The Promise of Trauma-Informed Approaches
By Darby Penney
These are dangerous and trying times for those who believe that the human rights of people involved with the mental health system must be promoted and protected. The Murphy Bill – “The Helping Families in Mental Health Crisis Act” (H.R. 2646)- and its only slightly less frightening companion bill in the Senate- would undermine what little progress has been made toward rights protection in recent years. It would perpetuate and expand current rights violations like Involuntary Outpatient Commitment (disingenuously referred to as “Assisted Outpatient Treatment”), and would return the nation’s state mental health systems to the failed policy of mass institutionalization.
These possibilities frighten me. For more than 25 years, I’ve worked in a range of positions in the system – as a state mental health official, a historian and writer, and a researcher and trainer – and, in my free time, as an activist in the human rights movement for people with psychiatric histories. Over that time, I’ve seen coercion and cooptation increase. I’ve seen people’s rights trampled in both inpatient and outpatient settings. I’ve seen years of work that resulted in tiny improvements wiped out in the blink of an eye. I’ve often been discouraged and I’ve often felt like my years of work have been largely in vain.
But recently, one development has kept hope alive for me: the slow but growing realization within the field that the vast majority of people with psychiatric diagnoses are trauma survivors, and the recognition that many of the system’s common practices traumatize and re-traumatize the people the system is supposed to serve. While the research has been clear on this for at least the last 30 years, this new awareness has led to conversations across the country about the need for trauma-informed approaches within the mental health system, and a broadening of the field’s awareness of how widespread these problems are.
This emergent awareness of trauma and these conversations about change are just the first small steps toward a needed overhaul of a system that has historically valued control over compassion, authority over understanding, and the convenience of providers over the human needs of people. The scope of the issue is enormous and the magnitude of the changes needed to create a truly trauma-informed system is staggering.
To begin this process, people who run the system- policymakers, administrators, managers, researchers, direct service staff – and people who use services (voluntarily or not) need to be educated about the extent to which trauma is at the root of most psychiatric diagnoses. People with diagnoses have the right to this information to help them make sense of their own struggles, and people who administer and deliver services need this information in order to understand that the people they have seen as “diseased” are in fact people who have been deeply hurt by violence in many forms. It starts, as Sandra Bloom, founder of the Sanctuary program points out, by asking about what happened to people, rather than what is “wrong” with people.
This basic awareness needs to be followed by a commitment to explore the values and principles of trauma-informed approaches; to take inventory of the many ways in which the current service system does not comport with these values; and to a commitment to the hard work of ridding the system of all practices that routinely re-traumatize people. This means an end to coercion in all its forms: restraint, seclusion, inpatient and outpatient commitment, forced drugging, forced shock, and requiring adherence to treatment in order to get housing and other generic services. This is a long, complicated undertaking that will unsettle many powerful interests, but it is necessary to achieve the goal of a trauma-informed system.
Those of us with trauma histories who have been through the mental health system can help move this agenda forward by learning about and practicing trauma-informed peer support. In 2012, my colleagues Andrea Blanch, Cathy Cave, Beth Filson and I developed a guidebook with the goal of providing people with the understanding, tools, and resources needed to engage in culturally responsive, trauma-informed peer support relationships with trauma survivors. The guide is called Engaging Women in Trauma-Informed Peer Support: A Guidebook, but most of the information, aside from a gender-specific chapter, is applicable to all people. It can be downloaded from http://www.ahpnet.com/Files/PeerEngagementGuide_REVISED_10_2012.aspx
Darby Penney is a long-time activist in the human rights movement for people with psychiatric histories. She is the author, with Peter Stastny, of The Lives the Left Behind: Suitcases from a State Hospital Attic.