Addressing Violence by Advancing Equity

A robust volume of research has found early interpersonal trauma is a risk factor in subsequent perpetration of violent behavior. A number of evidence-based treatments for trauma exist, including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR), and access to these support healing and positive growth in a way that protects against harmful behavior, whether or not the individual has or has not yet become a perpetrator of violence.

Kar, H. (2019). Acknowledging the victim to perpetrator trajectory: Integrating a mental health focused trauma-based approach into global violence programs. Aggression and Violent Behavior (47). https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1359178917303269.

Not everyone who needs mental health care receives it for several reasons, including inadequate insurance coverage, lack of services in their area, stigma, and mental health workforce shortages. Increasing the availability of high quality, culturally competent, and coordinated care and reducing access barriers is a protective factor against exposure to violence. People deserve the opportunity to receive the mental health support they need to thrive. Some recommendations for improving access include partnerships with primary care settings, utilizing strategies from WHO’s Mental Health Gap Action Program (mh-GAP), increasing telehealth, and educating more mental health providers.

Mongelli, F., Georgakopoulos, P., and Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. Focus, 18(1), 16-24. https://focus.psychiatryonline.org/doi/10.1176/appi.focus.20190028.

Whether you are a survivor of gun violence or know someone who is, every person has a different path toward healing. Understanding trauma, healing, accessing resources, connecting to community, and becoming an advocate when you are ready are all part of that. The “From Healing to Action: A Toolkit for Gun Violence Survivors and Allies,” was developed by and for survivors and might be helpful along that difficult journey.

Aligning several strategies to support well-being includes social, economic, and environmental policy interventions, public health practice interventions, and health care system interventions. These can work together to reduce the incidence of traumatic events and adverse childhood experiences, modify the built environment, address financial and housing insecurity, reduce stigma, remove barriers to access, enhance the effectiveness of services, and support community organizations. All of these are protective factors against exposure to violence.

Purtle, J., Nelson, K. L., Counts, N. Z., & Yudell, M. (2020). Population-Based Approaches to Mental Health: History, Strategies, and Evidence. Annual Review of Public Health, 41(1), 201-221. https://doi.org/10.1146/annurev-publhealth-040119-094247.

Researchers have examined the effects that expanding access to substance use treatment would have on local crime and found the availability of these facilities reduce both violent and financially motivated crimes. Supporting individuals seeking and in recovery helps them on a personal level, supports their families, and has far-reaching positive effects on public health and safety. Reducing the stigma around seeking treatment and engaging policy makers in increasing funding and infrastructure would benefit entire communities on multiple levels.

Bondurant, S. R., Lindo, J. M., Swensen, I.D. (2018). Substance abuse treatment centers and local crime, Journal of Urban Economics, 104. https://doi.org/10.1016/j.jue.2018.01.007.

Grounded in justice and human rights, harm reduction is meeting individuals where they are, without judgement or coercion, and not requiring them to end substance use as a condition of support. It recognizes that individuals are vulnerable to substance use because of the larger issues of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities. In that way, harm reduction and violence prevention can be effective by extricating their structural and systemic roots to improve equity, opportunity, and access.

Lack of access to mental health care is a risk factor for suicide, and this limited access is not something an individual is able to change for themselves. The U.S. healthcare system as well as a lack of competent providers reduces a person’s ability to seek help. A preventative approach includes improved health insurance coverage for mental health conditions, increased amount and training of providers offering mental health services, and continuity of care for those who have sought help. The CDC’s technical package of policy, programs, and practices for suicide prevention provides guidance for organizations and governments to implement in their communities.

Knowing risk factors, reducing stigma, and letting individuals know that support is available can make a difference. The CARE (Connect, Accept, Respond, Empower) Training from The Trevor Project provides adults with an overview of LGBTQ youth and the several factors that contribute to their heightened risk for suicide.

Knowing how to communicate with and connect with someone who may be suicidal may save their life. #BeThe1To offers five steps supported by evidence in the field of suicide prevention – Ask, Be There, Keep Them Safe, Help Them Connect, and Follow Up.

Trauma results from more than just experiencing or witnessing violence. Structural violence that prohibits people from accessing their basic needs impacts entire communities, creating community trauma across populations. A framework that explores adverse community experiences can support community healing and prevent trauma at the community or population level. Funded by Kaiser Permanente Community Benefit in Northern California and based on interviews with practitioners in communities with high rates of violence, Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma outlines specific strategies to address and prevent community trauma — and foster resilience — using techniques from those living in affected areas. This report is helpful across sectors and at multiple organizational and governmental levels.

First responders are considered the gatekeepers to victim support services, and knowing more about how their interactions with gunshot survivors affect the survivors healing and recovery will be helpful to ensuring survivors receive the services they need. According to research, law enforcement and other first responders could benefit from implicit bias training and reviews of victim rights policies and practices to help increase access to social, legal and support services for victims of nonfatal shootings.

Roman, C. (2020). ‘He’s not helping us, so we are not helping him’: the police as gatekeepers to victim services for victims of street violence. Injury Prevention, 26(A8). https://injuryprevention.bmj.com/content/26/Suppl_1/A8.2.

Individuals can experience exposure to violence in their homes, schools, and communities as well as from police and within the carceral system. Researchers investigating the connection between trauma exposure and contact with the criminal legal system found that not only is trauma exposure a risk factor for contact with the criminal legal system but that incarceration is a place where trauma occurs and that a history of incarceration may increase the likelihood of exposure to subsequent trauma after release. This sets up a possible cyclical relationship between trauma and incarceration that needs further examination.

Jäggi, L. J., Mezuk, B., Watkins, D. C., and Jackson, J. S. (2016). The Relationship between Trauma, Arrest, and Incarceration History among Black Americans: Findings from the National Survey of American Life. Society and Mental Health 6(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079438/.

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