Trauma and homelessness are deeply linked. We spoke about this with clinical psychologist and researcher Dr Kathryn Taylor who recently completed her PhD thesis about these issues, and with Professor Monica Thielking from Swinburne University of Technology, co-author and fellow expert in this field.
Kathryn: The participants were all part of Sacred Heart Mission’s J2SI Phase Two research study, led by Swinburne University and the Centre for Social Impact at University of Western Australia between 2016 and 2020.
Simply put, the PhD study anticipated most participants would have a history of trauma, however, we wanted to take a nuanced look at people’s experience of trauma and mental health over three connected studies.
For the first two studies, we asked people about their worst lifetime trauma, and whether it involved a violation of trust – whether someone they knew and trusted was responsible for that trauma. The first two studies compared two groups, people who’d had that violation of trust and people who hadn’t.
In the first study, we found 40% of people reported that they had experienced a violation of trust trauma, and those 40% had a higher prevalence of posttraumatic stress disorder (PTSD) compared to those who had not (81% compared to 50%), and their symptoms of PTSD were significantly more severe.
The second study surprised us – we expected that people who experienced violation of trust trauma wouldn’t want to engage with services; that the experience would be a barrier. In fact, the violation of trust group had on average four times as many visits to outpatient services, suggesting that they were wanting and seeking help.
“It reinforced that mental health professionals should adopt a trauma-informed approach when working with people experiencing homelessness, because the people seeking help have likely had complex traumas that have involved a violation of trust. Our research highlighted how important it is for services to make the effort to be ‘trustworthy’.”
Monica: This part is really important for J2SI and Sacred Heart Mission because it highlights the importance of trust in the experience of becoming homeless, and for help seeking to end homelessness. Service providers need to consider the role of trust in service provision, because it’s an important psychological factor that contributes to help seeking and staying engaged. Services need to be able to deliver in a way that matches the needs of clients, and this study adds to the research evidence of the trauma-informed service model Sacred Heart Mission uses and how J2SI is delivered.
Kathryn: In the third study, we looked at everyone together and how they were going 12 months into the J2SI Phase Two research study. We found that there was a significant improvement in alcohol use severity, illicit substance use severity and PTSD symptoms. We also found that having seen a mental health professional in that 12-month period led to a significant reduction in alcohol and illicit drug use but not PTSD symptoms – so this highlights the importance of access to a mental health professional to get treatment.
Unfortunately, there’s little research and evidence on treating PTSD in this client group – treatment guidelines exist for defence and emergency services personnel for example, but not people who have experienced homelessness. The research needs to catch up on how best to treat PTSD in this cohort so mental health professionals can engage in evidence-based practice with the aim of improving mental health and ending homelessness.
Kathryn: Trauma is an almost universal experience among people who experience homelessness and knowing the detail of those experiences can be quite confronting sometimes. Even though I work as a clinical psychologist and I have been involved in homelessness research for many years, I am still surprised by the extent and nature of the trauma some people have had to endure.
“Despite these experiences, many have hope of recovery and want help, but they don’t always know how to access it or what’s available.”
Overall, people do want to feel better, they’ve carried their trauma around for a long time. For many people, their worst trauma has come from childhood and they’re now adults, they have been dealing with these experiences on their own for decades without help. They are also willing to talk about their experiences.
You have to be careful, but in asking people about trauma and PTSD symptoms, we found that their experiences are at the forefront of their mind all the time and it’s impacting them on a daily basis. It needs to be dealt with, and people want support with that.
“It is extremely sad, but trauma, particularly significant childhood trauma and experiences of child abuse, especially where that person never receives support to cope with it, their life trajectory after abuse can lead to homelessness.”
Understanding this removes the stigma around homelessness because this shows it is not their fault, they are survivors of crimes perpetrated by trusted adults or peers in many cases and it demonstrates the importance of prevention of abuse.
Kathryn: The next step is about improved access to mental health care. The homelessness cohort really need and want psychological help but face a number of systemic barriers in accessing it, such as cost, and long waiting lists.
From our perspective, we would like to see greater access to mental health professionals for people with experience of homelessness and people at risk of homelessness. For example, psychologists could be embedded in housing and homelessness services, like Sacred Heart Mission, so that they can provide mental health services to clients directly.
It can’t work without funding and support from homelessness organisations and the government, but we think it would be very beneficial and we want to advocate for that.
Monica: Kathryn and I are also involved in our professional body, the Australian Psychological Society. I supervise students, like Dr Kathryn Taylor, doing psychological research on homelessness and we both teach, so we are working on training the next generation of psychologists, building awareness and leading our profession, working with the homelessness sector, and influencing policy change. And I think it’s possible – we have well established psychological services in prisons and schools, we can have them in homelessness services too. There’s definitely a need there.
Kathryn’s recommendations to reduce homelessness and the impact of trauma:
- Permanent Supportive Housing
- Timely Access to Appropriate Mental Health Care
- Trauma-Informed Care in Homelessness Services
- Trauma-Informed Care in Mental Health Services
- Better Access to Psychological Services.
Kathryn: The J2SI model combines housing with three years of intensive support – which is consistent with our recommendations for permanent supportive housing with timely access to appropriate mental health care.
The findings also highlight the extent of trauma exposure among people who experience chronic homelessness and underscore the importance of adopting a trauma-informed care approach in homelessness and mental health services.
Trauma-informed practice is a key element of the J2SI program – it is already happening at Sacred Heart Mission, but the research certainly backs up the importance of that approach. Within J2SI, brokerage funding is used to support participants to have better access to mental health professionals.
This is important, but we also need to improve access to mental health care on a wider scale because it’s essential to recovery from homelessness and trauma.
Monica: The goal of research of this kind is also to give people a voice, and we hope we have been able to do that through this study – we want to thank everyone who shared their story with us.
Dr Kathryn Taylor expresses her gratitude for the PhD scholarship provided jointly between Swinburne University of Technology, the Centre for Social Impact University of Western Australia, and Sacred Heart Mission. Kathryn would also like to thank co-supervisors Dr Jessica Mackelprang and Professor Denny Meyer.
Dr Kathryn Taylor is a clinical psychologist who recently completed a PhD in Health Sciences (Public Health) at Swinburne University of Technology. Her thesis focused on trauma involving a violation of trust, Posttraumatic Stress Disorder (PTSD) and mental health help seeking, using Sacred Heart Mission’s J2SI Phase 2 participants as her study cohort.
Kathryn is also a lecturer and tutor in the Faculty of Medicine and Health at The University of Sydney, and she has a bulk-billing psychology practice, which is supported by Mission Australia in Sydney.
Professor Monica Thielking is Chair of the Department of Psychological Sciences at Swinburne University of Technology and the Principal Coordinating Supervisor of Kathryn’s PhD thesis.
She has also been integral in researching and refining Sacred Heart Mission’s Journey to Social Inclusion program over several years and holds other leadership appointments in her field, such as Non-executive Board Director of the Australian Psychological Society and Chair of the APS Division of Psychological Research, Education and Training.
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