Introduction by Croakey: Can the public health response to the pandemic take into account people’s previous trauma?
That was a question asked by a group of researchers and health leaders, who work on Healing the Past by Nurturing the Future project for Aboriginal and Torres Strait Islander parents experiencing complex trauma.
In the article below, published originally at The Conversation, the group — Dr Christina Heris, Professor Catherine Chamberlain, Cindy Woods, Professor Helen Herrman, Dr Janine Mohamed, Dr Michelle Kennedy, Dr Shannon Bennetts and Simon Graham — outline 10 principles that may decrease stress or trauma by fostering a sense of security, well-being, confidence, hope and resilience.
It comes as countries across the globe continue to mark World Mental Health Day (see tweets at the bottom of the post), with the acknowledgement of the major impact of the COVID-19 pandemic, which has created and exacerbated mental health issues for individuals and significantly disrupted services for mental, neurological and substance use disorders.
However, there is good news, said the World Health Organization, with governments around the world recognising — during the World Health Assembly in May 2021 — the need to scale up quality mental health services at all levels and with some countries finding new ways of providing mental health care.
See more information here and some relevant #WorldMentalHealthDay tweets below.
Thanks to Yued/Whadjuk Noongar Aboriginal primary health care physician Dr Jason King for permission to use the photo from his tweet as our feature image.
Christina Heris, Catherine Chamberlain, Cindy Woods, Helen Herrman, Janine Mohamed, Michelle Kennedy, Shannon Bennetts and Simon Graham write:
Fear is one of the central emotional responses during the pandemic. Every day brings a new level of stress: concerns about getting sick, the stigma of testing positive, financial difficulties due to not being able to work, separation from loved ones in lockdown (or being locked in an unsafe household). The list goes on.
For many of us, uncomfortable feelings can be “natural” responses to a “threat”. Our strong, primitive defence or “threat response” (sometimes called “fight, flight or freeze”) has enabled human beings to survive. This stress response is essential for survival against poisonous snakes, crocodiles and other dangerous situations.
Unfortunately, our “threat responses” are not good at recognising the difference between the “threat” from a crocodile and a pandemic. These responses happen much faster than any conscious thought.
It can be particularly hard for people already experiencing complex post-traumatic stress disorder or trauma associated with earlier exposure to severe, repeated and inescapable threats or abuse, often from those meant to protect them.
As the pandemic hit last year, we were working on the Healing the Past by Nurturing the Future project, which aims to improve support for Aboriginal and Torres Strait Islander parents experiencing complex trauma.
We asked ourselves whether the public health response to the pandemic can take into account people’s previous trauma.
The Centers for Disease Control and Prevention in the US thought so when it integrated key principles of trauma-informed care into training for its Office of Public Health Preparedness and Response in 2018.
Taking core concepts from our research and guiding principles, we identified 10 principles that may decrease stress or trauma by fostering a sense of security, well-being, confidence, hope and resilience.
1. Safety
The first priority of any emergency or “trauma-informed response” is to ensure physical safety from the immediate threat (like first aid principles). This includes the safety of people most at risk during lockdowns (for example, those experiencing family violence).
2. Connectedness and collaboration
Humans are social beings and being “connected” is another essential survival strategy that is more helpful to us in the pandemic than “fighting, fleeing, or freezing”.
When we have social support, it’s easier to take action in an emergency. But it’s not easy staying “socially connected” yet “physical distanced” in an infectious disease outbreak.
Inequitable responses to the pandemic can also lead to divisions in society, such as when one community appears to receive greater financial support or an unfair allocation of vaccines.
However, looking after each other is our ticket out of here. We have seen this with the global scientific collaborations in the quest to create COVID-19 vaccines.
3. Compassion and caring
Acts of kindness, compassion and caring are needed more now than ever. Compassion and empathy promote well-being and we know social supports act as a buffer against difficult times.
Understanding stress and distress responses is an important way to “normalise” our feelings, and the actions of others.
4. Trust and transparency
Clear, compassionate action and transparent communication from governments are also important. These things increase a sense of safety and potential for people to follow public health advice.
Hiding information leads to distrust in government and the media. This can contribute to mistrust in COVID-19 responses and lead to non-compliance.
A lack of information and exposure to misinformation can also increase distress, and leave people vulnerable to conspiracists who target marginalised groups most at risk.
Rebuilding trust in an emergency may not be possible, but this is where trusted community partners become invaluable mediators and sources of truth for communities.
5. Cultural safety and responsiveness
Public health approaches and messaging needs to be appropriate and sensitive to local contexts.
Communities need health messaging that draws on cultural strengths to increase trust and access to services, such as the way Aboriginal and Torres Strait Islander community-controlled health organisations quickly mobilised to take control of the local response to COVID-19.
6. Commitment to equity and human rights
COVID-19 has not had the same impact on everyone. Many people, including Aboriginal and Torres Strait Islander and refugee communities, are affected by historical and intergenerational trauma, racism, and ongoing socio-economic deprivation.
These things can be exacerbated in this current crisis. We must address the socio-cultural determinants that can impact people’s health, such as insecure work and housing, and focus on equity.
7. Good communication
Crisis communication principles say messages are most likely to be effective when they are clear, credible and interactive, shared consistently, and targeted to community groups.
The public may feel the need to seek information to manage their anxiety, but distressing content can also increase their feelings of stress, confusion, and a lack of control, impacting their ability to take action.
The media play a critical role here. Accessing trustworthy, reliable information through these channels is important so people know what action to take and where they can go for help.
8. Positive leadership
Good governance helps us feel safe. It’s important for the government to be highly visible, provide regular updates and practical support, and help people understand and manage feelings of stress.
But we don’t just need leadership from politicians and officials. Local leaders also need to support their communities to process fear, grief and loss, and to help people understand the crisis will pass and there is hope.
This was on show when Aboriginal and Torres Strait Islander community-controlled organisations took quick action to protect their communities from COVID-19.
9. Empowerment
Individual and community empowerment comes from having choice, voice, and control. This promotes the confidence to respond to an emergency, as well as resilience, hope and the ability to cope.
Communities that are empowered to play an active role in disaster response actually recover better, with lower rates of post-traumatic stress. However, communities must be adequately resourced to do this.
10. Holistic support
We need big responses that address health and safety, social and emotional well-being, community connectivity and cultural responsiveness to improve quality of life, relationships and social functioning.
However, effective emergency responses must be embedded in well-functioning social systems, including emergency social and economic support and high-quality healthcare services everyone can access when needed.
Our next step will be to discuss these 10 principles with community members and public health experts in an October workshop, to develop a culturally responsive, trauma-informed, public health emergency framework for First Nations communities.
This pandemic is far from over and there is now a race to vaccinate communities that have been left behind as states open up. A trauma-informed public health emergency response is possible. And with cases due to rise just as the next bushfire and cyclone seasons arrive, we need one now.
Christina Heris is a Research Fellow, Australian National University
Catherine Chamberlain is Professor Indigenous Health Equity, The University of Melbourne
Cindy Woods is a Research Fellow, The University of Melbourne
Helen Herrman is Professor, The University of Melbourne
Dr Janine Mohamed is a Distinguished Fellow and CEO, The Lowitja Institute
Dr Michelle Kennedy is a Senior research fellow, University of Newcastle
Shannon Bennetts is a Research Fellow, Judith Lumley Centre at La Trobe University, La Trobe University
Simon Graham is an NHMRC Fellow, Peter Doherty Institute for Infection and Immunity, The University of Melbourne
Read more from The Conversation:
The community-led movement creating hope in the time of coronavirus
Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities
See Croakey’s archive of stories about trauma-informed care.
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