Reducing Barriers in Trauma-Informed Care

This personal article piece was prepared by Tabetha, based on a webinar attended by the Ontario Association for Social Workers (OASW) (Chandrasekera, 2022). The post was edited by Ifarada.

Mental health illness or addiction issues is prevalent in the lives of Canadians.

This is indicated in research that shows early childhood/adolescent onset of mental illness, and one in two persons experiencing a mental illness by age forty (Chandreasekera, 2022).

Males have higher addiction rates than women, and as expected, people experiencing poverty are more likely to report poor mental health.  The two continuum of mental health are positive – described as flourishing, and negative – described during the pandemic as languishing (Chandreasekera, 2022).

Mental health is substantially impacted by problematic substance use that leads to addiction.  There are ‘4 Cs of substance use’ explanation as follows: craving, compulsion to use, loss of control of amount and frequency of use, and continued use despite consequences.  An individual who uses substances has a craving for the substance followed by compelled feeling to use.  Eventually, the user will lose control of the amount being used and how often they are using it, but this does not disrupt the usage.  Instead, the person will continue to use regardless of what the consequences are.  Addictions can be substance related (alcohol or opioids) or process-related (behavior addictions like gambling or poorly managed, excessive internet usage) (Chandreasekera, 2022).

Having established substance use and addiction can affect mental health, and further the individual's social determinants of health

(Chandreasekera, 2022).

There were sixteen social determinants of health as follows: health, gender, housing, income, social exclusion, (dis)ability, education, employment, food insecurity, early childhood development, geography, globalization, health services, immigration, indigenous ancestry, and race.  Avoidable, unfair, systemic inequities contribute to negative health outcomes.  For example, access to healthcare as a direct line leading to needed services for certain resource-rich individuals was shown in contrast to other individuals with the same needs, seeking the same services but who had a more convoluted, time-consuming path.  Thus emphasizing how a negative outcome can occur as a result of lacking in area/s of the social health determinants e.g., education, income, and/or social status (Chandreasekera, 2022).

Discrimination affects health.  It can also result in oppression as represented by cultural imperialism, marginalization, exploitation, powerlessness, and violence.  The stigma and discrimination resulting from mental illness means that many people would share information about a family member’s diabetes or cancer diagnosis willingly, but they would not be equally willing to share information about a mental illness diagnosis of a family member.  Likewise, many people are concerned or afraid to be in the company e.g., relationship, workplace, or social setting of someone with a mental illness.  As a result many people indicate they would not tell their manager or seek medical help if they had a mental issue.  Stigma surrounding mental health can lead to micro-aggressive messages that communicate to a person that they are different and do not fit in.  Different types of discriminatory acts against persons over time can result in traumatic stress.  Some types of traumatic stress include single incident/specific life event, daily lived experiences and microaggressions, intergenerational trauma, chronic contextual experiences, collective experiences, or vicarious experiences.  Not only can discrimination cause trauma, but that it is trauma.  Because of discrimination, when tennis legend Serena Williams gave birth to her baby, she experienced complications afterwards.  However, the medical staff did not initially take her seriously or did not attend to her complaints swiftly.  It turned out that she had blood clots in her body.  Serena had to advocate for herself while she was severely ill.  There is a stigma that Black women are strong, thereby possessing a higher pain threshold than most.  Consequently, when Black women alert medical staff to pain/discomfort they have, their calls for help are largely disregarded, because of racial stigma.  If this can happen to a wealthy celebrity who has access to the best resources in the system, imagine then the conditions faced by the average minority person within the same system.  Many people of color face these and other types of health inequities often with fatal results (Chandreasekera, 2022).

The data showed that people experiencing poverty were more affected by COVID-19 than their wealthy counterparts as indicated by number of COVID-19 cases and hospitalizations

(Chandreasekera, 2022).

Similar results were seen for ethno-racial groups when compared to White people; and along the same lines, the neighbourhoods with the highest visible minority and lowest incomes had the highest weekly new sporadic COVID-19 cases.  This was in stark contrast to high income neighbourhoods with the lowest percentage visible minority which showed lowest weekly new sporadic COVID-19 cases (Chandreasekerea, 2022).

Discrimination can be addressed at the individual, community/program, and system/policy level. At the individual level the affected person must be assessed, validated, and supported.  At the community/program level it becomes necessary to engage people with lived experience, collect data and use decision support tools to aid the process.  At the system/policy level discrimination can be addressed by engaging people with lived experience, collecting data, and engaging in policy advocacy.

Discrimination is trauma. Therefore, discrimination must be addressed to achieve healing

(Chandreasekera, 2022).

Reference: Chandreasekera, 2022, "Discrimination is Trauma: Trauma Informed Care Approaches to Supporting Marginalized Populations" [webinar] Toronto: Ontario Association for Social Workers.