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Discuss about the Cumulative Burden of Lifetime Adversities.

Trauma and Mental Illness

The impact of trauma has been reported a significant impact on the psychosocial and emotional wellbeing of the patients under consideration. Refuges are the one community that have faced a world of trauma and torture while being held in the detention centre. The impact of the trauma in most cases is bidirectional. As discussed by Muskett (2014), the refugees often have been struggled with war conflict and torture already in the native country that they have fled which contributes a major share of the trauma they carry. Additionally, the impact of the torture, both physical and emotional in the detention centres of the country they have immigrated to only aggravates the trauma and deteriorates their emotional and psychological condition.

The impact of the trauma affects their behavioural characteristics and the nature of the patients under trauma. The care approach taken for the psychological issues often only focussed on the clinical manifestations that the patient is exhibiting rather than the underlying reasons complicating the mental state of the patient. Hence, there is need for a more trauma focused care approach that will address the trauma and its impact of the trauma on the psychological condition of the patient and the clinical manifestation. The trauma informed care approach provides a systematic psychotherapeutic framework addressing the trauma affecting the patient and the psychological symptoms that the patient exhibiting (Earlytraumagrief.anu.edu.au, 2018). This essay will attempt to focus on the evidence on trauma as a perpetrator of mental illness, its neurobiology and how trauma informed care approach fits appropriately in the care scenario of a patient suffering from trauma taking the aid of a case study.

Trauma has a history embellishing itself and its prevalence in the mental health deterioration representations. Trauma had had a strong presence in the mental health literature and there is mounting evidence that indicates at the trauma being one of the most impactful contributors to different mental health disorders. The first and foremost element that is needed to be discussed in this context is the post-traumatic stress disorders. It is one of the most abundantly reported psychological disorders affecting the people that have gone through trauma, the severity of this disorder however depends entirely on the severity of the trauma that the individual has encountered. As per the literature evidence, as discussed by Finklestein, Stein, Greene, Bronstein and Solomon, (2015), the post-traumatic stress disorder is prevalent in not just the patients going through, there is a significant presence of vicarious trauma on the mental health staff that addresses the care needs of the PTSD patients that have went through trauma.

Neurobiology of Trauma

Now the impact of the adverse events that accumulate across the lifespan of the individual is not just limited to the post traumatic disorder. The impact of the trauma is also affects the youth from either the refugee background or low socioeconomic background as well. As mentioned by Myers et al. (2015), the impact of the lifetime cumulative impact of the adverse events and trauma also led to depression, personality disorders and anxiety. In this case however, the impact of the trauma had been linked to the detention centre experience, uncertainty faced in the new country and the guild of leaving the family behind in Afghanistan facing persecution, which eventually led to symptoms of anxiety, negative thoughts and risk of depression as well. According to Panter?Brick, Grimon, Kalin and Eggerman (2014), that for the afghan youth, the cumulative impact of the trauma memories and the adverse social experience contribute to detrimental changes in the mental health status.

In order to understand the impact of trauma, it is very important to also explore the neurobiology of trauma on the individual who is suffering from it. By definition, psychological trauma is a range of chronic traumatic stress, which is felt emotionally and physically. However, considering the neurobiological impact of the trauma, Rosenzweig, Jivanjee, Brennan, Grover and Abshire (2017) have mentioned that the psychological trauma affects the brain circuitry, in turn affecting the stress response system. On a more elaborative note, traumatic psychological event can have a significant imp act for adolescents and youth, which changes their subjective perception of what is perceived as a traumatic experience. With respect to the neurobiology, neuroplasticity is the key to healing from the psychological trauma to reverse the negative impact of the trauma. On a more elaborative note, the stress response system which is called the hypothalamus-pituitary-adrenal system. Amygdala is the first responder of the threat which acts like the gatekeeper of the incoming sensory information which is screened for the danger or threat while experiencing a particular traumatic experience which in turn activates the pituitary gland for releasing the hormone. For continual or persistent exposure to trauma, the impact of the trauma causes the HPA axis to keep flooding the body with stress hormones cortisol and creates a toxic stress environment altering the response mechanism of the brain and affecting the function of HPA axis and amygdalae (Rosenzweig, Jivanjee, Brennan, Grover & Abshire, 2017).

