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.

Healing Race Trauma

I attended my first Black funeral in January 2012. My beautiful grandmother had passed away a few days prior, and my mother, sister and I arrived to Port of Spain, Trinidad West Indies within a few hours. I loved my trips to Trinidad, but this one was bittersweet. Each day, before the funeral we sat in my grandmother’s home as visitors came to visit every day. The visitors brought food, told stories, prayed, played music, hugged, and connected with each other.

So after learning of Mr. Floyd’s passing, I think the world engaged in a similar experience of mourning. The world developed community, told stories, prayed, shouted hymns, and marched. People all around the world highlighted that anti-Black racism continues to exist, and that the lives of Black children, youth and adults remain in danger across the world, and #BlackLivesMatter. In the days after Mr. Floyd’s passing, the world became divided, but also unified. The work that was started centuries ago, is now entering another process. It is also stirring up the impact of race trauma.

I discovered that I was Black, well actually, referred to in the traditional slave master terminology in a kindergarten playground in junior kindergarten. I was 4. Race is a social construct. Someone decided to create the concept of “race”. When this occurred, someone decided to divide people based on colour, into categories of superiority and inferiority. Thus, whiteness became superior. Whiteness came with unearned privileges, that those considered inferior could not participate in. Whiteness defined the way of being for the world. Thus, at 4 years old, I was indoctrinated to know that I was inferior, I was “less than”, and “not good enough” than everyone else.

“Race trauma creates further post traumatic stress that can lead to symptoms such as chronic physical pain, depression, anger, anxiety, disease, unhelpful thinking patterns, substance use, lack of motivation, mood disorders, hyper vigilance, night terrors and flashbacks, repeated traumas, and more”.

As a four year old, this experience shaped the next 40 years of my life. And now, as I write this article, I reflect back on how the constant name calling, belittling, microaggression, avoidance, lack of mentorship, isolation, ignoring, silencing, exclusion, misunderstanding, disregarding, mocking, petting, gaslighting perpetuated on me. This truly impacted my sense of self worth, my disconnection from my identity and my culture, my opportunities for the “Canadian Dream”, my relationships with others and the ability to form trusting relationships, and so much more. Race trauma creates further post traumatic stress that can lead to symptoms such as chronic physical pain, depression, anger, anxiety, disease, unhelpful thinking patterns, substance use, lack of motivation, mood disorders, hyper vigilance, night terrors and flashbacks, repeated traumas, and more. And, I have not even started to discuss: intergenerational trauma, health inequities, gender inequality, disproportionate involvement with child welfare, educational penal systems and the criminal justice systems which are intertwined and intersected with race.

Today, the world is focusing on highlighting that anti-Black racism is not a political issue but an undeniable human right to not experience racism. Nevertheless, the impact of race trauma exists for Black people across the diaspora and our world. Our white counterparts watched in horror as Mr. Floyd was murdered by the systems, and Black people could only cry and turn their heads. There was no way I could watch the horror show. Instead I cried. I cried for my ancestors. My grandparents. My parents, aunties, uncles and elders of my community. I cried for my child. My child clients and the many youth in my life. I cried for my cousins. My cousins. I cried for my nephews and the unborn children. Our lives are forever shaped because of whiteness, white privilege, racism, hate, inferiority, and injustice.

During a session, I was asked, “can you tell me some tips on how to deal with racism at work?”. I said and I always say, “it is ridiculous, that I have to tell you how to deal with racism.”. This angers me. We should not have to tell the oppressed how they should accept their oppression, and stand in complacency to the injustices of racism. But we do. We need to heal. All I know is that, I can not cry for us any longer.

Take good care of yourself

If there was a step, this is STEP 1:

Put yourself first. Develop a self-care routine. Ensure your needs are met. Create space for your emotional needs. Attend counselling. Learn to say no. No. Be mindful of your body’s needs. Reduce your work when you can. Take time off. Take your vacations… travel or stay home or do nothing. Exercise. Invest in your friends and close connections. Embrace Joy. Show love to yourself and others. Be kind, compassionate, and find other values as rooted into your foundation. Practice mindfulness. Take good care of you.

Build a supportive community

Do you know the phrase, “it takes a village”. It really does. Your village is your people of friends, aunties and uncles, mentors and elders who guide you along your way. Invest in these key relationships to provide you the support you require. Choose wisely. Not all elders are made for you. Choose people in your life who shares your values, your belief systems, and can inspire you to be your best self. A key piece to healing trauma is social engagement, relationships, and positive life experiences.

Create Positive Life Experiences

I may not have had many positive memories at elementary school. But I had a wealth of positive life experiences at home, at my church, my aunties homes, and my travels to the United States with family. When I reflect upon my past, I remember these experiences as though they were experienced yesterday. Positive life experiences helps to re frame the messages of self and identity that Black people receive from their educators, their employers, in the community, in the media and on television, and the whiteness culture. Positive experiences reaffirm that you are, “good”. You are worthy. You are loved and appreciated. Life is pleasant and can be joyful. You are apart of something greater. Finally, creating positive life experiences builds your overall resiliency which further builds your health and mental wellness.

Incorporating a healthier way of being focusing on healing the impact of trauma, and protecting yourself from further harm.

We are Kings and Queens and People

destined for greatness and to meet our human counterparts as people. People deserving to exercise the rights and privileges of humanity. I do have a dream. While we should not have to heal from racism, we do. Race trauma creates post traumatic stress which passes down from generations. We need to create space, and recognize that our healing is central to this process.