10 ways we can better respond to the pandemic in a trauma-informed way

Fear is one of the central emotional responses during the pandemic^[1]. Every day brings a new level of stress^[2]: concerns about getting sick, the stigma of testing positive, financial difficulties due to not being able to work, separation from loved ones in lockdown (or being locked in an unsafe household). The list goes on.

For many of us, uncomfortable feelings can be “natural” responses to a “threat”. Our strong, primitive defence or “threat response” (sometimes called “fight, flight or freeze”)^[3] has enabled human beings to survive. This stress response^[4] is essential for survival against poisonous snakes, crocodiles and other dangerous situations.

Unfortunately, our “threat responses” are not good^[5] at recognising the difference between the “threat” from a crocodile and a pandemic. These responses happen much faster than any conscious thought^[6].

It can be particularly hard for people already experiencing complex post-traumatic stress disorder^[7] or trauma^[8] associated with earlier exposure^[9] to severe, repeated and inescapable threats or abuse, often from those meant to protect them.

As the pandemic hit last year, we were working on the Healing the Past by Nurturing the Future^[10] project, which aims to improve support for Aboriginal and Torres Strait Islander parents experiencing complex trauma.

We asked ourselves whether the public health response to the pandemic can take into account people’s previous trauma.

The Centers for Disease Control and Prevention in the US thought so when it integrated key principles of trauma-informed care^[11] into training for its Office of Public Health Preparedness and Response^[12] in 2018.

Read more: Whiteness in the time of COVID: Australia's health services still leaving vulnerable communities behind^[13]

Taking core concepts from our research^[14] and guiding principles^[15], we identified 10 principles that may decrease stress or trauma by fostering a sense of security, well-being, confidence, hope and resilience.

1. Safety

The first priority of any emergency or “trauma-informed response” is to ensure physical safety from the immediate threat^[16] (like first aid principles^[17]). This includes the safety of people most at risk during lockdowns (for example, those experiencing family violence^[18]).

2. Connectedness and collaboration

Humans are social beings^[19] and being “connected” is another essential survival strategy that is more helpful to us in the pandemic than “fighting, fleeing, or freezing”.

When we have social support, it’s easier to take action in an emergency^[20]. But it’s not easy staying “socially connected” yet “physical distanced”^[21] in an infectious disease outbreak.

Read more: The community-led movement creating hope in the time of coronavirus^[22]

Inequitable responses to the pandemic^[23] can also lead to divisions in society, such as when one community appears to receive greater financial support^[24] or an unfair allocation of vaccines^[25].

However, looking after each other is our ticket out of here. We have seen this with the global scientific collaborations^[26] in the quest to create COVID-19 vaccines.

3. Compassion and caring

Acts of kindness, compassion and caring are needed more now than ever. Compassion and empathy promote well-being and we know social supports act as a buffer against difficult times^[28].

Understanding stress and distress responses^[29] is an important way to “normalise” our feelings, and the actions of others.

4. Trust and transparency

Clear, compassionate action and transparent communication^[30] from governments are also important. These things increase a sense of safety and potential for people to follow public health advice.

Hiding information leads to distrust in government and the media. This can contribute^[31] to mistrust in COVID-19 responses and lead to non-compliance^[32].

A lack of information^[33] and exposure to misinformation can also increase distress, and leave people vulnerable to conspiracists^[34] who target marginalised groups most at risk.

Rebuilding trust in an emergency may not be possible, but this is where trusted community partners^[35] become invaluable mediators and sources of truth^[36] for communities.

Read more: Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities^[37]

5. Cultural safety and responsiveness

Public health approaches and messaging needs to be appropriate and sensitive^[38] to local contexts.

Communities need health messaging that draws on cultural strengths to increase trust and access to services, such as the way Aboriginal and Torres Strait Islander community-controlled health organisations quickly mobilised to take control of the local response to COVID-19^[39].

6. Commitment to equity and human rights

COVID-19 has not had the same impact on everyone^[41]. Many people, including Aboriginal and Torres Strait Islander and refugee communities, are affected by historical and intergenerational trauma, racism, and ongoing socio-economic deprivation.

These things can be exacerbated in this current crisis. We must address the socio-cultural determinants that can impact people’s health, such as insecure work and housing, and focus on equity.

7. Good communication

Crisis communication^[42] principles^[43] say messages are most likely to be effective when they are clear, credible and interactive, shared consistently, and targeted to community groups.

The public may feel the need to seek information to^[44] manage their anxiety, but distressing content^[45] can also increase their feelings of stress, confusion, and a lack of control, impacting their ability to take action^[46].

The media play a critical role here. Accessing trustworthy, reliable information through these channels is important so people know what action to take and where they can go for help.

8. Positive leadership

Good governance^[47] helps us feel safe. It’s important for the government to be highly visible, provide regular updates and practical support, and help people understand and manage feelings of stress.

But we don’t just need leadership from politicians and officials. Local leaders^[48] also need to support their communities to process fear, grief and loss^[49], and to help people understand the crisis will pass and there is hope.

This was on show when Aboriginal and Torres Strait Islander community-controlled organisations took quick action to protect their communities from COVID-19^[50].