Trauma informed care is undoubtedly one of the most revolutionary addition to the mental health scenario and has helped several trauma affected youth to recover from their mental illnesses respectively. By definition, trauma informed care is defined as the organizational structure and treatment framework which takes into consideration the understanding, recognizing, and responding to the effects of all types of trauma (Earlytraumagrief.anu.edu.au, 2018). There are various benefits associated with the implementation of the trauma informed care model in the psychotherapeutic care model for a patient who is suffering from a mental disorder which is aggravated from a traumatic past events. As discussed by Kelly and Lebel (2014),  the trauma informed care model emphasizes entirely on the physical, psychosocial and emotional safety of the patient as well as the provider, taking a more holistic and integrative approach to care. Along with that, the trauma informed care also helps in the establishment of a care approach that provides a sense of control back to the patient which in turn reinstates the sense of optimism and empowerment to not just help the patient overcome the helplessness but also instil hope of recovery. On the other hand, the trauma informed care models have received considerable criticism as well. On a more elaborative note, Levenson, Willis and Prescott (2016) have discussed that trauma informed theory makes a completely different and rather contradictory assumption of disease or illness and requires adaptation of a completely new paradigm of care service delivery which can be difficult for carers to implement in practice. Even sympathizing with the patient is abhorred in trauma informed model, whereas empathy and compassion is a strong foundation of patient centred care models. Hence, the stark contrast represented by the approach of trauma informed theory can be interpreted as disrespectful and culturally unsafe, especially culturally diverse population (Muskett, 2014). Although, the benefits of the trauma informed care model has been considered to outweigh the cons by the most of the psychological researchers.

Criticism of Trauma Informed Care

The case study represents the traumatic experience of Amir Daud who was the 28-year-old refugee from Afghanistan. Trauma represents the disturbing experience of individuals that affect the mental and physical wellbeing of that particular individual. In the case study, the patient explained the number of factors that possibly give rise to trauma. He explained that he experienced discrimination, prosecution and was witnessed of murders in family members, which is a possible cause of trauma. He also narrated that he was the witness of subsequent episodes of self-harm by fellow detainees, which can be the possible cause of trauma. Moreover, he was away from the family and experiencing guilt for leaving them behind which caused the trauma. These experiences had a negative impact on his emotional wellbeing. He experienced anxiety and time to time, he had poor concentration. Moreover, he sleeps poorly at night, often has nightmares about his experiences in the detention. Since he had negative thoughts during waking hours and had anxiety, uncertainty, without treatment it can lead to severe depressive disorder and post-traumatic stress disorder (Levenson, Willis, & Prescott, 2016). Subsequently, he may decide to commit suicide or involve himself in violence. Therefore, trauma-informed care will help him to live a better life by managing the trauma experiences (Kenan, 2018). Trauma-informed care involves a broad understanding of traumatic stress and common response to the trauma (Muskett, 2014). It also emphasizes the psychological physical and emotional safety for both patients and care providers (Levenson, Willis, & Prescott, 2016).. Therefore, the trauma-informed care would help him to rebuild a sense of empowerment and self-control for not taking any rational decision for actions (Muskett, 2014). Moreover, it will manage his negative thoughts; will improve his concentration and manage his poor sleeping habits.

Trauma-informed care model is an organizational structure and framework for treating patients who are experiencing trauma due to the subsequent episodes of disturbing experiences (Baker et al., 2016). The concept of trauma-informed care have evolved 30 years ago from a variety of innovations and now applied in a wide range of healthcare setting in order to enhance the quality of life and mental wellbeing (Oral et al., 2015). Trauma can result from varies negative and disturbing experiences which may give rise to the mental health crisis and people who experience trauma are more likely to exhibit pronounced symptoms and negative consequences (Baker et al., 2016). As observed in this case study, the patient experienced trauma due to a series of adverse experience, which further affected his mental and physical wellbeing (Bassuk, Unick, Paquette & Richard, 2017. Therefore, trauma-informed care is essential in order to manage the experience of the patient and reduce the psychological symptoms of the patient. In order to address the needs of the individual, the sanctuary model of trauma-informed care was developed by Dr. Sandra Bloom. In this model of care, the training should be provided to all of the health professionals for effectively provide the treatment to the patient. The model of care would help Amir to understand his reason for anxiety and uncertainty and how trauma is intertwined with it. Since he had intrusive negative thoughts, which is a risk factor for the major depressive disorder and post-traumatic stress disorder (Oral et al., 2015). Consequently, he may develop the tendency of self-harm and violence. Therefore, an individual safety plan can be made with the collaboration of health professionals and patient, which would help professional to identify the triggers of the mental illness, and plan can be made accordingly (Bassuk, Unick, Paquette & Richard, 2017). The model plan would help him to create his own personal safety kit in order to manage the trauma and consequences of trauma. Since there is a huge cultural gap between Afghanistan and Australia and he belong to a Persian speaking ethnic minority, he felt isolated when he came to Australia and it further gives rise to the traumatic experiences. Cultural liaison officers and culturally competent language interpreter can be recruited for him in order to close the gap between language and ethnicity (Reeves, 2015). Traumatic informed care model can be implemented by boosting his self-esteem, encouraging him explaining that his symptoms are not signs of weakness. It will in turn help to reduce his anxiety and uncertainty of thoughts (Bartlett et al., 2016). Moreover, therapeutic communication is one of the essential features for providing care (Reeves, 2015). Therefore, communication would help him to release his guilt of leveling behind his family, managing all of the negative thoughts, reduce impulse of committing self-harm. He would able to live a quality life (Levenson, Willis, & Prescott, 2016).

