The Cashless Debit Card Symposium was held at both the University of Melbourne and the Alfred Deakin Institute on Thursday, the 1st of February 2018. The Power to Persuade is running a series of blogs drawn from the presentations made on the day. In this piece, Katherine Curchin from Australia National University uses a trauma-informed lens to assess the effectiveness of the Cashless Debit Card to address the social issues it was introduced to address.
Trauma and its impacts
If we look through a trauma-informed lens, measures aimed at controlling welfare recipients appear likely to do more harm than good.
Thanks to the rapidly advancing field of neuroscience, there is compelling evidence that overwhelming, life-threatening experiences can have lasting effects on the structure and functioning of the human brain. Traumatic events can powerfully shape behaviour many decades later.
The likelihood of developing long-term problems is greater when the trauma happens in childhood, especially early childhood, and takes the form of a series of traumatic events. Trauma is especially damaging when it is the result of intentional harm by another person, particularly if that person is a trusted caregiver.
Some of the impacts of trauma, such as flashbacks and nightmares, might be easy for others to connect to the traumatic event. But other impacts such as difficulties trusting other people, concentrating, regulating emotions and calming down are less obviously linked to the trauma experiences.
Various interventions have been identified that are effective in promoting safety and recovery not just in the immediate aftermath of a traumatic events, but many decades later. However, many people who might benefit from this kind of help never get access to it.
Trauma-informed care in service delivery
Originating in the US, there is a growing trauma-informed care movement seeking to use what is now known about trauma to inform the design of human services. This movement draws on insights from neuroscience as well as insights from trauma survivors who have shared their lived experience.
Various human services whose central purpose is not the treatment of trauma are realising that many of their clients have (undisclosed) trauma histories. Mental health services, drug and alcohol services, homelessness services, children's services, schools, and custodial institutions among others are proactively redesigning their operations in order to avoid inadvertently re-traumatizing their clients (see for example here, here, here and here). These services need to become trauma-informed because how they do their jobs has an impact on whether their clients can heal and recover from their trauma.
Trauma-informed care is a strengths-based approach which shifts the emphasis from punishing and stigmatising non-compliant behaviour to helping clients to regulate their emotions, feel safe and make connections with other people. It recognises that people recover from trauma in the context of supportive relationships. It promotes collaboration with clients rather than paternalism. How can trauma-informed care improve welfare delivery?
I believe the time has come to examine the social security system through a trauma-informed lens.
If we think of social security as a system whose sole objective is distributing income support, then we might see the trauma-informed care movement as irrelevant to it. But in recent decades the Australian social security system has been saddled with other objectives that diminish its capacity to adequately provide a social safety net. The social security system is now seen by government as a lever for changing the behaviour of disadvantaged people and promoting personal responsibility.
Not everyone who relies on income support has a trauma history. But people with unresolved trauma are more likely to be chronically ill and more likely to be on a low income than others, so they are likely to be overrepresented among income support recipients.
We should be asking: what factors are present in Australia’s social security system which may be re-traumatizing vulnerable people? How are the principles underpinning Australia’s current treatment of welfare recipients in tension with the core principles of trauma-informed services?
The dangerous misconceptions of neo-paternalism
Looking through a trauma-informed lens provides a powerful impetus to reverse the punitive trend in welfare reform. The neo-paternalist approach advocated by the US academic Lawrence Mead, and subsequently embraced in Australia and other countries, rests on a profound misunderstanding of why people experiencing deep and persistent disadvantage sometimes appear to make self-defeating choices.
Mead argues that neo-paternalism will help people who are passive, who have learned helplessness, who don't see a future for themselves, and who can't seem to act in their own best interests. Without appearing to realise it, Mead is talking about traumatized people. When trauma experts describe how people affected by unresolved trauma behave, they talk about hopelessness, lacking a sense of the future or agency. Neuroscientists can convincingly describe why childhood adversity can lead to brain changes with these behavioural effects.
While Mead thinks that the availability of government-provided income support is toxic, it seems more plausible that in places of concentrated disadvantage it is the chronic stress of poverty and racism, and the traumatic stress of violence that is really having this toxic effect on people's brains.
Trauma experts couldn't be more different from the advocates of punitive welfare reform when it comes to what they think should be done. While Mead advocates for enforcing rules and punishing the noncompliant, trauma experts argue that punishment is an ineffective way of encouraging positive behavioural change.
For Mead, the fact that people do self-destructive, self-sabotaging things legitimizes paternalism. Interestingly, the trauma experts argue that paternalism is inappropriate and counter-productive, and that even people who are prone to self-destructive behaviours need to be listened to, need to be empowered, need opportunities to make decisions, and need to be treated as collaborators - not naughty children.
As one of the foundational articles in this field put it: ‘Regrettably, a relationship with a powerful authority figure who controls all of the resources and whose opinions and wishes take priority over one’s own is tragically reminiscent of the abuse dynamic in which the trauma survivor was forced to accept an unequal relationship in order to avoid even worse treatment’.
‘Good intentions’ or an evidence-based approach?
We are told the rationale for paternalistic measures is care and compassion for vulnerable people – these policies are supposedly 'based on love'. But the trauma-informed care movement is making the case that good intentions are not enough. Rather than promoting responsible behaviour among welfare recipients, disempowering initiatives, such as income management, may be promoting disconnection and despair.
If it is becoming increasingly untenable for well-intentioned human services to be re-traumatizing vulnerable people through paternalistic interventions, then it should also be untenable for the social security system to be re-traumatizing vulnerable people.
My point is not just that the money we spend on initiatives such as the cashless debit card could instead be spent on trauma-informed services - although I certainly think it should be. My point is that paternalistic measures could actually be making matters worse. The government should be held to account for the traumatizing effects of policies that are supposedly motivated by care and concern for vulnerable people but disregard an evidence base that does not fit their agenda.
To read more from the Cashless Debit Card Symposium, see:
 Van der Kolk, B. 2014. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Penguin.
 Bloom, S. L., & Farragher, B. 2013. Restoring sanctuary: a new operating system for trauma-informed systems of care. Oxford: Oxford University Press.
 Mead, L. 1997. The New Paternalism: Supervisory Approaches to Poverty. Washington: Brookings Institution Press.
 Bloom, S. L., & Farragher, B. 2011. Destroying sanctuary: The Crisis in Human Service Delivery Systems. Oxford: Oxford University Press, chapter 10.
 Harris, M., & Fallot, R. D. 2001. ‘Envisioning a Trauma-Informed Service System: A Vital Paradigm Shift’. New Directions for Mental Health Services, 89, 3-22.