9. Empowerment

Individual and community empowerment^[51] comes from having choice, voice, and control. This promotes the confidence to respond to an emergency, as well as resilience, hope and the ability to cope.

Communities that are empowered^[52] to play an active role in disaster response actually recover better^[53], with lower rates of post-traumatic stress^[54]. However, communities must be adequately resourced^[55] to do this.

10. Holistic support

We need big responses^[57] that address health and safety, social and emotional well-being, community connectivity and cultural responsiveness to improve quality of life, relationships and social functioning^[58].

However, effective emergency responses must be embedded in well-functioning social systems, including emergency social and economic support and high-quality healthcare services everyone can access when needed.

Our next step will be to discuss these 10 principles with community members and public health experts in an October workshop, to develop a culturally responsive, trauma-informed, public health emergency framework for First Nations communities.

This pandemic is far from over and there is now a race to vaccinate communities that have been left behind as states open up. A trauma-informed public health emergency response is possible. And with cases due to rise just as the next bushfire and cyclone seasons arrive, we need one now.

References

1. ^{^} central emotional responses during the pandemic (www.nature.com)
2. ^{^} Every day brings a new level of stress (www.drloucozolino.com)
3. ^{^} “threat response” (sometimes called “fight, flight or freeze”) (www.ncbi.nlm.nih.gov)
4. ^{^} stress response (blueknot.org.au)
5. ^{^} are not good (www.youtube.com)
6. ^{^} much faster than any conscious thought (www.pnas.org)
7. ^{^} complex post-traumatic stress disorder (blueknot.org.au)
8. ^{^} trauma (blueknot.org.au)
9. ^{^} earlier exposure (blueknot.org.au)
10. ^{^} Healing the Past by Nurturing the Future (mspgh.unimelb.edu.au)
11. ^{^} key principles of trauma-informed care (ncsacw.samhsa.gov)
12. ^{^} training for its Office of Public Health Preparedness and Response (www.cdc.gov)
13. ^{^} Whiteness in the time of COVID: Australia's health services still leaving vulnerable communities behind (theconversation.com)
14. ^{^} our research (bmjopen.bmj.com)
15. ^{^} guiding principles (ncsacw.samhsa.gov)
16. ^{^} immediate threat (guilfordjournals.com)
17. ^{^} first aid principles (www.betterhealth.vic.gov.au)
18. ^{^} family violence (linkinghub.elsevier.com)
19. ^{^} social beings (vimeo.com)
20. ^{^} take action in an emergency (psycnet.apa.org)
21. ^{^} “socially connected” yet “physical distanced” (theconversation.com)
22. ^{^} The community-led movement creating hope in the time of coronavirus (theconversation.com)
23. ^{^} Inequitable responses to the pandemic (www.ncbi.nlm.nih.gov)
24. ^{^} greater financial support (www.themonthly.com.au)
25. ^{^} unfair allocation of vaccines (www.abc.net.au)
26. ^{^} scientific collaborations (www.nature.com)
27. ^{^} James Ross.AAP (photos.aap.com.au)
28. ^{^} buffer against difficult times (www.cambridge.org)
29. ^{^} stress and distress responses (www.frontiersin.org)
30. ^{^} transparent communication (doi.apa.org)
31. ^{^} contribute (doi.apa.org)
32. ^{^} non-compliance (www.cambridge.org)
33. ^{^} A lack of information (www.cambridge.org)
34. ^{^} conspiracists (www.frontiersin.org)
35. ^{^} trusted community partners (doi.org)
36. ^{^} mediators and sources of truth (doi.apa.org)
37. ^{^} Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities (theconversation.com)
38. ^{^} sensitive (guilfordjournals.com)
39. ^{^} quickly mobilised to take control of the local response to COVID-19 (intouchpublichealth.net.au)
40. ^{^} Dan Himbrechts/AAP (photos.aap.com.au)
41. ^{^} COVID-19 has not had the same impact on everyone (www.jclinepi.com)
42. ^{^} Crisis communication (www.frontiersin.org)
43. ^{^} principles (www.frontiersin.org)
44. ^{^} feel the need to seek information to (guilfordjournals.com)
45. ^{^} distressing content (onlinelibrary.wiley.com)
46. ^{^} ability to take action (journals.plos.org)
47. ^{^} Good governance (www.mdpi.com)
48. ^{^} Local leaders (www.frontiersin.org)
49. ^{^} process fear, grief and loss (www.frontiersin.org)
50. ^{^} took quick action to protect their communities from COVID-19 (www.lowitja.org.au)
51. ^{^} Individual and community empowerment (guilfordjournals.com)
52. ^{^} empowered (guilfordjournals.com)
53. ^{^} recover better (www.frontiersin.org)
54. ^{^} lower rates of post-traumatic stress (www.cambridge.org)
55. ^{^} adequately resourced (guilfordjournals.com)
56. ^{^} Dan Himbrechts/AAP (photos.aap.com.au)
57. ^{^} responses (psycnet.apa.org)
58. ^{^} improve quality of life, relationships and social functioning (journals.sagepub.com)