Appropriateness of Trauma Informed Care for Amir

Conclusion:

Thus, it can be concluded that trauma is a huge contributive factor that caused by a series of event that eventually gives rise to intense psychological and physical stress reaction.  People of all ages, ethnic background, different economic conditions, and different sexual orientation can experience trauma that affects their functional ability. As observed in this case study, Amir Daud who was a 28-year-old refugee from Afghanistan experienced trauma due to a series of event. The trauma experiences had a huge impact on his functional ability including interacting with, surrounds, developing insomnia-like symptoms, poor concentration and without treatment, he may give rise to psychological distress which has adverse consequences. Therefore, trauma-informed care model can be implemented in order to manage his symptoms of trauma. The component of the former model includes communication, individual safety plans with the collaboration of patient, recruitment of the cultural liaison officers and culturally competent language interpreter in order for managing his traumatic experiences. Therefore, during assessing the patient, Amir Daud, I came to know about the trauma and trigger factors and how trauma-informed care can be implanted in the clinical setting. This will help me in implementing the care model in future practice.

References:

Baker, C. N., Brown, S. M., Wilcox, P. D., Overstreet, S., & Arora, P. (2016). Development and psychometric evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC) scale. School Mental Health, 8(1), 61-76. DOI 10.1007/s12310-015-91610

Bartlett, J. D., Barto, B., Griffin, J. L., Fraser, J. G., Hodgdon, H., & Bodian, R. (2016). Trauma-informed care in the Massachusetts child trauma project. Child maltreatment, 21(2), 101-112.

Bassuk, E. L., Unick, G. J., Paquette, K., & Richard, M. K. (2017). Developing an instrument to measure organizational trauma-informed care in human services: The TICOMETER. Psychology of violence, 7(1), 150.

Earlytraumagrief.anu.edu.au, (2018). Refugees and asylum seekers: Supporting recovery from trauma. [Online] Retrieved from https://earlytraumagrief.anu.edu.au/files/Refugee%20Tipsheet.pdf. [Accessed on 20th Oct]

Finklestein, M., Stein, E., Greene, T., Bronstein, I., & Solomon, Z. (2015). Posttraumatic stress disorder and vicarious trauma in mental health professionals. Doi: 10.1093/hsw/hlv026

Kelly, N., & Lebel, J. (2014). Trauma-Informed Care. In Residential Interventions for Children, Adolescents, and Families (pp. 98-115). Routledge. Doi: 10.4324%2F9780203743492-13

Kenan, K. (2018). Trauma Informed Care.retrived from : https://www.advocatedocs.com/wp-content/uploads/2018/08/Violence-in-Communities-Trauma-Informed-Care-A-Paradigm-Shift-In-How-We-Care-For-Patients.pdf

Levenson, J. S., Willis, G. M., & Prescott, D. S. (2016). Adverse childhood experiences in the lives of male sex offenders: Implications for trauma-informed care. Sexual Abuse, 28(4), 340-359. Doi: 10.1177/1079063214535819

Levenson, J. S., Willis, G. M., & Prescott, D. S. (2016). Adverse childhood experiences in the lives of male sex offenders: Implications for trauma-informed care. Sexual Abuse, 28(4), 340-359. DOI: 10.1177/1079063214535819

Muskett, C. (2014). Trauma?informed care in inpatient mental health settings: A review of the literature. International journal of mental health nursing, 23(1), 51-59. Doi:1 0.1111/inm.12012

Muskett, C. (2014). Trauma?informed care in inpatient mental health settings: A review of the literature. International journal of mental health nursing, 23(1), 51-59. doi: 10.1111/inm.12012

Myers, H. F., Wyatt, G. E., Ullman, J. B., Loeb, T. B., Chin, D., Prause, N., ... & Liu, H. (2015). Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. Psychological Trauma: Theory, Research, Practice, and Policy, 7(3), 243. Retrieved from https://psycnet.apa.org/buy/2015-19946-002 

Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., ... & Peek-Asa, C. (2015). Adverse childhood experiences and trauma informed care: the future of health care. Pediatric research, 79(1-2), 227. https://doi.org/10.1177/1077559516635273

Panter?Brick, C., Grimon, M. P., Kalin, M., & Eggerman, M. (2015). Trauma memories, mental health, and resilience: A prospective study of Afghan youth. Journal of Child Psychology and Psychiatry, 56(7), 814-825. Doi: 10.1111/jcpp.12350

Reeves, E. (2015). A synthesis of the literature on trauma-informed care. Issues in mental health nursing, 36(9), 698-709. Retrieved from : https://psycnet.apa.org/buy/2016-03236-001

Rosenzweig, J. M., Jivanjee, P., Brennan, E. M., Grover, L., & Abshire, A. (2017). Neurobiology of Psychological Trauma. Retrieved from https://www.pathwaysrtc.pdx.edu/pdf/projPTTP-neurobiology-tip-sheet.pdf 

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