Mental Health Care That Disrupts Cycles of Violence | Celina de Sola | TED

譯者: Lilian Chiu 審譯者: Thomas Tam

There's a shocking statistic I want to share with you.

我想跟大家分享 一個驚人的統計數字。

Latin America is home to only eight percent of the world’s population

拉丁美洲的人口只佔全世界的 8%，

but one third of its homicides.

自殺人數卻佔三分之一。

This is especially extreme in the Northern Triangle countries

在北方三角國家中 這個情況特別嚴重，

of Honduras, Guatemala and El Salvador,

包括宏都拉斯、瓜地馬拉，

及薩爾瓦多，

where I'm from and where I live.

也是我的家鄉和居住地。

Just imagine the impact that this kind of unrelenting violence can have

想像一下這種持續的暴力會如何影響

on a person's health, productivity and well-being.

人的健康、

生產力，以及幸福感。

Especially because we know that if we're exposed to violence,

特別是因為我們知道，

如果我們暴露在暴力之下，

this can result in trauma.

可能會造成創傷。

And when that happens,

如果發生了，

our brain's stress response actually shuts down core functions

我們的大腦對壓力的反應 會是關閉掉核心功能，

like problem solving, critical thinking and emotional regulation.

比如解決問題、

批判性思考，以及情緒調節。

And it elevates the ones that we need to protect ourselves and survive.

並會提升我們保護自己 及生存所需要的功能。

So this makes it really hard to learn to make decisions

所以就會讓我們很難學習

做決策，甚至維持關係。

and even maintain relationships.

It can also increase our risks of lung and heart disease, diabetes,

也會讓我們更有可能得到心肺疾病、

糖尿病、

anxiety and depression.

焦慮症，及憂鬱症。

So imagine what this can mean for entire communities

想像一下這對於 整個社區的意涵是什麼，

when almost everybody can be walking around

幾乎每個人都有可能帶著 未處理的壓力和創傷到處走。

with unaddressed stress and trauma.

Then picture what can happen as individual

接著再想像，當個人和集體的

and collective trauma collide.

創傷發生碰撞時會如何。

To make matters worse,

火上加油的是，

we know that exposure to violence can lead to more violence.

我們知道暴露在暴力之下 會導致更多暴力。

Research has shown that survivors of violence

有研究指出，

暴力倖存者再次涉入暴力

can be up to six times more likely

或再次受害的可能性是六倍之多。

to either be involved in violence or be revictimized.

It's literally the definition of a vicious cycle.

這正是惡性循環的定義。

The good news is we know that we can interrupt this cycle

好消息是我們知道 我們可以打破這個循環，

by addressing the underlying trauma with better access to mental health care.

透過讓心理健康照護更容易取得，

來處理這背後的創傷。

The only problem is

唯一的問題是，

access to mental health care in these communities

在這些社區想取得心理健康照護，

is virtually non-existent.

根本是不可能的。

So just to give you an idea,

讓各位有個概念：

in the United States,

在美國，每十萬人 就會有大約兩百七十名

there are about 270 mental health care workers

for every 100,000 people.

心理健康照護工作者。

In Honduras, this drops to two.

在宏都拉斯，只有兩名。

所以我們要面對的 是這個典型的難題。

So we're left with this classic conundrum.

We know how to help solve the problem,

我們知道如何協助解決問題， 但我們沒有資源來做。

but we don't have the resources to do it.

But what if we re-envision what or who these resources could be?

但如果我們重新想像這些資源 可能是什麼或是誰呢？

I think we should,

我認為我們該這麼做，

because there are ways to flood communities

因為有些方法可以讓社區 取得大量的心理健康照護。

with access to mental health care.

It’s already being done, and it’s working.

已經上路了，

且行得通。

And I want to tell you a little bit about how we're doing it at Glasswing.

我想跟大家分享一下 在 Glasswing 是怎麼做的。

We're training thousands of existing government employees like teachers,

我們在訓練數以千計的 既有政府員工，比如

老師、護理師、醫生，

nurses, doctors and police officers

以及警員，

on trauma education and self-care.

