Destroying Sanctuary

The Sanctuary Model


  • Both a thoughtful indictment of our mental health and social service systems and a blueprint for reform
  • Combines trauma theory and organizational psychology to describe a mental health system in crisis
  • Develops the Sanctuary Model, a trauma-informed, whole-system approach to organizational change
  • Offers administrators and clinicians realistic tools for better serving their clients

Editorial Reviews

"Health care and human services have become commodities, and caregivers are forced into a factory system where productivity has nothing to do with patient care. This volume forms the diagnosis; we can eagerly look forward to the next volume in which the authors promise a treatment plan."
-Judith L. Herman, MD, Cambridge Hospital

"This should be required reading for clinicians, administrators, public policy makers, and the general public. Sandra Bloom and Brian Farragher do nothing less than describe in gripping detail what is wrong with the mental and medical health service delivery systems as they have become profit-driven and dehumanized."
-Christine A. Courtois, PhD, Associate Editor of Psychological Trauma: Research, Theory, Practice & Policy

"Sandra Bloom and Brian Farragher provide reflective readers with a wonderful description of human development and the observable steps by which we grow into content, productive people or become chronically distressed and physically ill. Destroying Sanctuary is particularly timely as we rethink various aspects of the U.S. medical care system, especially the cost of our comfortable inattention to the far-reaching impact of traumatic life experiences. "
-Vincent J. Felitti, MD, Kaiser Permanente Medical Care Program and University of California

"Bloom and Farragher challenge administrators to think in terms of reform and recovery, rather than falling back on our emphasis on 'fixing people' when in fact our systems need to be fixed. This is a rallying call for creating and sustaining healthier service systems."
-Angie Logan, Pennsylvania Department of Public Welfare

"Packed with wisdom, scientific evidence, and concepts that are vital to understanding and healing the 'chronic public health disaster' that is a consequence of endemic traumatic stress and adversity. Read it once and it and learn more."
-Robert Anda, MD, MS, Adverse Childhood Experiences (ACE) Study

"Bloom and Farragher remind us that the essential task of our human services and mental health organizations is to create and maintain environments that provide physical, psychological, social, and moral safety. They make a strong case that our current policies and programs produce institutions that are toxic for both staff and patients and this toxicity destroys any potential for emotional growth, stability, or safety."
-Michael Nunno, DSW, Cornell University

"The concept of Sanctuary has served as the guiding star of Dr. Sandra Bloom's determined quest to find better ways to offer solace, succor, and hope for people experiencing the ravages of violent and traumatic experiences. In this book series, she brings these unique talents together in creating a vision of how we can all move ahead together toward dreams that we hold dear for our individual and collective futures."
-Susan Salasin, Center for Mental Health Services, SAMHSA

"This powerful, disturbing and highly readable new book shows, with poignant examples, that toxic stress affects not only individuals but also impairs the function of organizations, including those that are supposed to provide sanctuary for traumatized children and adults."
-Bruce McEwen, PhD, The Rockefeller University

Product Description

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.

Table of Contents



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