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Why It Matters

When it comes to treating chronic stress, it will take a village effort

By Dennis Archambault

I recently had an opportunity to discuss psychotherapy and analysis with a young psychiatrist with a successful practice. He was confident that proper therapeutic intervention really improves the well-being of his patients, many of whom suffer deeply from psychological distress. One of the modalities we discussed was psychoanalysis, an expensive process that has shown to help people recover from severe psychological problems. To be effective, psychoanalysis requires multiple sessions on a weekly basis, often for a long time.

I explained to the psychiatrist that I represent an organization that promotes population health among low income, vulnerable populations where there isn’t sufficient access to mental health services and a lack of financial resources to afford more involved therapies like psychoanalysis, not to mention access to transportation to reach a psychoanalysis. He acknowledged the cost issue, but went further to confirm that people living in the lower economic strata of society endure such depth and breadth of cumulative trauma, that individual psychotherapy wouldn’t be effective.
That message came out of a conference on “Building a Resilient Community,” sponsored by Starfish Family Services http://www.starfishfamilyservices.org/ earlier this year. One of the concepts discussed was a form of community psychology, “trauma-informed community building.” While individual counseling is helpful , care must come through the ongoing reinforcement of a healthy community – specifically family and neighbors.

The State of Michigan offers a good resource list on “Building Trauma Informed Communities” http://www.michigan.gov/mdhhs/0,5885,7-339-73971_4911_69588_80205—,00.html. One of the sources cited was a Robert Wood Johnson Foundation program in Washington, promoting the “self-healing” of the community, which promotes collaboration across sectors of resources, empowers local leadership to think systemically, use data to focus initiatives, and ultimately “instill a real sense of hope in communities that had given up on the prospect of a better world for their children.”

In the absence of a progressive health policy at the national level, local solutions like trauma informed communities and support networks are worth pursue. But, to reference a familiar adage, it will take a village.

Dennis Archambault is vice president, Public Affairs, for Authority Health

Healthy community design requires resilience in the face of chronic stress

By Dennis Archambault

Chronic stress is increasing throughout society, but is becoming an oppressive force among safety net populations. This has been a topic of discussion among mental health and public health professionals for some time. Authority Health’s population health program, this year, is focusing on chronic stress and the application of resilience as a public health strategy.

The Rockefeller Foundation is in the midst of a “resilient cities” initiative http://www.100resilientcities.org/, supporting the work of 100 cities worldwide to become more resilient to the physical, social, and economic challenges that are part of the new reality of the 21st century. The foundation defines building urban resilience as “the capacity of individuals, communities, institutions, businesses, and systems within a city to survive, adapt, and grow no matter what kinds  of chronic stresses and acute shocks they experience. Acute shock is defined as sudden, sharp events such as earthquakes, floods, disease outbreaks, and massive violent experiences. Chronic stress is cumulative, like high unemployment, poverty, violence, and persistent physical and natural environmental disasters.

Resilience thinking demands that cities look holistically at their capacities and their risks. Society is learning that individuals can adopt resilient strategies for surviving repeated onslaughts of pressure points, but perhaps the most challenging lesson — and one that is directly related to healthy community design — is developing collective impact from the cohesion of a resilient culture. That will take some work.

Dennis Archambault is vice president, Public Affairs, for Authority Health.