Any effort to understand and treat co-occurring disorders cannot ignore the prevalence of trauma in the lives of those who are struggling with recovery from mental illness and addiction. A look at the trauma prevalence data in both general and behavioral health populations clearly makes the case. According to a report by The National Council for Community Behavioral Healthcare, 70% of adults in the U.S. have experienced some type of traumatic event in their lives, and 90% of individuals in public behavioral health have experienced trauma. These numbers make trauma a serious risk factor in nearly all mental health and substance abuse disorders.
We are in a period of unprecedented healthcare system reform, in which health integration and social determinants of health are recognized as key in achieving the best health outcomes of populations served. At this moment, it is difficult to consider the viability of any healthcare practice that does not attend to “whole person” health, each individual’s complex behavioral and primary health conditions and needs. The days of siloed and singularly focused practice are obsolete.
People with complex healthcare needs are challenging to health practitioners who have historically been lacking in the necessary literacy, competencies and resources to meet the demands of whole person health. Over the last 30 years mental health and substance abuse treatment providers have struggled with categorizing the co-incidence of mental health and addiction in the same person. Historically labels like MICA (Mentally Ill/Chemical Abuser), CAMI (Chemical Abuser/ Mentally Ill), Dual Disordered, and, now, COD (Co-occurring Disorder) have assuaged practitioner boundary anxieties, yet, they have largely misdirected practitioner attention to the periphery of the person resulting in a fundamental failure to embrace the entirety and complexity of a person’s health condition and needs.
Additionally, chronic health conditions like Diabetes, Hypertension, Cardio-vascular Disease, Asthma and HIV are inextricably entwined in the mental health and addiction profiles of populations with complex healthcare needs and cannot be ignored in the delivery of treatment and services aimed at achieving optimal health outcomes. The first step for practitioners adopting an integrated approach to healthcare is engagement, keeping persons served in treatment long enough to yield the best health outcome. This is where recognition of the high prevalence of trauma in the lives of the people we serve becomes critical. Without adoption of an integrated and trauma-informed approach to engage, support, and treat people with complex healthcare needs, the practice of “whole person” healthcare will not be realized.
Trauma-informed treatment is not a new concept, and trauma treatment models are being practiced in many behavioral health settings. However, in the interest of best practice, a trauma informed and chronic disease literate behavioral health practitioner versed in a trauma treatment model is insufficient to promote lasting client engagement resulting in optimal health outcomes. Unless the entire health care practice or service is trauma-informed, from reception and intake to facilities management and maintenance, client engagement will be fragile, inconsistent and, consequently, inadequate to optimize health outcomes. Improving health outcomes of people with complex co-occurring chronic disease, mental illness and addiction disorders, necessitates that behavioral and primary healthcare providers examine and alter their organizational culture, a “whole organization” foundational endeavor designed to support the delivery of “whole person” healthcare.
“What does trauma-informed culture look like?” is usually the question I am asked in conversations with healthcare providers. It is a culture where every employee understands the prevalence of trauma in the people served by the organization. It is a culture that appreciates the negative social, emotional, cognitive and physical consequences of unrecognized trauma. It is a culture where practitioners are skilled and competent in screening for, and asking about, trauma in every initial client encounter. Finally, it is a culture that is willing to examine itself and change any and every aspect of its philosophical, practical and physical presence to prevent re-traumatization of the people it serves and to recognize and address the inevitable impact of vicarious trauma and compassion fatigue on its employees.
As I believe that readers of Behavioral Health News subscribe wholeheartedly to person-centered and recovery-based approaches, it should come as no surprise that denying the impact of trauma on a person’s overall health will undermine the power of those approaches for improving health outcomes. Similarly, in denying the re-traumatizing impact of non-trauma informed environments in our healthcare system, we are ignoring barriers that ultimately prevent those who need care the most from getting it. Without acknowledging trauma in the lives of the people we serve, and without making our treatment and service environments and interactions feel safe, engagement in treatment and services of our most vulnerable populations will remain out of reach.
For any questions or elaboration regarding this article, Dr. Ades can be reached via email at adesy.ihs@gmail.com or by phone/text message at (917) 596-6584.
