On September 12, the University of Pittsburgh School of Social Work’s Center on Race and Social Problems opened it fourth year lecture series with a presentation by Dr. Carl C. Bell on mental health risk factors in people of color with a focus on how “risk factors are not predictive factors due to protective factors.”
In an effort to “destroy” our idea of health care, Dr. Bell, a professor of Psychiatry and Public Health at the University of Illinois and President and CEO of the Community Mental Health Council, tackled how our society waits until people are already in the “mental health iron lung” before anything is done to help them.
Dr. Bell presented studies from the last 20 years showing the percentage of youth of color who witness and experience violence and concluded, “We don’t need another damn study.” According to Dr. Bell people already know where trauma is taking place.
Noting that trauma is fairly ubiquitous, Dr. Bell gave seven categories of adverse childhood experience psychological, physical and sexual abuse; violence against mother; and living with someone who is a substance abuser, mentally ill or suicidal, or an exoffender and showed that most people experience at least one form of adverse childhood trauma. But if you experience four or more of these you’re at much greater risks of alcoholism, drug abuse, depression and suicide attempts. As well as greater increase in health disparities, including increased heart disease, cancer, lung disease and liver disease.
“Until we address this issue of trauma we have missed the boat,” said Dr. Bell. “I’m tired of waiting until someone gets schizophrenia before we do anything about it. Where’s the prevention?”
Dr. Bell said the common belief about post traumatic stress disorders (PTSD) is that if you experience trauma you life is ruined, but that this isn’t true. He said, “It’s not the trauma that causes post traumatic stress disorders, it’s the helplessness from the trauma.”
To remedy our current perception of health care, Dr. Bell emphasized a paradigm shift away from risk factors. He stated the need for psychosocial interventions as protection from PTSD.
Dr. Bell discussed seven protective factors that help prevent PTSD: rebuilding social fabric, access to modern medical technology, connectedness, social skills, self esteem, reestablishing the adult protective shield, and minimizing the effects of trauma.
However, by treating a trauma as a catastrophe, Dr. Bell explained, we actually make things worse in terms of PTSD. Prisons and foster care are two examples used by Dr. Bell to show how the way we treat people, especially blacks, can lead to increased risk factors.
Dr. Bell noted that with many incidents of trauma, “if you’re white the police aren’t coming for you, but if you’re black they are.” While aware of the business motivation for putting people in prison, Dr. Bell questioned the moral and ethical sense of demonizing people who are in risky situations.
Rather, Dr. Bell emphasized the need to minimize trauma. He said, “Behind all anger is hurt and attached to the hurt is fear of being hurt.”
In this sense, the prison system has “missed the boat” because it doesn’t “address the hurt.” Since prisons don’t address the trauma at the root of the behavior, they actually increase risk factors. The system itself can be said to contribute to recidivism that is, the likelihood that someone will reoffend once released.
As with prisons, the foster care approach fails to address the trauma that is taking place and can increase risk factors. Calling the color of foster care black, Dr. Bell noted the high rates at which black children are being taken from their families and put into foster homes.
Dr. Bell said that when trauma happens people run from the family when they should be running to the families with protective factors. In McLean County, Illinois, 35,000 black children where being snatched out of their homes and put in foster care in 2000. By implementing protective factors Dr. Bell and his colleagues were able to reduce the number of black children going into foster care to 13,580 in 2002.
While use of protective factors helped families turn helplessness into helpfulness, Dr. Bell noted that the reduction in children entering foster care was unwelcome by a number of foster service businesses experiencing a dramatic decrease in profits due to his work.
Dr. Bell believes that through the use of protective factors and other preventative measures many of today’s mental health problems associated with post traumatic stress disorders can be eliminated in a fashion similar to diseases like smallpox and polio.
(First published in The NewPeople, October 2007)