Undetected. Untreated. Unvoiced.

When a health trauma leads to a mental health crisis, medical professionals and patients have a new, groundbreaking resource for ensuring a patient’s emotional health isn’t on the back burner.

Michelle Flaum Hall ’02 nearly lost her life when she gave birth.

She went to the hospital anxious and excited to meet her daughter. But as doctors induced labor, she suffered the most severe type of hemorrhage and required 18 units of blood — the equivalent of the entire blood supply of a person plus half that of another.

She underwent an emergency Caesarean and a life-saving hysterectomy. She spent five days in the intensive care unit and developed pneumonia.

A steady stream of health care professionals visited her room to give her additional units of blood, monitor her vital signs, check her incision, look for infection, adjust her IVs, administer painkillers and closely monitor her physical recovery. But, Hall says, “My emotional needs weren’t even on the radar.”

Now, she is working to change that for other patients.

Hall, a graduate of the counselor education program, and her husband, Scott Hall, associate professor of counselor education and human services, have written a new guide for health care professionals that, for the first time, describes best practices for treating medical trauma in health care settings.

They say the need was clear: Too often, the emotional costs of medical experiences go undetected, untreated and unvoiced. It is staggering to think about the number of people who might be affected, they write. Every minute in the United States, one person will have a heart attack and two will suffer strokes; every hour, nearly six women will suffer grave complications while giving birth, according to the Centers for Disease Control.

Their book, Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Healthcare Professionals, offers models for how to bring mental health professionals into the treatment team to ensure a patient’s emotional health isn’t on the back burner. It also gives doctors, nurses and students the tools and strategies they need to recognize signs of stress in patients and their families.

“Health care has really become a team sport, in a sense. But what we have seen is mental health is still sometimes separated, or even absent,” said Michelle Flaum Hall, an associate professor in counseling at Xavier University.

“We want to put the need for mental and emotional well-being on the radar for health care professionals and for patients,” Scott Hall added. “It starts with awareness.”

Building a bridge

There’s never been a better time to work to bridge the gap between mental and physical health care to better meet the needs of patients, the Halls write in their book. Medicine has made great strides in treating the whole person, but more can be done to address the emotional effects of medical trauma.

“In medicine, it’s often only about doing the surgery, making sure this person is healing properly and getting the right medication,” Michelle Flaum Hall said. “There’s nothing that says, ‘You might really struggle emotionally following this surgery. Here are some signs of depression or anxiety, and here are the resources that can help you.’”

The Halls drew on their own experiences as patients and professionals to develop tools that allow clinicians to be much more proactive about protecting a patient’s emotional well being.

One tool, the Medical Mental Health Screening, helps doctors flag risk factors in patients before a surgery or treatment. It asks patients to mark “yes” or “no” on a series of statements, such as “I have experienced depression at some time in my life” or “I tend to be pessimistic about many things (for example, the future or my health).” It also gauges whether the patient is worried about going under anesthesia or how their families will cope with the illness or procedure.

Other tools help monitor the patient’s emotional well-being after a procedure, including the Secondary 7-Lifestyle Effects Screening. The checklist also uses “yes” or “no” questions, such as, “Since my medical procedure/diagnoses, I have had to alter my life plan or have been unable to reach important milestones (for example, delayed graduation or marriage, relocation).”

Also included are tools Michelle Flaum Hall developed as part of her work on a maternal safety bundle for the Council on Patient Safety in Women’s Health Care. The materials lay out what every hospital should have in place to support women, their families and health care providers when the unexpected happens, said Christine H. Morton, research sociologist at Stanford University and program manager for the California Maternal Quality Care Collaborative.

“The impact for this work in the area of maternity care is potentially quite high,” said Morton, who worked with Michelle Flaum Hall as part of the council. “This book is essential reading for every maternity care clinician in the United States.”

