Community healing is needed more than ever. It’s time we start using a healing-centered lens to recover and build a better world
By Debbie Liu and Chloe Gurin-Sands, MPC, Jim Poole, NAMI Chicago, Alexa James, NAMI Chicago - April 30, 2021
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It has been over a year since COVID-19 changed our worlds. Since the shelter-in-place order, residents have been faced with an emotional few months of racial tensions, lost income, unexpected death of family members and close friends, family and childcare burdens, and potential foreclosures and evictions on top of a heavy and isolated year. The pandemic highlighted the emotional traumas that result from the inequities that the region already faces.
Trauma is inalienable from our lived experience of the past 14 months, trauma response should be baked into everything we do moving forward--from policy making to social interaction. For some, it added to the trauma already experienced in local neighborhoods, for others it was a new experience. But what does that mean and what does it look like as we all undergo such a long and collective experience? We talked to Jim Poole, Chief Integration Officer with the local chapter of National Alliance On Mental Illness, NAMI Chicago, a nonprofit which educates, advocates and supports the community around mental health. NAMI Chicago has fielded thousands of calls since the pandemic.
- What is trauma and how might it look in today's context (especially given the COVID-19 pandemic and civil unrest)? Who are some vulnerable populations that are being more affected in more challenging ways?
Trauma has become a buzzword over the past decade, and it is commonly understood as a response to a particularly violent or frightening event like combat or a natural disaster. This common understanding misses the fact that trauma can also be experienced as the cumulative impact of chronic stress. As we think about trauma and COVID-19 we may be tempted to focus solely on those who have lost loved ones or been working on the frontlines in hospitals, but it touches far more people than that. As human beings, we are not designed to experience high levels of stress over extended periods. The health, economic, and social consequences of COVID-19 and other current events leaves most, if not all of us, with some level of stress and uncertainty. Given that reality, our exposure to trauma has increased during this pandemic.
In an interview with NPR, California Surgeon General Dr. Nadine Burke Harris explains trauma this way, “when individuals are exposed to repeated threats, particularly during critical development stages, these threats can activate their biological stress response, she says. When the biological stress response is activated too frequently or severely, this can lead to changes in the immune system, brain development or hormonal system — called a toxic stress response.”
Thinking about trauma through the frame of toxic stress helps us understand how COVID-19 and its impacts could be a traumatizing experience for so many. Front-line healthcare workers have found themselves working long hours with very sick patients. They are fighting a disease with no cure — they are experiencing trauma. People are losing people they know and love to this new disease, and are unable to gather and mourn - they are experiencing trauma. People with disabilities are having to limit their interactions, may be unable to comply with public health guidance like wearing masks, and have reduced access to the support they had before social distancing - they are experiencing trauma. People have lost their jobs or businesses, and are struggling to meet their basic needs - they are experiencing trauma.
Exposure to trauma and toxic stress can leave people feeling all kinds of ways. Common reactions include: shock, denial, anger, mood swings, difficulty concentrating, anxiety, withdrawal from others, trouble sleeping, or fatigue. The Substance Abuse and Mental Health Administration (SAMHSA) lays out many immediate and delayed emotional, physical, and cognitive reactions to trauma. Many of these reactions make it harder to go to work or find a job, engage with friends or family, or navigate systems. At the same time, these symptoms can be misinterpreted as a person being lazy, angry, difficult or uncommitted. This misinterpretation can often lead to a person being in conflict with family, healthcare providers, or service agencies as they struggle to meet expectations. People are losing needed support because we don’t properly recognize that they are experiencing trauma and respond with care before consequences.
While so many are experiencing traumatic events due to COVID-19, we know that the health, economic, and societal impacts of COVID-19 are not equally distributed across society. According to the CDC, African-American persons are 5 times more likely to be hospitalized than non-Hispanic whites. Similarly Hispanic or Latinx persons are 4 times more likely to be hospitalized than non-Hispanic whites. This means that the communities being hardest hit by COVID-19 are the same communities that have been the victims of systemic racism. We must also recognize that these communities experience more than their fair share of toxic stress and therefore more risk of trauma. For example the noteable racial uprest beginning the summer of 2020 following the murder of George Floyd in Minneapolis, it is clear that intersection of race, sex, socioeconomics and health are always at play as well.