提供他們創傷教育 及自我照護的訓練。

We're essentially trying to create a whole core of lay mental health workers

基本上，我們是試圖創造出 由外行心理健康工作者組成的基礎，

who are already serving on the front lines

他們都已經在前線服務了，

and can therefore step in and buffer the impacts of violence and trauma

因此能夠介入並緩衝 暴力及創傷的衝擊，

on themselves and on the communities they serve.

包括對於他們自身 及他們服務社區的衝擊。

We've trained health care workers

我們訓練健康照護工作者

to be able to recognize the signs of trauma,

讓他們能辨識出創傷的徵兆，

to be able to help patients understand what they're experiencing

能協助病人了解他們經歷的狀況，

and equip them with tools to cope or refer them if they need it.

並讓他們有工具可以處理，

或者需要時幫他們轉介。

We've actually seen that trauma-informed violence prevention work in hospitals

我們實際上已在醫院裡 看到創傷知情的

暴力預防工作 能將再次受害的可能性減少

can reduce the likelihood of revictimization by up to 30 percent.

達 30% 之多。

(Applause)

（掌聲）

In schools, we know that if children and adolescents

在學校裡，我們知道如果孩童 和青少年能找到關心他們

have access to a caring adult that can help them cope with stress,

並可協助他們處理壓力的成人，

their grades improve,

他們的成績和行為會改善，

their conduct improves and their resilience.

連韌性也會提升。

And in our work with police,

至於我們與警方的合作， 我們訓練的警員中有 90%

90 percent of the police we trained

actually felt better able to regulate their emotions

確實覺得更能夠調節 他們自己的情緒，

and to deal with anxiety and fear.

也更能處理焦慮及恐懼。

Eighty percent even told us

當中甚至有 80% 的人告訴我們， 他們覺得自己更能協助同儕。

that they felt better equipped to help their peers.

I want to share a story with you.

我想跟大家分享一個故事。

Back in 2018, our Guatemala team was working in a community

2018 年，我們的瓜地馬拉 團隊所協助的社區

with really high rates of crime, violence and stigma.

有著極高的犯罪率、暴力，以及汙名。

One of the schools we were working in

和我們合作的其中 一間學校是專門收容

is actually a school where kids ended up

if they got expelled or if they got in trouble.

被退學或惹上麻煩的孩子。

So that's why Walter, a 17-year-old student,

那就是為什麼十七歲的學生華特

was really surprised and a little confused, when Eluvia,

會感到很意外且有點困惑，

因為當時我們的創傷知情 學校協調員之一，伊露薇雅，

one of our trauma-informed school coordinators,

showed up to recruit him and his friends to work at the local primary school.

到那裡去招攬他和他的朋友 到當地的小學工作。

But Eluvia's from that community,

但伊露薇雅來自那個社區，

and she knew that if she could empower a young man like Walter

她知道如果她能讓像華特 這樣的年輕人有能力

to become involved and become a school coordinator,

去介入並成為學校協調員，

she could not only transform his life

她能改變的不僅是他的人生， 還有他將來能協助的孩子。

but also the life of the kids he'd work with.

So sure enough, a couple of weeks later,

果真，幾週後，

Walter was trained and leading a group of 20 little kids in a glee club.

華特受了訓練，

並帶領一個二十名 小朋友組成的歡樂合唱團。

He loved it.

他愛這份工作。

(Applause)

（掌聲）

He loved it so much that he continued to show up every week

他好愛這份工作， 所以他每週都出席，

for over two years.

持續了兩年以上。

But one afternoon,

但有天下午，

one of Walter's neighbors ran into the school screaming

華特的一位鄰居

跑到學校，大叫著要華特得要回家，

that Walter had to get home

because his sister had been shot and killed.

因為他的姐姐被射殺了。

Walter sprinted out.

華特衝出去。

And as he described it to me,

他向我描述的說法是

he felt his mind and body go numb.

他覺得他的大腦和身體都麻木了。

Then he felt his heart start to race and his chest fill with rage.