The assessments, available online at hawthorneintegrative.com, are also important for many patients because it can be difficult to recognize what is happening to them emotionally. Physicians need interventions and strategies in place automatically, as the Halls write, as a “safety net to ensure that fewer patients who experience medical trauma ‘slip through the cracks’ of a health care system that can sometimes have a singular focus on caring for the physical body at the expense of all else.”

“We’re all responsible,” Michelle Flaum Hall said. “It doesn’t end when the patient walks out the hospital doors. We have to do a better job of protecting patients’ mental health.”

A personal journey

Medical trauma goes beyond what is obviously a traumatic event — like someone in a car crash who is rushed to the hospital in an ambulance with life-threatening injuries. Any kind of medical experience can be medical trauma. There are different levels of trauma, and many just aren’t on the radar, the Halls write.

Patients can also suffer emotional effects later — long after a hospital stay or doctor’s visit.

“Patients can suffer what we call a secondary crisis,” said Scott Hall, whose more than two decades of experience as a counselor includes work with veterans who experience trauma. “A traumatic event can impact them in terms of their careers, their relationships and in developmental milestones. And sometimes that impact might not show up for three months, six months, 12 months.”

Scott Hall said he gained insight into secondary crises after he had lower-back surgery and realized he could no longer do taekwondo with his daughter. Their weekly lessons had been a bonding time over the eight years they earned black belts together. With his surgery, he was not able to achieve the second-degree black belt they had been working toward, although his daughter did.

“I couldn’t do taekwondo anymore. I couldn’t do the kicks or the twists. I had to stop doing the very thing we shared for years, and in some ways it redefined our relationship,” he said.

“I had to think about what the new normal was, and what else in my life I needed to modify,” he said. “And I realized: If I’m experiencing this, how many modifications are other people trying to make in their lives by themselves as a result of health care? It highlights the need on a much larger scale of how there are deficits in the health care system.”

Scott Hall, whose experience as a patient is built into a case study in the book, said he has addressed similar issues with patients and friends. It could be someone who can no longer play golf. Or someone who can no longer run with their husband, wife, son or daughter because of an orthopedic injury — an example they use in the book.

“It’s the kind of medical event that a lot of people would say is outpatient surgery — no big deal,” Michelle Flaum Hall said. “The focus of recovery is very much on managing pain and recapturing whatever mobility may be possible. But something like an orthopedic injury and surgery can be the first of many dominos to fall in someone’s life, because all of a sudden they’re not as mobile and they’re not engaging in aspects of their lifestyles that are really important to them.”

Even for professionals, it can be difficult to recognize the signs of depression and get treatment. Michelle Flaum Hall described herself in the hospital as “utterly drained” and “exhausted, raw and very fragile.” In a daze, she did not ask for mental health care.

“If anyone on my treatment team had enlisted the help of a mental health professional … then I could have begun treatment for what eventually became PTSD,” she wrote for Nursing for Women’s Health. She notes PTSD refers to a long-term clinical set of symptoms, which for her stemmed from the magnitude and complexity of the trauma she experienced and the fact that she spent several more days in the hospital where the trauma originally occurred.

Sharing her story in the Nursing for Women’s Health clinical journal started the Halls’ journey to write the book. Through new connections, the Halls pitched the idea for the book and received almost immediate acceptance.

“It’s been a very personal journal for me,” Michelle Flaum Hall said, “because it’s been about ensuring the suffering I endured was not in vain, and I could potentially make a difference, even in a small way in sharing my story.”

Michelle and Scott Hall hope their book can revolutionize the way mental health and health care professionals work together to better meet the needs of patients. From current practitioners to better training protocols, their goal is to have this model at the forefront of people’s minds when they approach their work with patients.

And while the book is written for health care professionals, the message has resonated outside the industry.

“People reached out with their personal stories of being patients or knowing patients, and knowing how painful emotionally these experiences can be,” Michelle Flaum Hall said. “They just wanted to say ‘thank you’ for bringing awareness because there was a hopefulness that something would change.”