Understanding Trauma and Mental Health in promoting women’s health and well-being

By Theresa S. Betancourt, ScD, MA

The crisis on the US-Mexico border, reminds us of the primary importance of mother-child attachment relationships and how important it is to attend to issues of trauma when working to advance the well-being of vulnerable children and families. The situation of family separation has also reminded us of the importance of understanding the full picture of family relationships and how important the entire family system is to the well-being of the lives we hope to advance in global maternal and child health. The sad reality of the current situation is the fact that many of these families from Central America are fleeing horrible violence and trauma in their own countries. For women, these traumas often involve sexual violence and violence towards loved ones. These are individuals who are rightfully seeking asylum to escape horrific violence. It has been disheartening to witness how these attempts to seek safety, have been met by policies that only exposed these caregivers and their children to additional traumas by the forced separations. From the perspective of child development, the risks to the mental well-being of both parents and children are grave. A body of research has demonstrated how exposure to such a level of “toxic stress” can be disruptive to the developing architecture of a child’s brain with lasting consequences for learning, behavior and health: http://bit.ly/toxicstressthroughhealth

As a result, providers will need to be sensitized to the mental health needs of these populations. For families and children fleeing violence in Central America, it is imperative that family reunification be a priority both as a human rights issue and as a critical element of addressing the well-being of both mothers and children. The situation also provides valuable reminders about the intersection of health, mental health and trauma. Trauma-sensitive interventions are those that take into account the reality of the violence, loss, another life-threatening and frightening events experienced by populations exposed to war and communal violence. Such situations are the reality in many parts of the world where Every Mother Counts and other organizations work to increase access to maternal and child health services in resource-limited settings. For health professionals and extension workers, this reality may mean different approaches to thinking about promoting maternal and child health. Populations affected by trauma often feel a tremendous sense of distrust and fear which can be major barriers to providing maternal and child health services. Trauma sensitive maternal and child health services may need to invest further in sensitization and outreach campaigns and ensure that services meet people where they are as well as advancing the care available in clinics. For instance, in Sierra Leone, we have been integrating evidence-based mental health services for youth exposed to violence into education and livelihoods programs: http://bit.ly/evidence-basedmentalhealthservices

For global maternal and child health (MCH) professionals, trauma-informed services might involve recognizing that due to problems such as maternal depression or post-traumatic stress reactions not all populations may present easily for health services. New innovations may be needed to ensure trauma-sensitive care for families. Services may need to be adjusted or new features added to address these barriers. For instance, more attention may be needed that focuses on the use of health extension or outreach workers. MCH services in violence affected areas may need to take more of a focus on building trusting relationships to ensure engagement in care. Looking ahead, given the nature of “toxic stress” that these asylum-seeking families and children have experienced, it is imperative that reunification happen as soon as possible. Every day that passes is like poison for the developing brain of a young child separated from a primary attachment figure. Given the history of trauma that has led to many families to flee as well as the new trauma created by recent policies, trauma- sensitive approaches that combine maternal health and trauma-sensitive mental health will be important. Through trauma sensitive approaches to recent human rights abuses, we can continue to move the needle on global maternal and child health, ensure higher quality of care and advancement of the rights of the most vulnerable.

Theresa S. Betancourt, ScD, MA, is the inaugural Salem Professor in Global Practice at the Boston College School of Social Work and Director of the Research Program on Children and Adversity (RPCA). Her central research interests include the developmental and psychosocial consequences of concentrated adversity on children, youth and families; resilience and protective processes in child and adolescent mental health and child development; refugee families; and applied cross-cultural mental health research. She is Principal Investigator of an intergenerational study of war in Sierra Leone (LSWAY). Domestically, she is engaged in community-based participatory research on family-based prevention of emotional and behavioral problems in refugee children and adolescents resettled in the U.S.