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

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.