接著他感到心跳加速，

滿腔怒火。

He knew who had killed his sister.

他知道是誰殺了他的姐姐。

And he ran up to his room to get a gun.

他衝上他的房間去拿槍。

Let me pause there for a sec.

讓我在此暫停一下。

Do you remember what I told you a minute ago,

還記不記得我剛才告訴各位，

about how violence can lead to more violence?

暴力會導致更多暴力？

That could have been Walter.

那本來可能發生在華特身上，

But it wasn't.

但並沒有。

Because he told me that when he pictured his mentor, Eluvia,

因為他告訴我，當他 想像他的導師伊露薇雅

and the little glee club kids finding out that their role model had killed someone,

以及歡樂合唱團的那些小朋友 發現他們的榜樣

殺了人，

he put the gun down.

他就把槍放下了。

And that, that right there --

就是在這個時點——（掌聲）

(Applause)

is where the cycle of violence stopped.

暴力循環被中斷了。

(Applause)

（掌聲）

That's everything.

那是最重要的。

I have other stories like Walter and Eluvia's.

我還有其他像華特 及伊露薇雅的故事。

But to interrupt and to stop this epidemic of violence,

但若要打破和中斷這種暴力的流行，

we need thousands more.

我們還需要數千個這樣的故事。

And there are great ways to do this that are replicable.

且有些很好的做法是可以複製的。

We know that we can provide more health care in communities

我們知道我們可以在社區中 提供更多健康照護，

provided by regular people.

由一般人來提供。

I’m talking about community, and I’m talking about systems change

我在談的是社區，

我在談的是體制改變，

at the same time.

同時要發生。

First, we train everybody in public schools,

首先，我們訓練 公立學校中的每個人，

public hospitals, clinics and police precincts

公立醫院、診所， 及警方轄區的每個人，

on trauma, education and self care

教他們創傷、教育，及自我照護。

so they can better take care of themselves

讓他們能把自己及服務對象 都照顧得更好，

and also those that they serve understand trauma and manage it.

了解創傷並管理它。

Then we train a subset as interventionists

接著我們訓練當中一些人 成為處理緊急狀況的介入者，

so they can deal with emergencies,

providing crisis intervention and ongoing support.

提供危機介入處理以及持續的支持。

And then we train a subset of those interventionists as trainers

接著我們再將一些介入者 訓練為培訓員，

so they can continue to train their peers

讓他們能夠繼續訓練他們的同儕， 也能訓練其他組織，

and they can train other organizations

擴大我們的網路，讓每個社區內

so we can have a growing network of trauma-informed services

都有創傷知情服務，

in each community.

The great thing is this model is scalable and it’s cost-effective,

很棒的是，這個模型的規模 有擴大空間且成本效益佳，

because we're working within public systems

因為我們在公共體系內進行， 用的是本來就在體系內的人。

with people that are already there.

So really, we know that violence happens between people,

所以，

確實，我們知道 人與人之間會發生暴力，

but so does healing.

但也會發生療癒， 療癒正是從那裡開始。

That's where it starts.

So we know the power lies in people, in relationships,

所以我們知道力量 來自於人，來自於關係，

in a community healing itself.

來自於能自我療癒的社區。

One of my favorite quotes by Viktor Frankl in “Man’s Search for Meaning” is:

維克多‧弗蘭克的《活出意義來》 當中有句話我很喜歡：

"Between stimulus and response, there is a space.

「在刺激與反應之間，有一個空間。

In that space is our power to choose our response.

在那空間中的，是我們 選擇如何反應的力量。

And in our response lies our growth and our freedom."

而我們的成長與自由 就在我們的反應當中。」

Our goal is to literally infiltrate the space

我們的目標是要能真正滲入到 暴力刺激和反應的這個空間，

in between violent stimulus and response,

with mental health knowledge and skills

靠的是心理健康知識和技能，

so that communities can pave their own way to healing and resilience.

這樣社區才能為自己鋪路， 邁向療癒和恢復力。

Thank you so much.

非常謝謝。

(Applause and cheers)

（掌聲及歡呼）