The COVID-19 pandemic continues to leave a lasting impact on how our communities, economy, and healthcare system are functioning. We must recognize that it is making a deep impact on our well-being and increasing the risk of exposure to trauma due to toxic stress.
- What are some methods of healing from trauma? How does community healing fit in?
For years NAMI Chicago has discussed the impact of community on healing. While mental health professionals play a critical role in skill building, connecting to resources, and healing at an intimate and interpersonal level, we know that trusted community networks have the power to infuse healing broadly.
(The Healing Hurt Communities recommendations put out in 2019 included recommendations included expanding access to services more quickly, building communities to address community needs, and addressing the unique needs of youth to name a few.)
There must be a strategy to address the complicated layers of trauma and how differently people heal depending on their resources, their experiences, and of course the way systemic racism has in and of itself been a generational experience of trauma and oppression. We have to examine how powerlessness and lack of freedoms play a role in the opportunity to engage in meaningful healing. Entire communities have to be supported through investment, creating opportunities for building individual purpose, and equity created in education and access to housing.
People need to know what resources already exist in their communities. We know many mental health resources are underutilized for multiple reasons and must meet communities with the respect they deserve and deliver services how they want them delivered. For example, faith-based communities and community-based organizations (CBOs) that are trusted in communities should be equipped with those who understand mental health, trauma and have the same lived experience of those in the community they serve.
NAMI Chicago feels their work isn’t transactional. Through our helpline we strive to walk a person through their healing journey and help build resiliency. Our work with workforce wellness is also critically important. We must have a strong, healthy workforce as a foundation. Our toolkit on Workforce Wellness offers tools - but we can’t rely on communities to show up and help if we do not do the same for them.
- What can policymakers learn from a healing-centered (trauma-informed) policy model to recover in a world that truly works for all of us?
Policymakers must actively assess the policies and practices they promote from a trauma-informed lens. This requires acknowledging the ways potential policies promote or discourage wellness, healing, safety, inclusion and equity. Policymakers must take a deliberate look at how current policies contribute to increased disconnectedness and inequity in resource allocation and service provision and the ways in which these policies contribute to cumulative trauma. As we have discussed, trauma is impacted by both poverty and racism, and therefore policies that seek to address trauma must also lift people out of poverty and dismantle systemic racism.
Acknowledging these impacts allows decision-makers to specifically examine policies from a lens that seeks to reduce trauma inflicted on communities. Here are some frames that can be used to think about policies:
- How does this policy promote wellness? Does it expand access to health services? Does it restrict access for some? Who will benefit?
- How does this policy promote safety? Will stakeholders feel more or less safe in their environments as a result of this policy?
- How does this policy promote community? Does it include broad stakeholders who have a voice in the process? Does it allow for services or interventions at the community level? How does it create connectedness?
- How does this policy promote equity? How does this policy reduce barriers for Black and Brown communities specifically? Does it perpetuate policies that disproportionately harm communities of color and if so, how can that be changed?
There are many other resources that can help policymakers think critically about healing-centered/trauma-informed policymaking and racial equity assessments.
Our communities are an important part of this conversation. Policymakers must learn from our experiences and stories so we can best implement trauma-informed policies together. Together we can heal from the trauma experienced from the pandemic and the underlying social inequities that caused and were exacerbated the past year.
Please note that this conversation used the terms “healing-centered” and “trauma-informed” interchangeably. However, a healing-centered approach is holistic, fostering a sense of wellbeing which involves all parts of an individual’s life. A healing-centered approach understands trauma not as an individual experience, but as trauma and healing are experienced collectively and intersectionally. Healing-centered is an asset-driven approach that highlights the world that could be, not simply the world that is. Mental health is everyone’s responsibility and we should start devoting resources to take care of each other for a world we want.
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