TED演講者：Celina de Sola / 塞麗娜·德·索拉

演講標(biāo)題：Mental health care that disrupts cycles of violence / 精神衛(wèi)生照料能夠打破暴力循環(huán)

內(nèi)容概要：In Latin American countries like El Salvador, homicide rates are alarmingly high thanks in large part to a vicious cycle of violence -- people don't have a chance to heal from recurrent individual and collective trauma. With her team at Glasswing International, de Sola is hoping to break this cycle by equipping government employees like teachers and police officers with the skills and knowledge they need to provide mental health care to those who need it most. Their goal: to transform more than 2,000 frontline institutions in 25 of the highest risk municipalities in Central America with community-based approaches to mental health support, reaching nearly 10 million people along the way. (This ambitious plan is a part of the Audacious Project, TED's initiative to inspire and fund global change.)

在薩爾瓦多共和國這樣的拉美國家，居高不下的兇殺率在很大程度上是因為暴力行為的惡性循環(huán)——人們無法擺脫反復(fù)發(fā)生的個人與群體精神創(chuàng)傷。隨著在 Glasswing International 的團(tuán)隊開展工作，de Sola 希望通過給她認(rèn)為最迫切需要的人群——諸如教師、警察之類的公職人員——提供精神衛(wèi)生照料的知識與技能來打破這一惡性循環(huán)。她們的目標(biāo)是：通過改變位于中美地區(qū)的 25 個最高風(fēng)險城市的 2000 家一線機(jī)構(gòu)，使機(jī)構(gòu)能夠在改變過程中以所在社區(qū)為基地為接近 1000 萬人口提供精神健康支持。（這一宏大的計劃是無畏項目(Audacious Project) 的組成部分。這一促進(jìn)全球改變的項目受到 TED 的支持與資助）

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

我想跟大家分享 一個驚人的統(tǒng)計數(shù)字。

【2】Latin America is home to only eight percent of the world's population but one third of its homicides.

拉丁美洲的人口只占全世界的 8%, 自殺人數(shù)卻占三分之一。

【3】This is especially extreme in the Northern Triangle countries of Honduras, Guatemala and El Salvador, where I'm from and where I live.

在北方三角國家中 這個情況特別嚴(yán)重, 包括宏都拉斯、瓜地馬拉, 也是我的家鄉(xiāng)和居住地。

【4】Just imagine the impact that this kind of unrelenting violence can have on a person's health, productivity and well-being.

想像一下這種持續(xù)的暴力會如何影響 人的健康、

【5】Especially because we know that if we're exposed to violence, this can result in trauma.

特別是因為我們知道, 可能會造成創(chuàng)傷。

【6】And when that happens, our brain's stress response actually shuts down core functions like problem solving, critical thinking and emotional regulation.

如果發(fā)生了, 我們的大腦對壓力的反應(yīng) 會是關(guān)閉掉核心功能, 比如解決問題、

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

并會提升我們保護(hù)自己 及生存所需要的功能。

【8】So this makes it really hard to learn to make decisions and even maintain relationships.

所以就會讓我們很難學(xué)習(xí) 做決策,甚至維持關(guān)系。

【9】It can also increase our risks of lung and heart disease, diabetes, anxiety and depression.

也會讓我們更有可能得到心肺疾病、 焦慮癥,及憂郁癥。

【10】So imagine what this can mean for entire communities when almost everybody can be walking around with unaddressed stress and trauma.

想像一下這對于 整個社區(qū)的意涵是什么, 幾乎每個人都有可能帶著 未處理的壓力和創(chuàng)傷到處走。

【11】Then picture what can happen as individual and collective trauma collide.

接著再想像,當(dāng)個人和集體的 創(chuàng)傷發(fā)生碰撞時會如何。

【12】To make matters worse, we know that exposure to violence can lead to more violence.

火上加油的是, 我們知道暴露在暴力之下 會導(dǎo)致更多暴力。

【13】Research has shown that survivors of violence can be up to six times more likely to either be involved in violence or be revictimized.

有研究指出, 暴力幸存者再次涉入暴力 或再次受害的可能性是六倍之多。

【14】It's literally the definition of a vicious cycle.

這正是惡性循環(huán)的定義。

【15】The good news is we know that we can interrupt this cycle by addressing the underlying trauma with better access to mental health care.

好消息是我們知道 我們可以打破這個循環(huán), 透過讓心理健康照護(hù)更容易取得,

【16】The only problem is access to mental health care in these communities is virtually non-existent.

唯一的問題是, 在這些社區(qū)想取得心理健康照護(hù), 根本是不可能的。

【17】So just to give you an idea, in the United States, there are about 270 mental health care workers for every 100,000 people.

讓各位有個概念: 在美國,每十萬人 就會有大約兩百七十名 心理健康照護(hù)工作者。

【18】In Honduras, this drops to two.

