Moving Beyond Stigma

As we move to the end of summer, further into this pandemic, and through the various healthcare topics Bree is addressing this year, I continue to return to the intertwined ideas of trauma and stigma. I think about how denial is a huge coping strategy for many people. I also think about the power of naming and normalizing to address stigmatized topics – race and racism, mental health, drug use, homophobia, death. I may have mentioned my favorite website, Death Over Dinner, and would like to introduce you to one of my new favorite podcasts: Death, Sex, and Money. I would encourage all of us to feel empowered to talk about uncomfortable topics.

And I do I believe in the power of semi-structured conversations. Much of therapy is a semi-structured conversation and this is also how I spend much of my time working with our Collaborative. Maybe 20% of my meetings are planned out or framed in some way, the other 80% is left to be met by the comments of the people present and the dynamic flow of conversation. The fun part for me lies in this unknown, unstructured space. We seek to identify systematic barriers, diagnose the problem, and think through how to overcome barriers or restructure our healthcare systems. This happens best when we bring together groups of diverse people with a shared goal of better meeting the health needs of our population in Washington State.

Semi-structured conversations are backed up by peer-reviewed evidence! See the article Durably reducing transphobia: A field experiment on door-to-door canvassing “where canvassers knocked unannounced on voters doors, “asked each voter to talk about a time when they themselves were judged negatively for being different…and encouraged voters to see how their own experience offered a window into transgender people’s experiences…results indicate that the intervention was broadly successful at increasing acceptance of transgender people…”

I want Washington state to be the healthiest state and I believe that incorporating trauma-informed principles into how we deliver health care is going to help us get there. To help us all better understand that this is more than a buzzword, I like the Substance Abuse and Mental Health Services Association’s four Rs:

• Realization that anyone may have experienced trauma and their behavior can be understood as a coping strategy to address past trauma
• Recognize the signs of trauma
• Respond to the above through using a universal precautions approach (e.g., all people are approached as though they have experienced trauma)
• Resist Re-traumatization by seeking to not create toxic or stressful environments

How do we incentivize trauma-informed health care? How do we measure that this is happening? What could moving upstream to a trauma-informed community look like? I think about the increase in behavioral health need caused by this pandemic and hope that we can help build capacity to address increased need outside of our already overwhelmed clinical systems. We need innovation and cooperation, we need to normalize and destigmatize, and we need to re-orient our healthcare systems to be trauma-aware and trauma-informed.

Ginny Weir, MPH
Director, Bree Collaborative