A. Kathryn Power, M.Ed.

Remarks submitted by A. Kathryn Power, M.Ed., Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

Trauma is increasingly seen as an almost universal experience of public mental health and human service recipients. Providers as well as consumers are beginning to see that, without integrating a focus on trauma, improvement in trauma-related symptoms such as depression and substance-use disorders will not occur…and, without this integration of mental health and substance services with trauma, a recovery-oriented system is impossible. Addressing trauma is increasingly recognized as essential for recovery!

Our knowledge about trauma in mental health system consumers began a decade ago when the Center for Mental Health Services held a groundbreaking conference called "Dare to Vision". For the first time, national attention focused on the effect of physical and sexual abuse on the lives of women who were diagnosed with mental illnesses. We heard from the women in heart-rending detail the clear, undeniable, and dramatic relationship between trauma and symptoms of mental illness and co-occurring substance abuse. We also heard from the women that the power of traumatic life events to destabilize individuals had been systematically missed by the mental health field almost altogether.

This poignant evidence of the relationship between trauma and symptoms of mental illness, however, did not leave us without hope. Women who were at that conference opened our eyes to a person's enormous potential to recover from trauma and co-occurring disorders when individuals and practices involved in mental health treatment acknowledged the underlying effects of abuse and worked with women toward hope and recovery. The recovery-oriented experiences shared by some of these women who collaborated with their helpers let us dare to believe that past violence need not cast its dark shadow forever over a woman's future.

Hope and belief in the possibility and power of recovery from trauma came naturally to me. For over a decade I had worked in Pennsylvania as: initially, as a victim service provider for women in a program at the community level; and, subsequently as a victim services advocate for women as part of a state level coalition. I learned again and again that a woman's searing exposure to the raw trauma of physical or sexual assault put her overall emotional health at very high risk for both the short and long term. Women told us that they wanted to recover from the traumas of rape, incest, and domestic violence but that they needed support and time to heal. For caregivers to provide this support and time, it became clear that it is that their job to find a way to move with women on their journey of recovery. For recovery to take root, however, it is necessary for the choice, direction, and leadership of recovery to flow from the woman herself.

As Director of SAMHSA's Center for Mental Health Services it is one of my personal priorities to help open the nation's eyes…to the impacts of trauma - whether it is trauma induced by criminal violence, disasters, terrorism, or wars - and about achieving emotional health and recovery for all adult men and women, and for children. In this role, I am proud that the first large-scale evaluation of trauma interventions, the SAMHSA-sponsored, five-year (1998-2004) 'Women, Co-Occurring Disorders, and Violence Study" has provided the most authoritative and comprehensive view to date of what can be accomplished with trauma integrated mental health and substance abuse care in the public health system…with women who have histories of physical and sexual abuse…who are in need of services for both mental health and substance-use conditions.

This groundbreaking study featured a trauma-integrated counseling approach that addressed both mental health and substance-use conditions. Findings at both six and 12 months suggest that integrated counseling-for example, group and individual therapy that addressed trauma, mental health, and substance-use conditions-was the key element associated with better outcomes. These better outcomes provided many real life case examples of women who had fought the hard battle for recovery with the help of peers and providers, and who had triumphed. These seemingly against-the-odds stories of recovery are available in a publication from the study entitled "Its My Time to Live".

Since that landmark study, CMHS is making real progress toward creating a trauma-informed and transformed national system of mental health care. Through the work of the CMHS supported National Center for Recovery from Violence and Trauma, SAMHSA is developing leadership networks to spread information and trauma training about emerging trauma "best practices" and to provide technical assistance to help stimulate State and community change. SAMHSA/CMHS has been making a major investment of resources in the issue of trauma. We are committed to helping States respond with trauma-integrated, community-based solutions.

There are millions of individuals who require care that recognizes and responds to their underlying trauma. They need our help. They need us-at both the Federal and State levels-to collaboratively develop trauma informed systems of care. These systems must be broad-based. We know that the effects of trauma spill over into our hospitals and our jails and our social welfare system. We also know that these organizations, too, must be part of a comprehensive solution. This fact echoes two finding of the President's New Freedom Commission: collaboration is critical to transformation, and our field must move forward with what we know into what we do.

To fully address the needs of survivors of trauma within the public mental health service system, we must adopt a systemic approach...an approach characterized both by trauma-specific diagnostic and treatment services and a "trauma-informed" environment capable of sustaining these services. This change to a trauma-informed service system environment represents a profound cultural shift in which consumers and their conditions and behaviors are viewed differently. Effective systems for service delivery must embrace policies and practices that create emotionally safe and personally empowering conditions and choices for trauma survivors and staff.

A public health, community-based approach that stresses the links between health and the physical, psychological, cultural, and social environments in which people live, work, and go to school is critical. The fundamental premise is that it is inherently better to promote health and prevent illness before it begins. We know we must address the impact of trauma on individuals to promote health and prevent illness.

This morning, I am sending out an urgent call to action. It is time for each of us to do something more about the problems we have seen and talked about for over a decade... An unprecedented window of opportunity is opening…right now. It's time for all of us…at the local, State, and national level…to advocate for the comprehensive, trauma-coordinated, consumer-centered mental health system that will give women and men …and all Americans… access to the full range of services they need to recover. It's time to deliver on our advocacy with personal action.