The Impending Necessity of Trauma-Informed Care in Behavioral Health Services Due to COVID-19 (Coronavirus)

“Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.” How the Pandemic Will End -The Atlantic

Defining Trauma and Its Effects

According to SAMHSA’s Trauma and Justice Strategic Initiative, “trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being” (SAMHSA, 2012, p. 2). There are three main types of trauma are acute, chronic, or complex.

• Acute trauma results from a single incident.
• Chronic trauma is repeated and prolonged such as domestic violence or abuse.
• Complex trauma is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature.

The Center for Disaster Philanthropy (CDP) “is the only full-time national resource dedicated to helping donors maximize their impact by making more intentional disaster-related giving decisions in response to domestic and international events.” As part of their effort to provide potential donors with the tools needed to support disaster preparedness, response and recovery, CDP names eleven separate types of disasters:

• Pandemics and Infectious Diseases
• Drought
• Wildfires
• Tornadoes
• Landslides
• Famine
• Earthquakes
• Hurricanes, Typhoons and Cyclones
• Floods
• Complex Humanitarian Emergencies
• Climate Change and Extreme Weather Patterns

Trauma can also be the result of the following experiences (SAMHSA, 2012):

• Sexual Abuse
• Physical Abuse
• Domestic Violence
• Medical Injury, illness, or procedures
• Community violence
• Neglect, deprivation
• Traumatic grief
• Victim of crime
• Kidnapping
• Accidents
• School violence
• Loss

For many of the disaster categories, the impact is confined to a relatively small number of people with a ripple effect sending waves of influence to ever smaller numbers of people. Sometimes the impact ends once a degree of normalcy is achieved and sometimes the influence is felt through generations. For the SARS-CoV-2 outbreak, the effects will likely involve people worldwide for generations to come – some severely – with unpredictable numbers of people being traumatized and in need of behavioral healthcare as a result. Others who already have a behavioral health or substance use disorder may need extra help to prevent or treat a relapse or development of a secondary disorder. Outbreaks of infectious diseases are always stressful, as is acknowledged by the Centers for Disease Control’s (CDC) Stress and Coping website for COVID-19, and the site recognizes some of the symptoms of stress:

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of alcohol, tobacco, or other drugs

The CDC also provides many suggestions for reducing the stress, preventing stress from escalating, and for watching populations such as children and older adults for changes that might signal trouble, such as

• Excessive crying or irritation in younger children
• Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
• Excessive worry or sadness
• Unhealthy eating or sleeping habits
• Irritability and “acting out” behaviors in teens
• Poor school performance or avoiding school
• Difficulty with attention and concentration
• Avoidance of activities enjoyed in the past
• Unexplained headaches or body pain
• Use of alcohol, tobacco, or other drugs

What Behavioral Health Providers Can Do

The world is still in a time of crisis and is still seeing numbers of cases of COVID-19 rise. The full consequences for losses of loved ones, employment, and other alterations to our way of life have yet to be realized. While currently behavioral health providers live in a reality of prevention, harm reduction, and damage control when it comes to mental health disorders and substance use disorders related to COVID-19, the resources on the CDC and other websites, print materials, and infographics are very useful. Some of those are listed in the resources below. But some new or additional issues will undoubtedly arise as the focus changes from immediate life and death situations to considering quality of life will probably include what was seen and well-documented in the research in the aftermath of the SARS virus of 2003, Ebola, and HIV. On the negative side there may be reduced productivity, burnout, post-traumatic stress, stigma, shunning, and development of new conditions or mental disorders such as agoraphobia, anxiety, and obsessive-compulsive disorder. On the positive side, “herd immunity,” new research, vaccines, new treatments, and public consciousness about social inequalities, racial differences, and social rituals may be seen (Yong, 2020). Given the history of behavioral health consequences due to SARS, HIV, and Ebola, and the global scope of the COVID-19 outbreak, the importance of preparing to deal with a potential onslaught of trauma-related issues in both existing and new clients should not be ignored. Behavioral health providers can prepare in the following ways:

• Help to reduce the increase in future caseloads by using tools and resources such as those on the CDC website to help people to cope with the current situation by establishing healthy coping strategies and watching those at risk for trauma such as children for signs they are not coping well.
• Help people to access resources related to difficulties they are having concerning rent, mortgages, employment, and recovery issues by referring to Nevada 211, Crisis Support Services of Nevada, Nevada Suicide & Crisis hotlines, and other resources listed below
  • Nevada resourcesNV health response website 
  • Nevada Behavioral Health Provider Resources:
    • 3/27 Nevada State Board of Pharmacy Prescription Medications during COVID-19
    • Nevada State Board of Pharmacy COVID-19 Information
    • Resources for Coping and Managing during COVID-19 (March 25, 2020)
• Access resources and training on the Technology Transfer Center (TTC) websites.
• Review Treatment Improvement Protocol (TIP) 57: Trauma-Informed Care in Behavioral Health Services and other trauma related resources on the SAMHSA website.
• Look for trauma-related trainings at CASAT Training
• Read the trauma-related blog posts on the CASAT OnDemand Catalyst Blog.
• Access trauma-related and PTSD materials and links the CASAT OnDemand Resources & Downloads section.

References

Sparks, E., & Ehrlinger, J. (2012). Psychological contributors to the failure to anticipate unintended consequences. Social and Personality Psychology Compass, 6(5), 417-427. doi:10.1111/j.1751-9004.2012.00435.x

Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Yong, E. (2020, ). How the pandemic will end. The Atlantic

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