Insights in Public Health: Toward a Trauma-Informed System of Care in Hawai‘i's Adult Mental Health Division

摘要

Traumatic life experiences play an important role in the etiology of such severe and persistent mental illnesses (SPMI) as schizophrenia, bipolar, and major depression.1 Posttraumatic stress disorder (PTSD) and other trauma-related conditions are known to be highly prevalent among individuals diagnosed with SPMI. Moreover, traumatic life events have been consistently shown to worsen an individual's prognosis with respect to the severity and treatment of SPMI symptoms. At the national level, epidemiological studies have estimated that between 70% and 98% of adults presenting SPMI also present a co-occurring history of trauma.2 In Hawai‘i, a 2009 survey of 175 consumers of state adult mental health services in Honolulu County found that 89% of the sample reported at least one traumatic life event and 32% screened positive for a history of PTSD.3 Aside from the prevalence data, there is substantial clinical evidence linking PTSD and trauma histories with higher rates of SPMI symptom relapse, comorbid substance use disorder symptomatology, and utilization of more costly mental health treatment services, such as inpatient care and emergency hospitalization.4,5 Studies also have noted those with SPMI are at a greater risk to experience traumatic life events and become more debilitated by their effects.6,7