Fear is one of the central emotional responses during a pandemic. Every day brings a new level of stress: anxiety about getting sick, the stigma of testing positive, financial difficulties due to not being able to work, being separated from loved ones in lockdown (or being locked in an unsafe home). the list goes on.
For many of us, uncomfortable feelings can be “natural” reactions to “threat.” Our strong, primitive defense or “threat response” (sometimes called “fight, flight or freeze”) enabled humans to survive. This stress response is necessary to avoid venomous snakes, crocodiles and other dangerous situations.
Unfortunately, our “threat response” is not good at recognizing the difference between a “threat” from an alligator and an epidemic. These reactions happen much faster than any conscious thought.
This can be especially difficult for people who are already coping with complex post-traumatic stress disorder or trauma associated with severe, repeated and unavoidable threats or prior exposure to abuse, often from those who are there to protect them.
As of last year’s pandemic, we were working on Healing the Past by Nurture the Future project, which aims to improve support for Aboriginal and Torres Strait Islander parents facing complex trauma.
We asked ourselves whether the public health response to the pandemic could take into account people’s past trauma.
The Centers for Disease Control and Prevention in the US thought so when it integrated key principles of trauma-informed care into the training of its Office of Public Health Preparedness and Response in 2018.
Read more: Whitewashing in the time of COVID: Australia’s health services still leaving vulnerable communities behind
Taking core concepts from our research and guiding principles, we identified 10 principles that can reduce stress or trauma by promoting a sense of security, well-being, confidence, hope, and resilience.
The first priority of any emergency or “trauma-informed response” is to ensure physical protection from immediate danger (such as first aid principles). This includes protecting those most at risk (for example, those experiencing family violence) during lockdown.
2. Engagement and Collaboration
Humans are social animals and being “connected” is another essential survival strategy that is more helpful to us in a pandemic than “fighting, running away or freezing”.
When we have social support, it becomes easier to take action in an emergency. But staying “socially connected” yet “physically distant” in infectious disease outbreaks is not easy.
Read more: A community-led movement that creates hope in the time of coronavirus
An unequal response to pandemics can also lead to divisions in society, such as when a community receives more financial aid or an unfair allocation of vaccines.
However, taking care of each other is our ticket from here. We have seen this with global scientific collaboration in the quest to make a COVID-19 vaccine.
3. Compassion and Caring
Acts of kindness, compassion and caring are needed now more than ever. Compassion and empathy promote well-being and we know that social support acts as a buffer against difficult times.
Understanding responses to stress and distress is an important way to “normalize” our feelings and actions of others.
4. Trust and Transparency
Clear, compassionate action and transparent communication on the part of governments are also important. These things enhance a sense of security and ability for people to follow public health advice.
Hiding information creates mistrust between the government and the media. This can contribute to mistrust in COVID-19 responses and lead to non-compliance.
Lack of information and exposure to misinformation can also exacerbate distress, and make people vulnerable to conspirators who put marginalized groups most at risk.
Rebuilding trust may not be possible in an emergency, but this is where trusted community partners become invaluable mediators and sources of truth for communities.
Read more: Vaccination needs to reach 90% of First Nations adults and teens to protect vulnerable communities
5. Cultural Security and Accountability
Public health approaches and messages must be appropriate and sensitive to local contexts.
Communities need a health message that is based on cultural strength to increase trust and access to services, such as Aboriginal and Torres Strait Islander community-controlled health organizations quickly mobilized to control the local response to COVID-19 .
6. Commitment to equality and human rights
COVID-19 has not had the same effect on everyone. Many people, including Aboriginal and Torres Strait Islander and refugee communities, are affected by historical and inter-generational trauma, racism and ongoing socio-economic deprivation.
In this current crisis, these things may increase further. We must address the socio-cultural determinants that can affect people’s health, such as unsafe work and housing, and focus on equity.
7. Good Communication
Crisis communication theory states that messages are most likely to be effective when they are clear, credible and conversational, shared consistently, and targeted to community groups.
The public may feel the need to obtain information to manage their anxiety, but troubling content can also increase their tension, confusion, and feelings of lack of control, affecting their ability to take action.
Media plays an important role here. It is important to access reliable, credible information through these channels so that people know what action to take and where they can turn for help.
8. Positive Leadership
Good governance helps us feel secure. It is important for the government to be highly visible, provide regular updates and practical support, and help people understand and manage feelings of stress.
But we do not need the leadership of politicians and officials only. Local leaders also need to support their communities through the process of fear, grieving and loss, and to help people understand that the crisis will pass and there is hope.
This came as Aboriginal and Torres Strait Islander community-controlled organizations took swift action to protect their communities from COVID-19.
Individual and community empowerment comes from having choice, voice and control. It fosters confidence to respond to an emergency as well as resilience, hope, and the ability to cope.
Communities empowered to take an active role in disaster response actually recover better, with lower rates of post-traumatic stress. However, communities must be adequately provided with resources to do so.
10. Overall Support
We need larger responses that address cultural feedback to improve health and safety, social and emotional well-being, community interaction and quality of life, relationships and social functioning.
However, effective emergency responses must be integrated into well-functioning social systems, including emergency social and economic support and high-quality health services that everyone can access when needed.
Our next step will be to discuss these 10 principles in an October workshop with community members and public health experts to develop a culturally responsive, trauma-informed, public health emergency framework for First Nations communities.
The pandemic is not over yet and now there is a race to vaccinate communities that have been left behind by states opening up. A trauma-informed public health emergency response is possible. And as cases increase as the next bushfire and cyclone season approaches, we need one right now.