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The Promise of Trauma-Informed Approaches: Alternatives to the Dangers of the Murphy Bill

These are dangerous and trying times for those who believe that the human rights of people involved with the mental health system must be promoted and protected.  The Murphy Bill – “The Helping Families in Mental Health Crisis Act” (H.R. 2646)- and its only slightly less frightening companion bill in the Senate – would undermine what little progress has been made toward rights protection in recent years. It would perpetuate and expand current rights violations like Involuntary Outpatient Commitment (disingenuously referred to as “Assisted Outpatient Treatment," and would return the nation’s mental health systems to the failed policy of mass institutionalization. 

 

These possibilities frighten me. For almost 30 years, I’ve worked in a range of positions in the system – as a state mental health official, a historian and writer, and a researcher and trainer – and, in my free time, as an activist in the human rights movement for people with psychiatric histories. Over that time, I’ve seen coercion and cooptation increase. I’ve seen people’s rights trampled in both inpatient and outpatient settings. I’ve seen years of work that resulted in tiny improvements wiped out in the blink of an eye. I’ve often been discouraged and I’ve often felt like my years of work have been largely in vain.

 

But recently, one development has kept hope alive for me: the slow but growing realization within the field that the vast majority of people with psychiatric diagnoses are trauma survivors, and the recognition that many of the system’s common practices traumatize and re-traumatize the people the system is supposed to serve. While the research has been clear on this for at least the last 30 years, this new awareness has led to conversations across the country about the need for trauma-informed approaches within the mental health system, and a broadening of the field’s awareness of how widespread these problems are.

This emergent awareness of trauma and these conversations about change are just the first small steps toward a needed overhaul of a system that has historically valued control over compassion, authority over understanding, and the convenience of providers over the human needs of people.  The scope of the issue is enormous and the magnitude of the changes needed to create a truly trauma-informed system is staggering. 

 

To begin this process, people who run the system– policymakers, administrators, managers, researchers, direct service staff – and people who use services (voluntarily or not) need to be educated about the extent to which trauma is at the root of most psychiatric diagnoses. People with diagnoses have the right to this information to help them make sense of their own struggles, and people who administer and deliver services need this information in order to understand that the people they may have seen as “diseased” are in fact people who have been deeply hurt by violence in many forms. It starts, as Sandra Bloom, founder of the Sanctuary program points out, by asking about what happened to people, rather than what is “wrong” with people.

 

This basic awareness needs to be followed by a commitment to explore the values and principles of trauma-informed approaches; to take inventory of the many ways in which the current service system does not comport with these values; and to a commitment to the hard work of ridding the system of all practices that routinely re-traumatize people. This means an end to coercion in all its forms: restraint, seclusion, inpatient and outpatient commitment, forced drugging, forced shock, and requiring adherence to treatment in order to get housing and other generic services.  This is a long, complicated undertaking that will unsettle many powerful interests, but it is necessary to achieve the goal of a trauma-informed system.

 

Those of us with trauma histories who have been through the mental health system can help move this agenda forward by learning about and practicing trauma-informed peer support. In 2012, my colleagues Andrea Blanch, Cathy Cave, Beth Filson and I developed a guidebook with the  goal of providing people with the understanding, tools, and resources needed to engage in culturally responsive, trauma-informed peer support relationships with trauma survivors.  The guide is called Engaging Women in Trauma-Informed Peer Support: A Guidebook, but most of the information, aside from a gender-specific chapter, is applicable to all people.  It can be downloaded from http://www.ahpnet.com/Files/Pe...REVISED_10_2012.aspx

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Sorry, 

 

I allowed my self to rant a bit.  However, these abuses are really unacceptable and occur easily in this system the way it is currently set up.  It is very important to not automatically assume someone who has a diagnosis cannot make decisions and it is also important to recognize that there are others out there who will use that diagnosis against vulnerable people for their own purposes and not for health, safety, and certainly not in a trauma-informed manner.  It truly is serious and no one should take the Murphy Bill lightly.  No one. 

 

Thanks

 

Tina Marie, I'm sorry to hear about your awful experience, and appreciate your sharing it with readers. Most of us who have been through the system unfortunately know that this is not an isolated incident, but I think the general public doesn't know that these kinds of traumatic experiences go on in the mental health system.

 

Not only that, after the fact, my mental health records were altered.  Advice, don't have a psychiatrist at the same rural hospital you work at. 

 

How do I know?  I requested my records and there were duplicate notes for the first several visits up to the time I was involuntarily committed.  Anyone can look at the records and see--- someone tried to redo the notes with different diagnoses based on post-discharge. 

 

It was absolutely ridiculous and no one has to this date been held accountable.

 

The Murphy bill can be used against anyone who is "different" and has acknowledged any mental illness to try to seek help.  This is terrible because - due to what I know now, I would never have seen psychiatry.   Is that where we should be going.  I was told by a very close medical student friend to NOT seek psychiatric assistance because it would follow me where ever I went.  He was very right. I thought this was non-sense because it was a field of medicine.   I actually don't believe that psychiatry the way it is done now has anything to offer that is positive but has a lot to offer that is very dangerous.  

 

Psychiatry is 10 min med visits and there must be some medication to treat everything.  Not true.  

Medications do not heal child abuse.   Medications do not heal family dysfunction. 

 

10 minute visits to get another medication added here and there doesn't help anyone's mental health at all.  What does a 10 min med visit do --- if one is inclined and has not been well versed in how current day psychiatry works -- well this may be helpful via the placebo effect for a short time but eventually everyone goes through the trauma and dissolution that psychiatry does not as currently practiced in most places and most institutions serve people. 

 

We need to hear about breathing, about guided imagery, about yoga, exercise, nature and the mind-body connection.  Patients with symptoms produced by developmental trauma should be educated about how the brain, HPA axis and genes are altered by abuse exposure but that working with the body can be very helpful.  Educating patients about the predictable outcomes of childhood trauma is very helpful by itself so that the person does not have to feel like they are fundamentally flawed.  

 

Educating about the brain changes and epigenetic changes ---- puts the onerous on us as physicians to engage in real prevention.   It is not enough to treat end result and damage --- and if physicians only want to treat the end result and damage, they at least need to understand they are doing nothing to prevent the damage that can result when a car crashes.  

 

We must insist on the use of seat belts instead of only being concerned with treating multi system trauma after the car hit another head on (just a metaphor).   

Last edited by Former Member

Darby, This is a very important piece. Unfortunately, people who are diagnosed with a mental illness are still somehow considered "different" from the rest of society, even from other trauma survivors.  We would never allow a woman who has been abused by her husband to be forced into treatment, why should it be OK for someone with a mental health diagnosis?  I hope the entire trauma movement joins with you and others to resist any policy initiative that doesn't fully embrace a trauma-informed approach.

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