Right after the Fourth of July, our Independence Day, this year, I was asked to give a brief talk on the psychological state of our country. After all, we had just had a terrorist attack in Orlando, killings by police and then the shooting of police officers last week. Is our country becoming traumatized by the violence?
Surely, it's presumptuous to analyze the American psyche at this time, but I am more optimistic than pessimistic. We are not in "a civil war," as the headline of the New York Post blasted. We clearly have made much progress since the U.S. Civil War in terms of internal violence and civil rights. But perceptions often trump reality, and trauma can make us more fearful than we need to be. Of course, there is still much room for further improvement.
Perhaps every year around the Fourth of July would be a good time to check the state of our own mental healthcare unions: our clinics, hospitals and office practices. This time of year dovetails with the annual turnover in our academic institutions, when the arrival of new students and residents behooves the medical schools being ready for the change and inexperience of these new caregivers.
Time to reflect
What, then, might be worth checking right now in your own organization, starting with issues related to the tragedies?
However unpredictable violence in psychiatry and society can be, there are ways to make our settings more secure. Assess where your setting is in terms of such preparedness.
2. Homicides and Suicides
Whenever those with mental illness are blamed for homicides, it is worth remembering that it’s usually those who are untreated or undertreated who might act in a way that causes harm to self or others. Being victims of violence is much more common for those with disorders, as are suicides. Do you have good policies and procedures in place to assess the risk of suicide, being the victim of violence and committing violence?
It should be self-evident that the well-being and the development of skills among your staff is the key to patient care, yet we have a burn-out rate in mental health caregivers approaching 50%. Being burned out correlates with poorer patient outcomes. Do we have an adequate wellness program in place to prevent burnout?
4. Cultural Competence
Mental healthcare has not been immune to problems in discrimination and racism in our care of patients, resulting in misdiagnosis and skewed provision of treatment resources, especially for the black community. Analyze whether you have any difference in processing patients along cultural or ethnic groupings and provide more training for cultural competence if you are. Moreover, do you have relevant cultural diversity in your staff?
5. Trauma-Informed Care
We've learned over the years that patients often have more trauma in their backgrounds than they first let on. Some of that is due to the dissociation of the trauma in the mind, as well as the distrust of those in authority if previously abused by people in authority. Try to make sure that trauma is analyzed carefully and gently.