Post-Crisis Communities

How can the field of mental health care best address the problem of systemic trauma at the international and community levels?

Post-crisis communities suffer from disruption in aid services, blocked access to relief, and traumatized populations without recourse. These communities are located within systems that may face chronic instability and therefore need organizations dedicated to growing beyond crisis using less regimented and paternalistic structures in favor of more focus on collaboration and fluidity (Brady, 2019; Lauder & Marynissen, 2018; Mihelicova et al, 2018).

Within the international world, the World Health Organization (WHO) outlined its mental health action guide in 2004 as a set of principles for mental health providers to follow. The recommended actions call for supporting various post-crisis crisis communities in the promotion of mental health well-being while attention to factors that result in long-term disability are addressed at the community and group level, with sensitive easy-to-implement interventions (Brady, 2019).

Without sensitivity towards those who have encountered trauma, practitioners may view and treat populations through a specific lens, furthering stigma and oppression (Mihelicova et al, 2018). The mental health practitioner who is consulting in such a situation will play multiple roles, including directing how connections are set up between stakeholders, designing collaborative models for organizations to utilize for the long-term, implementing evidence-based interventions, and bolstering already existing services. In addition, the consulting or community psychologist will ensure trauma-informed care serves everyone affected by crisis, homelessness, war, poverty, violence, and other systemic violations (Brady, 2019; Mihelicova et al, 2018). Even with their best practice and evidence-based approaches, psychologists are still challenged to translate their knowledge into practical applications in all kinds of settings, including non-crisis environments. When help is required at an international level due to war or other catastrophic events, consulting psychologists will be called on to create change at the organizational level while staying open to and mindful of cultural factors, infrastructure and technical operations, and sustainability of new models and developments (Brady, 2019).

Trauma-informed service delivery (TISD) targets the gaps between those whose needs are complex and usually not addressed due to barriers within and outside of the traumatized person or populations, and the services that will be delivered at the psychic, interpersonal and social levels. TISD works with several important principles which include fostering awareness of the impact of trauma, engaging trust and collaboration, and empowering survivors to seek choices in how they go forward, with an attention to client safety (Brady, 2019).

TISD principles support a framework for implementing organization-wide change only when trauma-informed care is not restricted to applications of specific interventions. These may not take into account broader structural dynamics like a community's history of deficits and possibly violence, poverty, homelessness and street living, organizational policies which have to choose between safety and re-victimization, and ingrained staff attitudes and cultural characteristics, all of which may lead to consequent re-traumatization (Brady, 2019; Mihelicova et al, 2018).

Trauma-informed services should also note that psychosis may arise not from organic, brain-centered or the usual, expected mechanisms functioning within a medical model, but instead emerge as a consequence of traumatization due to circumstances and events present in daily living (Mihelicova et al, 2018).

Additionally, first responders, families and clients all require psychoeducation on recognizing symptoms and seeking help, readily available at all times, in trauma-informed and appropriate ways (Mukherjee & Saxon, 2019). Clients should also be informed as to how long the helping intervention will be expected to last, thereby conferring upon the client agency and a sense of stability (Hatchett, 2020).

Trauma-informed and sensitively-administered therapeutic interventions can be successfully implemented to address post-crisis situations on an international level while also remaining relevant to local community needs (Brady, 2019; Mihelicova et al, 2018; Mukherjee & Saxon, 2019).

Understanding that events can't neatly be translated into specific therapeutic responses, and that people react to chaos by exhibiting behaviors and symptoms similar to those diagnosed in mental illness, can help shape an appropriate atmosphere in which trauma survivors find support (Brady, 2019; Mihelicova et al, 2018; Mukherjee & Saxon, 2019; Lauder & Marynissen, 2018).

Discussion

Chaos and crisis can be viewed as large-scale events impacting whole populations. Humanitarian, organization-wide projects which bring together various stakeholders in an effort to treat traumatized victims can have successful outcomes when certain trauma-informed principles are in effect. These principles include establishing trust within and between organizations and stakeholders, project transparency in order to instill a sense of safety, many opportunities for stakeholder participation, improving on communications through active collaboration, encouragement of stakeholders to discover their own empowerment, implementation of learning exchanges, and modeling of principles (Brady, 2019).

Retaining flexibility when assisting others in managing crisis, whether small or large, entails understanding not only how trauma-informed principles can be translated into practice, but also that rules made to conform to certain variables may have an opposite effect when rigidly retained in fluid situations. Organizations need to realize how their interdependence, stakeholder micro and macro-dynamics, and constantly changing reactions need continuing realignment and adaptation (Lauder & Marynissen, 2018).

Health care providers should keep in mind that that oppression can take on various forms – both overt as in catastrophes, and covert as in embedded racism – and should design their spaces and modulate their presence and interactions so that survivors and victims can feel safe enough to receive and benefit from services (Mihelicova et al, 2018).

Second-order change across organizations can be facilitated by consulting or community psychologists who will use strategies to increase collaboration, empowerment, and coalition-building. Both welfare of clients and provision of necessary services should act as common goal and intended mission (Brady, 2019; Mihelicova et al, 2018). When in-person therapeutic interactions are not possible due to outside circumstances or intrapsychic challenges, tele-health should be widely available (Mukherjee & Saxon, 2019).

Recognition that trauma-informed care – with its sensitivity to culture, history, ecology, family dynamics, stressors, oppression of all kinds, and the effects of widespread crisis – when implemented across organizations, can foster a newfound understanding within practitioners themselves who may then go on to reshape their work environment, policies, and outlook on life ((Brady, 2019; Lauder & Marynissen, 2018; Mihelicova et al, 2018).

True engagement in the process of constructing and implementing trauma-informed care comes about through active stakeholder participation as these members of various disciplines and entities are encouraged to reveal their situations, needs, and questions, and collaborate on shaping the training they will give and receive (Brady, 2019).

The consulting psychologist facilitates growth by offering evidence-based trauma-informed psychoeducation and training. Facility or organization members can then take useful paradigms and work together to translate their knowledge to their own special circumstances (Brady, 2019; Hatchett, 2020; Lauder & Marynissen, 2018; Mihelicova et al, 2018).

Community and consulting psychology can use transformative approaches to address power imbalances, facilitate empowerment, and help both practitioners and clients recognize the influence of the environment, including the systems and operations to which agencies must conform, as one which has important repercussions for individual and collective mental health (Mihelicova et al, 2018).

- Amy Discepolo, LMHC, EMDRIA Certified Therapist

(This article is reprinted from Bloom Behavioral Health)

References

Brady, L. L. (2019). Connected world, connected profession: Increased recognition of opportunities for local and global engagement by psychologists in postcrisis communities. Consulting Psychology Journal: Practice and Research, 71(1), 47-62.

Hatchett, G. T. (2020). Anticipating and planning for the duration of counseling. Journal of Mental Health Counseling, 42(1), 1-14. http://dx.doi.org/10.17744/mehc.42.1.01

Lauder, M. A., & Marynissen, H. (2018). Normal chaos: A new research paradigm for understanding practice. Journal of Contingencies and Crisis Management, 26(2), 319-323. http://dx.doi.org/10.1111/1468-5973.12189

Mihelicova, M., Brown, M., & Shuman, V. (2018). Trauma-informed care for individuals with serious mental illness: An avenue for community psychology's involvement in community mental health. American Journal of Community Psychology, 61(1), 141-152. http://dx.doi.org/10.1002/ajcp.12217

Mukherjee, D., & Saxon, V. (2019). “Psychological boarding” and community-based behavioral health crisis stabilization. Community Mental Health Journal, 55(3), 375-384.