For Trauma and Beyond, an Argument for Health Care That Comes to You
Most of us probably imagine sexual health screening and primary health services as events that occur in large buildings in relatively cold and sterile conditions. For the most part, that works well. But what if those same services and more could be conducted—with the same level of professionalism and discipline—while you lounged in the comforts of your own home?
Home health visits are an old concept largely relegated to antiquity. But there's room for a home health revival in the wake of COVID-19. According to Christine Brennan, a registered nurse in Louisiana and an associate professor at Louisiana State University's School of Public Health, the obstacle to home health often boils down to liability, especially as related to disease prevention and ongoing healthcare issues.
It's hard, though, to refute the fact that more options for care typically lead to better-managed care for the patient. With that philosophy in mind, it makes you wonder where American discomfort with home health for primary and/or sexual health care originated.
Understanding home health discomfort
"The discomfort really comes from our upbringing," said Karol Darsa, Psy. D., a licensed psychologist who wrote a book on trauma mapping, "The Trauma Map," and owns a trauma treatment center in Los Angeles. "In terms of prevention, the ideal situation would be, the moment a child is born and when they leave the hospital, a social worker follows the family and helps them. Not just about, like, how to change the diaper and whatnot, but it's like, 'What are the emotions that come up?' 'How do parents deal with the frustration?' and 'What do they teach the kids about emotions?' Could you imagine?"
Tracking this idea forward in life, it's easy to see how this could play out positively in terms of complex social problems such as intimacy issues, addictive tendencies, sexual compulsions and more. Many people don't realize the different ways these struggles affect them negatively until it's too late, and by that time, they've already arrived at the very lowest point of their journey.
"For a lot of people, it's when they hit rock bottom," Darsa said. "But for some of them? No. Thank God, some people become aware of what they're doing and how detrimental it is way before rock bottom."
Home visits already occur across many different categories of social and medical work in the United States. For some people, the concept of the home visit might be tainted by stories they've heard or perceptions they've formed around the negligent actions of social workers and others who sometimes make a home visit a part of their work. For what it's worth, the bad actors are typically an exception rather than the rule.
We've all heard stories of medical providers with too many patients on their client list and too many homes to visit. It's true people who are unable to leave the home for vital support services are often uniquely vulnerable. But these examples are typical byproducts of institutional systems that have long sought to recover from decades, if not centuries, of poor medical choices sometimes causing more harm than good to patients.
Let's say Darsa's theoretical family has been working with the same social worker for 12 or 13 years, since the birth of their first child. Wouldn't it be wonderful for a family to have the knowledge and resources of those individuals—and by extension, the physicians and health experts in their network—for conversations about changing bodies, sexual health practices and the other mystifying, threatening new aspects of life that children are presented with as they approach adulthood?
Many young people would likely appreciate learning about their own reproductive system gradually and from a nurse or physician who makes home visits an option, especially compared with the awkward, semi-informed sex education most of them get from their parents or, often even worse, public school systems.
The flaw in fragmenting health
It's virtually impossible and unwise, to say the least, to try to separate primary health care and sexual health services from the complexities of addictive behavior, mental health problems or other complex issues and their treatment protocols. Siloing these issues often creates additional trauma for patients trying to get a handle on their health and their struggles with mental health.
"I have had clients who have been to eight, 10 different treatment centers, rehabs, hospitals before they finally come to our doors and say, 'I have worked on my trauma for years,'" Darsa said. "That's actually a trauma, too, to be in treatment year after year and failing, and how much it affects your self-esteem because you really feel like a failure."
This type of trauma is often seen in people who have repeat incidences of addiction relapse, multiple episodes of sexual health problems or sexual traumas for which they feel responsible, and many others who have simply been unable to access the services they need.
Would home health visits be an instant solution for these people? Certainly not, especially when you consider there will always be bad actors and gaps in the system for people to slip through. But it's hard to ignore the idea that for many people, simply eliminating the hurdles associated with finding one new provider after another could be a very big step toward mitigating the damage done by ongoing failed attempts at treatment or acquiring services for any number of conditions.
Human interaction is pivotal in all aspects of health
Maybe before we know it, we'll just have robots stopping by the house to take a monthly blood draw and nearly all of our interactions with doctors will take place via holographic projection.
Aside from the vague dystopian implications, that description doesn't sound so bad. However, that direction would only put increased emphasis on the importance of human interaction in medicine. After all, human interactions tend to go better when all participants are comfortable.
There will always be a need for some level of interpersonal relations in primary and sexual health care, just as there will always be a need for neutral, professional, sterile spaces. But who's to say those spaces can't occasionally be at home?
As we strive to build more options into our medical systems for everyone, we must also recognize that you can't truly separate your health from your home life. Maybe it's time we merge the two with all the right intentions and at least a touch of human compassion.