By Michelle Lugalia-Hollon, Global Health Contributing Editor

Imagine after years of unexplained and unmanageable heart disease sitting down with your doctor who explains that your heart condition may be a manifestation of unaddressed trauma that you experienced as a child. What would you do?

In 1985, Dr. Vincent Felitti, the Chief of Kaiser Permanente’s renown Department of Preventive Medicine, was struggling to understand why 50% of patients attending the center’s obesity clinic were dropping out of the program despite their success in reaching their weight loss goals. To get to the bottom of this problem, Felitti researched the program dropouts’ medical records and noticed several themes: 1. All were of average weight at birth; 2. They did not gain weight slowly over their lifetime as he had assumed but gained weight over a short period of time; and 3. When they lost weight, they would quickly regain all or more of it.

Intrigued by this data, Felitti decided to interview several hundreds of those patients but learned nothing from his initial survey until he jumbled his routine questions and accidentally asked a patient, “How much did you weigh when you were first sexually active?” The patient revealed that she weighed forty pounds and was only four years old when her father abused her. As he continued his interviews, he and his colleagues discovered that most of their overweight patients had been sexually assaulted as children and some more recently as adults. It was then that he realized his patients were eating to soothe their trauma. For some patients, being obese was a protective solution and losing weight often led to an increase in anxiety, depression, or fear. After making this connection, Felitti attempted to share the information with his peers to lukewarm reception.

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By Michelle Lugalia-Hollon, Contributing Editor, Global Health

In an unprecedented national call-to-action to lower the number of people with mental illness in the jails, the Council of State Governments Justice Center (CSG) and the National Association of Counties (NaCo) convened leaders in behavioral health and criminal justice at the end of last year. In the United States, where dealing with mentally ill citizens has caused much hand wringing and little sustainable progress over the last few centuries, this is a big deal.

The mentally ill have cycled through various institutions, from asylums to nursing homes, which have all assumed and lost the responsibility for treating them depending on the reform of the day. Though evidence-based solutions have been well researched, implemented and documented, years of effort to adequately address severe mental illness have failed to take root primarily due to inadequate financial support for well-meaning reforms. Across the nation, as best-practices have continued to be gutted, these primarily poor and under-resourced individuals have lost access to the mental health and social services that can keep them healthy, housed and employed. Without access to these vital services mentally ill citizens are left to survive in communities where their unmanaged mental illnesses drive their repeated involvement in illegal behaviors that lead to their arrests. This criminalization of mental illness has led to a disproportionate number of these citizens detained in jails and prisons. Consequently, prisons and jails have become the largest and most utilized mental health institutions across the United States.

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