I listened to her. She was young, an overnight worker in a congregate care facility. She was in anguish, her voice tight with pain, as she described seeing another worker taser a youth who was upset, and then high-five a co-worker and say “Got another one!” How could her organization claim to be trauma informed, she asked? She said she knew better than to file a complaint, because the youth who was tasered had been labeled a problem, and wouldn’t be believed.
How indeed? Trauma-informed is a buzzword right now. Everyone wants on the bandwagon. Some states even mandate trauma-informed care. But it’s clear—trauma-informed isn’t trauma-responsive.
Even the United Nations Human Rights Council understands that we need to “walk the talk” and “practice what we preach.” In 2013, the UN Special Rapporteur, Juan Mendez, delivered a stunning report that called for eliminating practices in mental health care that are tantamount to torture (including coercion and restraint). Ask the kid that got tasered if you don’t understand the connection.
So why don’t we “walk the talk” and put what we know into practice to move from being trauma-informed to trauma-responsive?:
1. Fear of “what might happen”
Because we have made people whose behavior reflects a history of trauma the “Other”, and have demonized these people, and because society’s barbaric and retraumatizing responses to people with trauma histories have often evoked behaviors that strongly reflect these trauma histories, society fears that “something might happen”. In short, society considers people with trauma histories dangerous. I am pleased to say that “something did happen” in the 90s, when residents in a state psychiatric hospital sued saying they were getting worse instead of better, and ultimately out of that legal case came the model of care called Risking Connection. I remember sitting at a table to receive an award for work I’d done on helping dissociative people learn associative skills and one of the most significant figures in the field of trauma and dissociation asked me if I was pursuing my own integration. “No,” I replied, “I’m pursuing better functioning, more cooperation, and quality of life.” He leaned forward, “But aren’t you afraid something might happen in the future?” I knew him to be a Vietnam vet with a difficult combat history. I thought a minute and replied, “If the people from whom I have learned how to be more functional have helped me effectively, my risks are as minimal as they are for you as a Vietnam vet”.
2. “Power-over” is the time-tried way of responding to people whom we have deemed “less than”
We are unaccustomed to affording respect, dignity, access, agency, and self-knowledge to people who are different or around whom we might feel uncomfortable. We often make our way in this world by oppressing others overtly or covertly. Add to that the fact there are few places where people are rewarded for practicing collaboration and consensus. In the absence of skills to do it different, “power-over” is our fallback response. Most of us can remember frustrated parents saying, “Because I said so!”
3. Most payers focus on managing use instead of getting better
I am devoted to the notion that people’s functioning is paramount in mental health. This includes the mental health of people who provide services and all others who work in agencies. The third party payer system defines care as providing a set number of sessions or specific medications based on a diagnosis. It’s as if the payer system has decided how many coats of paint a brightly-painted person needs in order to be recolored a nice neutral tone. The third party decides that a good primer and at most three coats will cover purple and red and so that’s what the system is paid to provide. After all, the people who determine what folks need to “get better” are pretty sure it’s a recipe. “Managing use” is about leveling payments and metering, not functioning.
4. There’s less money in it, and it’s not as billable
Sandy Bloom’s book, Destroying Sanctuary, does a great job describing what happened when she started a trauma-informed and trauma-responsive unit: it didn’t make it. Likewise, look at the demise of all the units addressing dissociative disorders – while they may not have been perfectly trauma-responsive, they were aware of the impacts of trauma (esp. child abuse, issues with attachment, and more), but meeting the needs of the people they served wasn’t compatible with any existing business model.
5. Organizational and cultural change takes generations and great effort
Even with all the resources of a major car manufacturer, GM’s culture change experiment, Saturn, lasted less than 50 years from idea to shuttering. Yes, many of the concepts bled back into traditional GM, and I still can’t buy a new Saturn. I will tell you, as the third contractor hired in Saturn’s People Systems Training and Development group, the issues Saturn faced were the same as the ones outlined above. Power over as a fallback position, managing to budget but not quality became the key, the new business model that wasn’t as immediately profitable and fear on both labor and management’s part about what might happen” all helped stop the change.
Any time a group chooses to start a cultural revolution, resistance is inevitable. And it’s a good thing: resistance proves there’s substance to the concern. But as long as we systematically validate pathological oppression we will have trauma-informed, but not trauma-responsive systems. We will “know” but not “do”.
Yet as each of us develops and informs others about respect, dignity, choice, and helping people learn how to have these things, we will make progress one step by one step. I see the degree to which people are convinced that we should increase coercive, restrictive mental health care in this country as evidence of a groundswell in support of the opposite. I see the oppressed beginning to speak out en masse – I see the roots of a cultural revolution in mental health care. Perhaps Juan Mendez will see his report enacted. Perhaps the distraught service provider will see the tasers locked up. Perhaps the young man who used the taser will overcome his use of power over relationship. Perhaps the youth who was tasered will recover.
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Elizabeth Power’s firm, EPower & Associates, is an authorized provider for Sidran Institute’s model, Risking Connection.® She helps organizations of all types (including faith communities) learn and adopt trauma responsive practices based on relational processes as a trainer, speaker, and consultant.