Treatment is Prevention: An Argument for Trauma-Informed Mental Health Treatment

By Andrea Blanch, Ph.D. and David Shern, Ph.D.

It is becoming increasingly clear that toxic stress and trauma play an important role in the development of mental health and addictive disorders.  We have recently explored some of the implications of this emerging picture for improving individual treatment. In this blog, we suggest that using effective trauma-informed treatments and family supports for adults will also help to prevent problems in their children’s development.

We know that having a parent diagnosed with a mental illness or addictive disorder puts children at risk for developing cognitive, emotional and behavioral problems. In fact, parental mental illness and addiction are two categories of adverse childhood events measured in the groundbreaking ACE study. Exposure to parents with these conditions increases the risk that children will develop similar problems when they grow up. However, in our field’s efforts to legitimize mental and addictive disorders as treatable medical conditions, we have under-emphasized the effects of experience and under-resourced environmental interventions. In addition, stereotypes about people with serious behavioral health disorders led the field to largely overlook their roles as parents. While excellent family support programs now exist, they are not uniformly available. As a result, many parents with behavioral health issues and their children are not getting essential supports.

Parents with behavioral health disorders are not a small or insignificant group. Two-thirds of American adults who are diagnosed with a mental illness are parents, including adults with serious mental illnesses.  One in four children is exposed to a family member’s alcohol abuse or dependence, and one in six lives with parents who have used illicit drugs in the past year. Clearly, providing prevention and treatment services to children along with parents entering treatment for their own problems would address a very common risk factor. 

Understanding intergenerational patterns of substance abuse, mental health and trauma gives us new ways of thinking of parental treatment as prevention. If we can help parents to understand and address the traumatic experiences that often contribute to their problems, they are less likely to act in ways that could unintentionally traumatize their children.   If we can teach them about building resilience, they will be more likely to have children that thrive. As one woman in substance abuse treatment told us: “Now that I understand my trauma, I have a reason to stay in recovery. My goal is for my children’s ACE score to be lower than my own.”

Research has demonstrated that this approach works. The 5-year SAMHSA-funded Women Co-Occurring Disorders and Violence Study  showed that women with substance abuse and mental health disorders along with histories of violence did significantly better if: 1) they received gender-specific group treatment, 2) they had a voice in their services, and 3) if all three of their conditions were addressed simultaneously. For those with children, an additional focus on child resilience-building significantly improved child outcomes. Since the conclusion of this study, several of the study treatment models have been extensively evaluated and shown to be effective.

Addressing the trauma histories that so often accompany serious mental illnesses and addiction will not only result in better outcomes for parents, but will increase the likelihood that their children will live healthy, productive lives.  Evidence-based programs should be available for all parents diagnosed with serious mental illnesses and addictions.  For those with children at home, it should be standard practice to provide parental supports and child resilience-building interventions.  These practices could make a huge difference in the lives of both parents and children.

	Andy Blanch, PhD, has been an advocate for the development of trauma-informed public policies and programs for the past 30 years.
	Dr. David Shern is the Senior Science Advisor at Mental Health America having served as its President/CEO from 2006-2014. He also has a faculty appointment in the Department of Mental Health at the Hopkins Bloomberg School of Public Health and previously was a Dean and Professor at the University of South Florida.