在宏都拉斯,只有兩名。

【19】So we're left with this classic conundrum.

所以我們要面對的 是這個典型的難題。

【20】We know how to help solve the problem, but we don't have the resources to do it.

我們知道如何協(xié)助解決問題, 但我們沒有資源來做。

【21】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 可能是什么或是誰呢？

【22】I think we should, because there are ways to flood communities with access to mental health care.

我認(rèn)為我們該這么做, 因為有些方法可以讓社區(qū) 取得大量的心理健康照護(hù)。

【23】It's already being done, and it's working.

已經(jīng)上路了,且行得通。

【24】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 是怎么做的。

【25】We're training thousands of existing government employees like teachers, nurses, doctors and police officers on trauma education and self-care.

我們在訓(xùn)練數(shù)以千計的 既有政府員工,比如 老師、護(hù)理師、醫(yī)生,以及警員, 提供他們創(chuàng)傷教育 及自我照護(hù)的訓(xùn)練。

【26】We're essentially trying to create a whole core of lay mental health workers who are already serving on the front lines and can therefore step in and buffer the impacts of violence and trauma on themselves and on the communities they serve.

基本上,我們是試圖創(chuàng)造出 由外行心理健康工作者組成的基礎(chǔ), 他們都已經(jīng)在前線服務(wù)了, 因此能夠介入并緩沖 暴力及創(chuàng)傷的沖擊, 包括對于他們自身 及他們服務(wù)社區(qū)的沖擊。

【27】We've trained health care workers to be able to recognize the signs of trauma, to be able to help patients understand what they're experiencing and equip them with tools to cope or refer them if they need it.

我們訓(xùn)練健康照護(hù)工作者 讓他們能辨識出創(chuàng)傷的征兆, 能協(xié)助病人了解他們經(jīng)歷的狀況, 并讓他們有工具可以處理,

【28】We've actually seen that trauma-informed violence prevention work in hospitals can reduce the likelihood of revictimization by up to 30 percent.

我們實際上已在醫(yī)院里 看到創(chuàng)傷知情的 暴力預(yù)防工作 能將再次受害的可能性減少達(dá) 30% 之多。

【29】In schools, we know that if children and adolescents have access to a caring adult that can help them cope with stress, their grades improve, their conduct improves and their resilience.

在學(xué)校里,我們知道如果孩童 和青少年能找到關(guān)心他們 并可協(xié)助他們處理壓力的成人, 他們的成績和行為會改善, 連韌性也會提升。

【30】And in our work with police, 90 percent of the police we trained actually felt better able to regulate their emotions and to deal with anxiety and fear.

至于我們與警方的合作, 我們訓(xùn)練的警員中有 90% 確實覺得更能夠調(diào)節(jié) 他們自己的情緒, 也更能處理焦慮及恐懼。

【31】Eighty percent even told us that they felt better equipped to help their peers.

當(dāng)中甚至有 80% 的人告訴我們, 他們覺得自己更能協(xié)助同儕。

【32】I want to share a story with you.

我想跟大家分享一個故事。

【33】Back in 2018, our Guatemala team was working in a community with really high rates of crime, violence and stigma.

2018 年,我們的瓜地馬拉 團(tuán)隊所協(xié)助的社區(qū) 有著極高的犯罪率、暴力,以及汙名。

【34】One of the schools we were working in is actually a school where kids ended up if they got expelled or if they got in trouble.

和我們合作的其中 一間學(xué)校是專門收容 被退學(xué)或惹上麻煩的孩子。

【35】So that's why Walter, a 17-year-old student, was really surprised and a little confused, when Eluvia, one of our trauma-informed school coordinators, showed up to recruit him and his friends to work at the local primary school.

那就是為什么十七歲的學(xué)生華特 會感到很意外且有點困惑, 因為當(dāng)時我們的創(chuàng)傷知情 學(xué)校協(xié)調(diào)員之一,伊露薇雅, 到那里去招攬他和他的朋友 到當(dāng)?shù)氐男W(xué)工作。

【36】But Eluvia's from that community, and she knew that if she could empower a young man like Walter to become involved and become a school coordinator, she could not only transform his life but also the life of the kids he'd work with.

但伊露薇雅來自那個社區(qū), 她知道如果她能讓像華特 這樣的年輕人有能力 去介入并成為學(xué)校協(xié)調(diào)員, 她能改變的不僅是他的人生, 還有他將來能協(xié)助的孩子。

【37】So sure enough, a couple of weeks later, Walter was trained and leading a group of 20 little kids in a glee club.

果真,幾周后, 華特受了訓(xùn)練,并帶領(lǐng)一個二十名 小朋友組成的歡樂合唱團(tuán)。

【38】He loved it.

他愛這份工作。

【39】He loved it so much that he continued to show up every week for over two years.

