David L. Shern, Ph.D.

Remarks submitted by David L. Shern, Ph.D., President and CEO, National Mental Health Association

• As the underlying cause of numerous mental illnesses in both children and adults, trauma is a critically important issue in the mental health and overall wellness of the United States.

• Traumatic events - ranging from family violence and child abuse to disasters and community violence - can result in post-traumatic stress disorder, depression, substance abuse and anxiety disorders.

• Recent national disasters such as the September 11 terrorist attacks and Hurricane Katrina have shown Americans the devastating effects of trauma on both those directly affected and on the country as a whole.
  • Two to three years after September 11, for example, 64.7% of building survivors reported experiencing a new onset of depression, anxiety or other mental health problem. ¹

  • Furthermore, in the two years following September 11, there was a 49% increase in the number of people attempting suicide, attributable to the chronic stress associated with the terrorist attacks. ²

• Frequently overlooked, however, is the trauma associated with chronic and acute exposure to violence that continues unabated in homes and communities across the country. Research is still emerging, but it is clear that these traumatic events have drastic implications - particularly for the emotional and mental development of children.

  • For instance, many inner-city children exposed to violence develop PTSD, which is often accompanied by depression and/or aggressive behavior. ³
  • Other research has linked traumatic childhood experiences with depression and suicidal behavior in adults. ⁴

• The burden of neglected mental health needs related to trauma is staggering. Its effects can be seen all aspects of society:

  • Trauma significantly increases the use of and further strains the financial resources of health care and behavioral health services, decreases productivity in the workplace, increases reliance on public welfare, and increases incarceration rates.

  • The economic costs of untreated trauma-related alcohol and drug abuse alone were estimated at $160.7 billion in 2000. ⁵

  • The estimated cost to society of child abuse and neglect is $94 billion per year, or $258 million per day. ⁶

  • For child abuse survivors, long-term mental and general health care costs are estimated at $100 billion per year. ⁷

• Resiliency to trauma varies - some recover quickly while others suffer more persistent problems that require long-term treatment. However, one thing is certain: early intervention and treatment is critical.

• A range of treatments is necessary for effective treatment, however, many prevention/treatment strategies remain under-utilized and under-funded, despite substantial evidence demonstrating their effectiveness.

• Traditional strategies rely heavily upon relieving symptoms of existing mental health conditions. Yet, they are only one piece of a much larger network of treatments and supports that persons with mental health problems may require.

• Newer strategies, including consumer and public education, prevention, treatment and services, are unique and integral components in the full range of services aimed at reducing trauma-related mental health problems.

• The prevention and reduction of trauma requires communities, families and policymakers to recognize its importance in public policy and to work towards making it a priority in this country:
  • Greater research on the effects of trauma and its relation to mental health and substance abuse

  • Fully integrating mental health services into disaster preparedness and response plans

  • Increasing culturally and linguistically appropriate trauma awareness programs and prevention-based services in communities to stop the cycle of violence

  • Increasing the development and use of new treatments and support systems for trauma victims

¹ Centers for Disease Control and Prevention. Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings. In: Surveillance Summaries, April 7, 2006. MMWR 2006;55(No. SS-2). http://www.cdc.gov/mmwr/PDF/ss/ss5502.pdf#search=%22CDC%20report%209%2F11%22
²Starkman, M. N. (2006). The terrorist attacks of September 11, 2001, as psychological toxin: Increase in suicide attempts. Journal of Nervous & Mental Disease. 194(7):547-550.
³National Institute of Mental Health. Helping Children and Adolescents Cope with Violence and Disasters (2001). http://www.nimh.nih.gov/publicat/violence.cfm
⁴Beth S. Brodsky, Ph.D., Maria Oquendo, M.D., The Relationship of Childhood Abuse to Impulsivity and Suicidal Behavior in Adults With Major Depression. Am J Psychiatry 158:1871-1877, November 2001. http://ajp.psychiatryonline.org/cgi/content/abstract/158/11/1871
⁵The Economic Costs of Drug Abuse in the United States 1992-1998. Report prepared by The Lewin Group. ⁶Prevent Child Abuse America. (2001). Total estimated cost of child abuse and neglect in the United States: Statistical evidence. Report funded by the Edna McConnell Clark Foundation.
⁷The Ross Institute (www.rossinst.com)