When talking about mental health care it’s essential to talk about trauma; even more so when we’re looking through the lens of complex needs. Not addressing the needs of traumatised individuals leads to care that simply doesn’t work and in the worst scenario causes serious harm. I have experienced this personally and seen this happen as a healthcare worker. Today we’ll be diving into re-traumatisation and how the healthcare system in the UK can cause it.
So, what is trauma?
The dictionary definition of it is “Emotional shock following a stressful event or physical injury, which may lead to long term emotional problems”. In this post trauma will refer to any life event that has caused significant ongoing stress, emotional or visual flashbacks, nightmares or even just an awful feeling that washes over you. Feel free to define your trauma in a way that makes sense for you.
What causes trauma?
Sexual, physical, financial or emotional abuse - this includes witnessing abuse
War, natural disasters, terrorism, religious abuse, racial abuse
Bullying, parental divorce, emotional neglect, death of a close relative
Having a parent in prison or a parent with a severe mental health condition
All of these and many more can lead to someone becoming traumatised. It’s also worth mentioning that sometimes it’s not the ‘big’ life events that can traumatise an individual, but ongoing smaller events that slowly grind someone down. We know from the Adverse Childhood Experiences (ACEs) Study that those who experience a certain amount of trauma actually have a lower life expectancy than others, if untreated. Trauma is serious business and the NHS is beginning to acknowledge the dangers, not to mention the suffering that it causes.
What is Retraumatization?
Reliving your previous traumas when faced with a similar event.
When I was around 10 my parents had a fairly messy divorce. My dad wouldn’t show up for visits and disappear for months on end with no explanation. This went on for many years and because of my age and previous attachment to him it caused me to become traumatised. I would become emotionally overwhelmed and clingy when situations triggered me. In my mid-teens I was able to push the memories down, but I never truly dealt with them. However, things got better and I got on with my life. Now here’s the thing with unresolved trauma, it has a way of rearing its ugly head. In my second year of university my parents decided to make an attempt at getting back together. It made me deeply uncomfortable, but I was happy for them. For a while it worked, but unfortunately I found out that my dad had started cheating on my mum again. I didn’t necessarily think they would stay together, but a fear started to arise in me that he would be gone from my life all over again. Dealing with these constant triggers from their relationship were what retraumatised me and pushed me over the edge. It was the biggest cause of me falling into my first proper breakdown of my adult life and when they eventually did split up, what caused me to drop out of uni. The emotions around being abandoned by a parent all came back to me and in my panic I ended up putting myself in A&E. This is the reality of the damage retraumatization can cause.
What happens in mental healthcare that retrumatizes?
So this is what we’re really here to talk about today. You might be wondering how a service that is set up to help people could ever exacerbate the symptoms they are seeking to treat? Or, like me and many others I know, you might have first hand experience of this happening. In my eyes there are two main things that healthcare professionals and the current Mental Health Act do that causes retraumatization.
Coercion
This is a tactic that I have experienced both in hospital and community settings. Coercion is a bit like emotional blackmail. It’s used to get people to do things that they don’t want to by threatening to give a punishment or take away a privilege. I remember once I questioned some of the long term medications I was prescribed, explaining that I didn’t think they were helping and that since the side effects were so bad I wanted to stop taking them. I was informed by the community nurse that if I didn’t take them that they would remove me from the therapy waiting list as I ‘clearly didn’t want to get better’. I immediately knew what she was doing was wrong, but she used her authority and power to take away my choice to make decisions about my own body. It wasn’t protective, it was to make her life easier. Even if the healthcare professional thinks the coercion is for the benefit of the patient, it’s almost always for their own. What she should’ve done was open up a conversation with me and schedule me in for a medication review. But that was going to take her more time than threatening me.
Control
This is an aspect of mental health care that you almost certainly have heard of. It conjures visions of old asylums and straightjackets. Whilst we have largely moved on from these methods, some still remain. These range from medical and physical restraint to being secluded for emotional outbursts. Now those of you that work in health care might be insisting that restraint is essential to keep others safe in certain situations, and I actually agree with you. However, I’ve seen it happen to a person for simply raising their voice and becoming emotional. Restraint should not be happening until there is no other option to prevent harm.
Coercion and control are used to force people into complying with mental health workers and services as a whole. It even goes higher than this. The current mental health act can leave those with mental health conditions with even less rights than prisoners.
So why do these actions re-traumatize people?
Physical restraint can look a lot like what survivors of sexual violence may have gone through. Being physically forced and held down can bring back horrific past memories.
The previous point is also relevant to the violence that BAME people may have experienced at the hands of the police force.
Those that experienced emotional abuse during childhood or domestic violence, will likely be triggered by coercive behaviour. Leaving them fearful and unable to trust their health care worker.
Those who have been abandoned in the past (like myself) might find the way that services suddenly discharge people to be very triggering. They then get labelled as clingy or problematic when they have a trauma response.
This is by no means an exhaustive list. There are many flaws in the system that are causing more hurt than healing. The way in which mental health services deal with trauma responses perpetuate further trauma. Thus creating a vicious circle of emotional and physical damage. Do I think the system can change? Yes, very much so. By educating organisations and staff we can minimise the damage caused. In my next post I will be talking about the steps that need to be taken in order to achieve this.