他好愛這份工作, 所以他每周都出席, 持續(xù)了兩年以上。

【40】But one afternoon, one of Walter's neighbors ran into the school screaming that Walter had to get home because his sister had been shot and killed.

但有天下午, 華特的一位鄰居跑到學(xué)校, 大叫著要華特得要回家, 因為他的姐姐被射殺了。

【41】Walter sprinted out.

華特沖出去。

【42】And as he described it to me, he felt his mind and body go numb.

他向我描述的說法是 他覺得他的大腦和身體都麻木了。

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

接著他感到心跳加速,

【44】He knew who had killed his sister.

他知道是誰殺了他的姐姐。

【45】And he ran up to his room to get a gun.

他沖上他的房間去拿槍。

【46】Let me pause there for a sec.

讓我在此暫停一下。

【47】Do you remember what I told you a minute ago, about how violence can lead to more violence?

還記不記得我剛才告訴各位, 暴力會導(dǎo)致更多暴力？

【48】That could have been Walter.

那本來可能發(fā)生在華特身上,

【49】But it wasn't.

但并沒有。

【50】Because he told me that when he pictured his mentor, Eluvia, and the little glee club kids finding out that their role model had killed someone, he put the gun down.

因為他告訴我,當(dāng)他 想像他的導(dǎo)師伊露薇雅 以及歡樂合唱團(tuán)的那些小朋友 發(fā)現(xiàn)他們的榜樣 他就把槍放下了。

【51】And that, that right there - is where the cycle of violence stopped.

就是在這個時點 （掌聲） 暴力循環(huán)被中斷了。

【52】That's everything.

那是最重要的。

【53】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。

【54】But to interrupt and to stop this epidemic of violence, we need thousands more.

但若要打破和中斷這種暴力的流行, 我們還需要數(shù)千個這樣的故事。

【55】And there are great ways to do this that are replicable.

且有些很好的做法是可以復(fù)制的。

【56】We know that we can provide more health care in communities provided by regular people.

我們知道我們可以在社區(qū)中 提供更多健康照護(hù), 由一般人來提供。

【57】I'm talking about community, and I'm talking about systems change at the same time.

我在談的是社區(qū), 同時要發(fā)生。

【58】First, we train everybody in public schools, public hospitals, clinics and police precincts on trauma, education and self care so they can better take care of themselves and also those that they serve understand trauma and manage it.

首先,我們訓(xùn)練 公立學(xué)校中的每個人, 公立醫(yī)院、診所, 及警方轄區(qū)的每個人, 教他們創(chuàng)傷、教育,及自我照護(hù)。 讓他們能把自己及服務(wù)對象 都照顧得更好, 了解創(chuàng)傷并管理它。

【59】Then we train a subset as interventionists so they can deal with emergencies, providing crisis intervention and ongoing support.

接著我們訓(xùn)練當(dāng)中一些人 成為處理緊急狀況的介入者, 提供危機(jī)介入處理以及持續(xù)的支持。

【60】And then we train a subset of those interventionists as trainers so they can continue to train their peers and they can train other organizations so we can have a growing network of trauma-informed services in each community.

接著我們再將一些介入者 訓(xùn)練為培訓(xùn)員, 讓他們能夠繼續(xù)訓(xùn)練他們的同儕, 也能訓(xùn)練其他組織, 擴(kuò)大我們的網(wǎng)路,讓每個社區(qū)內(nèi) 都有創(chuàng)傷知情服務(wù),

【61】The great thing is this model is scalable and it's cost-effective, because we're working within public systems with people that are already there.

很棒的是,這個模型的規(guī)模 有擴(kuò)大空間且成本效益佳, 因為我們在公共體系內(nèi)進(jìn)行, 用的是本來就在體系內(nèi)的人。

【62】So really, we know that violence happens between people, but so does healing.

所以,確實,我們知道 人與人之間會發(fā)生暴力, 但也會發(fā)生療愈,

【63】That's where it starts.

療愈正是從那里開始。

【64】So we know the power lies in people, in relationships, in a community healing itself.

所以我們知道力量 來自于人,來自于關(guān)系, 來自于能自我療愈的社區(qū)。

【65】One of my favorite quotes by Viktor Frankl in "Man's Search for Meaning" is: "Between stimulus and response, there is a space.

維克多?弗蘭克的《活出意義來》 當(dāng)中有句話我很喜歡: 「在刺激與反應(yīng)之間,有一個空間。

【66】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(yīng)的力量。

【67】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(yīng)當(dāng)中?！?/p>

【68】Our goal is to literally infiltrate the space in between violent stimulus and response, with mental health knowledge and skills so that communities can pave their own way to healing and resilience.

我們的目標(biāo)是要能真正滲入到 暴力刺激和反應(yīng)的這個空間, 靠的是心理健康知識和技能, 這樣社區(qū)才能為自己鋪路, 邁向療愈和恢復(fù)力。

【69】Thank you so much.

非常謝謝。