The U.S. Senate Health, Education, Labor and Pensions (HELP) Committee, led by Chair Patty Murray (WA) and Ranking Member Richard Burr (NC), is currently crafting a legislative package to meet the growing need for our nation’s mental health and behavioral health crisis.
We commend Senators Murray and Burr on their unwavering commitment to legislating healing by advancing solutions that will change the course of the rising suicide, overdose death, youth substance use, and depression rates.
North Carolina currently ranks 38th for overall access to mental health care. A recent survey of the state's behavioral health workforce found increased barriers to accessing services, including cost and staff shortages. Across North Carolina, drug-overdose deaths nearly quadrupled among teens during the pandemic, and the number of teens involuntarily committed to mental health facilities rose 52 percent from 2020 to 2021.
These challenges, and many others, share an underlying cause: trauma.
Author and psychotherapist Resmaa Menakem defines trauma as something that happens either too much, too soon, too fast, or too long without being attended to by something reparative or healing.
Expressly, Adverse Childhood Experiences (ACEs) represent a subset of traumatic experiences in childhood and include abuse, neglect, violence, poverty, substance use, or mental health problems in the home. Exposure to ACEs increases the risk of stroke (2.1 times as likely), depression (5.3x), cancer (1.4x), smoking (3.1x), heavy drinking (1.8x), asthma (2.2x), kidney disease (1.7x), and high school non-completion (1.4x). Sixty-one percent of U.S. adults report at least one ACE, and 16 percent have four or more.
Therefore, Congress should consider enhancing and improving trauma-informed provisions for any legislation that addresses mental and behavioral health problems. Of particular importance, Section 101 of the bipartisan RISE from Trauma Act funds these exact solutions and should be advanced.
Indeed, providing federal support to existing local programs that address ACEs could also save taxpayer dollars throughout other systems. A study by the World Health Organization (WHO) found that the U.S. spends $748 billion annually on health care costs and lost productivity caused by ACEs. A study by CTIPP found that ACEs contribute to nearly 650,000 deaths in the U.S.
Trauma-informed practices – like cross-sector community coalitions – can reduce problematic substance use by 86 percent, child mental health symptoms by 43 percent, and post-traumatic stress disorder (PTSD) symptoms by 65 percent.
Cross-sector community coalitions are efficient and effective. In Washington State, building community capacity helped dramatically reduce rates of health and social problems. For example, over a 10-15 year time period in Cowlitz County, births to teen mothers went down 62 percent, and infant mortality went down 43 percent. Youth suicide and suicide attempts also went down by 98 percent, youth arrests for violent crime dropped 53 percent, and high school dropout rates decreased by 47 percent.
In North Carolina, various community efforts centered around trauma, prevention, and resilience have partnered to tackle opioid use, mental health challenges, and other problems by increasing protective factors at the community level.
Among them: the Rural Opportunity Institute, Chief Justice’s Task Force on ACEs-Informed Courts, Resilient North Carolina Collaborative Coalition, Prevent Child Abuse North Carolina, North Carolina Partnership for Children, Community Impact North Carolina, North Carolina ECHO, Building Resilience and Courage to Excel (BRACE) at East Carolina University, New Hanover Resiliency Task Force, North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (NC DHHS), Charlotte Resilience Project, Duke University Center for Child and Family Health, Kellin Foundation, and Dogwood Health Trust.
North Carolina’s evolution towards trauma-informed change has primarily occurred at the grassroots level. For example, the Kellin Foundation’s Resilient NC report proposed eight strategies to be planned and executed across systems and the lifespan using a science-based, trauma-responsive, and equity-focused approach.
The initial strategies include expanding public awareness and building strategic communication, identifying an effective backbone agency, building public-private partnerships to assist with funding, expanding training and technical assistance in trauma-informed care using an upstream approach, building and facilitating cross-sector coalitions, promoting policy and advocacy efforts that support community resilience, supporting local coalitions, and identifying and implementing evidence-based measure systems.
North Carolina leaders have recognized that creating trauma-informed communities and building community resilience is not an “either/or” proposition but a “both/and” approach.
Traditional solutions are falling short because we can’t solve these complex challenges with the same approach that created them. Integrating trauma-informed policy into legislation helps prevent trauma in the first place.
We’ve found that even a modest investment into existing programs can produce an incredible return on investment. By utilizing the best scientific evidence available, cross-sector coalitions can continue to provide the necessary support to build community and individual resilience, healing, engagement, and empowerment.