Trauma involving violation of trust and mental health help seeking among homeless adults

Abstract

ABSTRACT Objective Lack of trust in others is a barrier to mental health help seeking and may be a consequence of trauma exposure, which is highly prevalent among people who experience homelessness. This study examined the association between trauma involving violation of trust and mental health help seeking. Method This study was a secondary analysis of data collected for a randomised controlled trial comparing a 3-year homelessness intervention with standard service provision. The sample included trauma-exposed adults with a history of chronic homelessness in Melbourne (N = 73). Participants identified their worst lifetime trauma and indicated whether someone they knew and trusted was responsible for that event. The primary outcome was 12-month formal mental health help seeking. Results Controlling for randomisation and baseline posttraumatic stress disorder symptom severity, participants whose worst trauma involved violation of trust reported, on average, 4.34 times as many visits to an outpatient service (e.g., hospital, mental health facility, alcohol and other drug service) as those whose worst trauma did not involve a violation of trust, p = .002. Conclusions Contrary to expectation, chronically homeless adults whose worst trauma involved violation of trust sought outpatient care more than those whose worst trauma did not involve violation of trust. Mental health professionals should adopt a trauma-informed approach and be aware that trauma exposure may influence help seeking among people who experience chronic homelessness. Key Points What is already known about this topic: Chronically homeless adults have high rates of trauma exposure, trauma-related mental health disorders, and unmet mental health care needs. People experiencing homelessness face multiple barriers to accessing mental health care, and qualitative studies have found feelings of mistrust may be one such barrier. In the general population, interpersonal trauma, particularly trauma involving betrayal, is associated with reduced trust in others, including physicians and health care systems. What this topic adds: Over 12 months, greater outpatient service use was reported by chronically homeless adults whose worst trauma involved violation of trust compared to those whose worst trauma did not involve violation of trust. The violation of trust group included a higher percentage of Aboriginal persons, and a higher percentage of participants whose worst trauma occurred in childhood compared to the no violation of trust group. Mental health professionals, such as psychologists, should apply trauma-informed care principles when providing mental health care for chronically homeless adults.