N Touch
Sunday 21 April 2019
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Endurance trauma

Colin Robinson

K’s wrist broke when they held up the maxi. R’s cousin killed himself. V escaped robbers walking home. M announces an “epidemic of loneliness.” C’s Facebook post recounts his path to an SLAA 12-step group. That’s just this month.

Instead of curling up, I ask Akilah Riley Richardson, clinical social worker/counsellor and university lecturer: How do folks cope with “endurance trauma”—this chirrip-chirrip of assaults all around? Through help-seeking, or assets we already have?

It’s not just constant crime, which typically goes unsolved (unless your dad sits in white leather armchairs and jokes with economists about raising gas prices without riots).

We talk about uncertainty the economy is generating. People’s persistent fear of job loss, self-doubts about career choices and small-business risks, years acquiring education as graduates go jobless. Only public servants nowadays have job security; a guarantee they’ll fear any reforms.

I recall the frustration getting anything done, long waits, unnecessary rigmarole, the indignities.

The traffic.

Waking up—and there’s no water.

Others in developing countries also face weak infrastructure and un-nurturing administrative cultures. But this is a small place where things do work for people in houses up or down the hill.

Akilah talks about families. Couples without skills to communicate effectively. Parents’ sense of incompetence to keep their children safe. I recall the running Children’s Authority ad, painting kids on vacation as walking targets for abuse. She notes the perceived helplessness by parents that government has taken away the one tool they know to discipline children: beating. We agree putting safe, professional childcare within parents’ reach would relieve much anxiety.

We turn to workplaces, where some turn for refuge from unaffirming families; but toxic, petty cultures prevent them from shining or growing, supervisors bully and undermine them.

I tell this story repeatedly. But what do people do?

Akilah gets descriptive, before prescriptive. How we turn desperately to social media for attachment. Post trauma stories there openly. Sharing normalises horror. But it is a unique space to speak it, find commiseration.

We drink, smoke; young people cut themselves. Reckless sex. Gambling. We find power and economic control in abusing those in our homes and relationships.

Where people turn looks really different whether you have money.

Some people deepen investment in healthy relationships they already have, with family, friends and in communities. But not everyone will find a solid support system here—opportunity to be authentic without condemnation. Masculinity prevents many men from learning how to offer this to others. Education levels also limit the emotional literacy adults can easily achieve. Much like substance use and social media, we can try to find support in wrong places, and get hurt. Unhealthy relationships feed much of the distress Akilah sees.

There’s an undeniable shortage of mental health services for lower-income people. But she emphasises how unaware the public is of many that exist. Trained professionals offer free individual, group and family counselling services through National Family Services, a Ministry of Social Development division. They’re ramping up marketing.

She’s also pleased at the growing body of competent private mental health professionals with a wide spectrum of qualifications and considerable diversity. Most take training seriously, and are invested in being good clinicians; though dissenting views about this mean fewer people access care.

Private counselling costs anywhere from $5,000 to $12,000 a year; and the cost structure of delivering services inhibits most providers from discounting them, she laments. Employee assistance programmes at government ministries and state enterprises increasingly are making such services accessible to their workers. Local businesses, too; not just multinationals.

Some professionals command as high as $1,000 an hour, others can be accessed for closer to $200. Akilah compares these costs to what we’d pay a private physician for an office visit for ourselves or a child; and asks if we don’t value mental health more highly because of its social stigma. The very term is ugly.

What about other systems of care, I press. Schools? She notes the under-resourced and understaffed work conditions for school social work and guidance officers, who often handle more difficult cases than other professionals. Then she underscores the powerful role a primary school teacher or principal can play, modelling caring behaviour for a generation of youngsters.

We both recognise in the Caribbean many folks will turn to faith before they seek secular help for mental health problems. Akilah acknowledges ways faith communities try to cope with demand, but hopes clergy commit to better training. Pundits and pentecostal ministers often enter office with little preparation or screening.

What can communities themselves do to foster emotional wellness, she asks, reminding me that the first social workers were men and women who harnessed the power of community, not paid professionals. She answers that we must invest more in communities’ capacity to offer such services, citing community-based NGOs providing low-cost services like Families in Action.

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