For the last thirty years, the nation's mental health and social service systems have been under relentless assault, with dramatically rising costs and the fragmentation of service delivery rendering them incapable of ensuring the safety, security, and recovery of their clients. The resulting organizational trauma both mirrors and magnifies the trauma-related problems their clients seek relief from. Just as the lives of people exposed to chronic trauma and abuse become organized around the traumatic experience, so too have our social service systems become organized around the recurrent stress of trying to do more under greater pressure: they become crisis-oriented, authoritarian, disempowered, and demoralized, often living in the present moment, haunted by the past, and unable to plan for the future. Complex interactions among traumatized clients, stressed staff, pressured organizations, and a social and economic climate that is often hostile to recovery efforts recreate the very experiences that have proven so toxic to clients in the first place. Healing is possible for these clients if they enter helping, protective environments, yet toxic stress has destroyed the sanctuary that our systems are designed to provide. This thoughtful, impassioned critique of business as usual begins to outline a vision for transforming our mental health and social service systems. Linking trauma theory to organizational function, Destroying Sanctuary provides a framework for creating truly trauma-informed services. The organizational change method that has become known as the Sanctuary Model lays the groundwork for establishing safe havens for individual and organizational recovery. The goals are practical: improve clinical outcomes, increase staff satisfaction and health, increase leadership competence, and develop a technology for creating and sustaining healthier systems. Only in this way can our mental health and social service systems become empowered to make a more effective contribution to the overall health of the nation. Destroying Sanctuary is a stirring call for reform and recovery, required reading for anyone concerned with removing the formidable barriers to mental health and social services, from clinicians and administrators to consumer advocates.

Sandra L. Bloom, MD, is Associate Professor of Health Management and Policy, School of Public Health, Drexel University.Brian Farragher, MBA, is Executive Vice President and Chief Operating Officer, The Andrus Children's Center.

Prologue Introduction Chapter 1: Human Service Delivery Organizations: Dead or Alive? Chapter 2: "I Gotta Get out of This Place": Workplace Stress as a Threat to Public Health Chapter 3: When Terror Becomes a Way of Life Chapter 4: Parallel Processes and Trauma-Organized Systems Chapter 5: Lack of Basic Safety Chapter 6: Loss of Emotional Management Chapter 7: Organizational Learning Disabilities, Organizational Amnesia, and Decision-Making Under Stress Chapter 8: Miscommunication, Conflict, and Organizational Alexithymia Chapter 9: Authoritarianism, Disempowerment, and Learned Helplessness Chapter 10: Punishment, Revenge, and Organizational Injustice Chapter 11: Unresolved Grief, Reenactment, and Decline Chapter 12: Restoring Sanctuary: Organizations as Living, Complex Adaptive Social Systems References Index