Hurricane Maria hit Puerto Rico two months ago on September 20. 2017. The Category 5 storm wreaked havoc on a region already struggling from previous hurricanes. The physical damage was intense. The island was destroyed and millions were without electricity or water. Two months later, these conditions have not improved by much. And mental health is becoming an even larger problem.

Caitlin Dickerson described the emotional turmoil in her New York Times article, After Hurricane, Signs of a Mental Health Crisis Haunt Puerto Rico. Over 2000 calls flooded the emergency hot-line for psychiatric crises established by the Puerto Rican health department, which is double the normal amount. Suicides have increased and more people that normal have been hospitalized for possibly being a harm to themselves or others. Many can’t refill their necessary prescriptions and some children haven’t spoken for months.

Parents and caregivers must be extra sensitive to their children in the aftermath of natural disasters. They should be aware of warning signs such as separation anxiety, new fears, acting out, not speaking, or anything that seems out of character. These signs could be a sign that the child is experiencing side effects from their trauma. The Adverse Childhood Experiences study talks about children who experience high stress situations in their childhood being more likely to have physical and emotional difficulties in life. Clinical Director David Gordon describes the ACE study in more detail in his blog post ACEs Too High | Saving Our Children Before Dessert Comes.

Puerto Rico is teetering on the edge of a full-blown mental health crisis. Most of their population show symptoms of post-traumatic stress and there is not enough care for them. It’s impossible for me to imagine what it must feel like to have your entire home destroyed and all sense of normalcy taken from you.

In my last blog post, The Impact of Natural Disasters | Chaos After the Storm, I told you that I didn’t know much about natural disasters and their aftermath. Now, I’m trying to understand what type of care is needed that could help these victims begin to take control of their lives again. I watched a webinar from the National Council for Behavioral Health called When Disaster Strikes:  Promoting Resilience through Prevention, Preparation and Intervention to learn more.

Why a Trauma Informed Approach Is the Right One

After watching the webinar, I learned that those affected by natural disasters need care, specifically trauma informed care. By adopting a trauma informed approach, the victim’s recent trauma is considered and used to guide treatment. To make sure that a trauma informed approach is effective, it needs to be carried out correctly.

The 4 R’s of a Trauma Informed Approach:

  1. Realizing trauma’s effect: To use a trauma informed approach, the provider must understand the effect trauma has on an individual’s mental and physical well-being.
  2. Recognizing signs: It’s important to be able to recognize the signs that someone has suffered trauma such as intense anxiety or new-found depression.
  3. Responding by changing practices: One aspect of using a trauma informed approach is understanding that the treatment plan may have to change to accommodate the client’s trauma.
  4. Resisting re-traumatization: If someone has been traumatized once, they are more likely to be re-traumatized. Re-traumatization is the main things the provider and the client want to avoid.

Principles of a Trauma Informed Approach:

For someone who has suffered trauma to benefit from a trauma informed approach, these principles must be evident.

  • Safety
  • Trustworthy
  • Peer Support
  • Collaboration
  • Empowerment

If these principles are evident, the client will feel more comfortable and able to move forward in their treatment process.

Steps to Recovery

Organizations practicing a trauma informed approach is not the only necessity for a traumatized region’s recovery.

  • Outreach to affected areas: Those who are traumatized won’t get better without help. Their physical and emotional needs need to be met for them to begin recovery. This includes food, water, shelter, education, etc.
  • Empowerment: These regions have seen their entire lives swept away by disaster. They’ll need extra support in order to believe that are still capable of achieving goals and recovering from the disaster. Education must be made available so they can continue to learn new skills.
  • Trauma Informed Organizations: Behavioral health professionals must be able to offer a trauma informed approach to make sure those affected by disaster are moving forward emotionally. For these organizations, this process can be more effective if their EHR has trauma informed features built into it.
  • Long term services: It’s not easy to recover from a natural disaster. There needs to be immediate relief, but the affected area will still need services months after the disaster. Support needs to be available to them.

Mental health cannot be ignored, whether on a college campus, at Christmas dinner, or after a natural disaster. But recognizing that mental health should be advocated for is not enough. Action needs to be taken, especially for those currently struggling because of recent natural disasters. We can’t expect anyone to get better if we don’t tell them it’s okay that they need help and then we help them. 

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