Presentation on theme: "Ontario Woman Abuse Screening Project"— Presentation transcript:
1Ontario Woman Abuse Screening Project May 2010Making Connections between Addictions, Mental Health and Woman Abuse/Sexual Violence/TraumaLinda Murray, RN, BScNSexual Assault Nurse ExaminerAbused Women’s Service, Sexual Assault/Domestic Violence Treatment Centre, Chatham-Kent Health AllianceTonya VerburgResidential ManagerChatham Kent Women’s Centre
3Woman abuse is any threat, act or physical force that is used to create fear, control or intimidate you.
4Woman Abuse: Incidence and Prevalence 25% of all women have experienced physical or sexual violence at the hands of a marital or a common law partner45% of incidents resulted in injuryIn 85% of family violence cases reported to police, the victims were femaleWomen are 7 times more likely to be killed or hurt in their homes by someone known to them than by a stranger60 % of women do not report abuse to policeDATA: Justice Statistics, Statistics Canada, 2006
5Violence against women is not about losing control Violence against women is not about losing control. It is the intentional control of another person.The abuser is purposefully using verbal, non verbal or physical means to gain control over the other person. In most cases the abuser is not abusive or violent to others outside the family or home.
6Power and ControlWith all abuse, the abuser uses power over those they are abusing. Abusers often use alcohol or drugs as an excuse. But the abuser is responsible for his or her behaviourData: Spousal Abuse Fact Sheet, Family Violence, Department of Justice
7Abusers are able to control their behavior—they do it all the time. Abusers pick and choose whom to abuse. They don’t insult, threaten, or assault everyone in their life who gives them grief. Usually, they save their abuse for the people closest to them, the ones they claim to love.Abusers carefully choose when and where to abuse. They control themselves until no one else is around to see their abusive behavior. They may act like everything is fine in public, but lash out instantly as soon as you’re alone.Abusers are able to stop their abusive behavior when it benefits them. Most abusers are not out of control. In fact, they’re able to immediately stop their abusive behavior when it’s to their advantage to do so (for example, when the police show up or their boss calls).Violent abusers usually direct their blows where they won’t show. Rather than acting out in a mindless rage, many physically violent abusers carefully aim their kicks and punches where the bruises and marks won’t show.
8Originally developed by The Domestic Abuse Intervention Project, Duluth, USA Further adapted by London Abused Women’s Centre
9Power and Control Exercise Create a power and control wheel for women you work with, either with Mental Health Issues or Substance Abuse IssuesHow are the tactics of abuse related to women’s use of drugs or their mental health
10POWER AND CONTROL Using Intimidation, Threats and Coercion Using Emotional AbusePutting her down, making her feel bad about self, feel guilty about past or present drug use, or MH conditionThreatening to hurt her if uses/does not use, hurt if goes to doctor, etcUsing Economic AbusePhysical AbuseForcing into prostitution, forcing to sell drugs, prescribed or illegal, calling boss with concerns of MH,Physically abusing her for her condition, for getting high, for not getting highPOWER ANDCONTROLUsing IsolationEncouraging DependenceKeeping her away from supportive people, preventing her from attending treatmentIntroduce to drugs, buying drugs for her, make her think she needs meds for MH, post partum etc.Making light of condition, saying she caused abuse by drug use or Mental illnessTreat her like a sex object, withhold sex or force even if traumatic, forcing into prostitutionMinimizing, Denying, BlamingSexual Abuse
12NOTE: Cycle of Violence is not the reality for all women ONE week they could have come in crisis, following explosion while the next appointment they could be at honeymoon phase – so will present so differently.Violence against women is a socialized problem, can go from generation to generation as they learn power and control – NEED STAT- women stay as they want their partner to change, believe it can get better- also have talked to women who stay because they know what will happen, if they are apart they do not know where he is in the cycle…NOTE: Cycle of Violence is not the reality for all women
13Women Who Face Additional Challenges Rural WomenGeographic locationIsolationLack of transportation and other servicesFirst Nations WomenHigh incidence &normalization of violence in First Nations communityabsence of public education about women’s legal rightsoften a First Nations woman has to leave her community to be free of the abuseRural: geographic location, isolation: lack of public transportation, other diverse services, economic conditions, access to services, lack of anonymity – close knit nature of the community as well as its small sizeDenial in rural communities may also stem from the community’s image of itself as a haven, free from the ills associated with urban lifeFirst Nations Women: high tolerance to violence in native community and an absence of public education about women’s legal rights – may be lack of trust of police and services unless they are native – often a native woman has to leave her community to be free of the abuse
14Immigrant Women Women with Disabilities: fear of jeopardizing their immigration status,often economically dependent and financially insecurelanguage barrierfear deportation and losing childrenWomen with Disabilities:difficult to leave if abuser is caregiver,barriers to access services, neglect is very prevalent in abusive relationshipviewed and treated as children,considered to be non sexualcaregivers often seen as good people for taking on such a challengeImmigrant Women: isolation due to their immigration context, fear of jeopardizing their immigration status, culturally prescribed role obligations and social pressure to remain in the marriage - often economically dependent and financially insecure – language barrier – lack occupational skills for gainful employment – may lack extended family and supports – often dependent on partners for sponsorship, fear deportation and losing children, deportation – threat of deportation – woman may have experienced discrimination and racism and therefore reluctant to seek helpWomen with Disabilities: difficult to leave if abuser is caregiver, barriers to access services, neglect is very prevalent in abusive relationship – while a disability can make it more difficult for women to escape or report, social attitudes towards people are a bigger factor in her increased vulnerability to violence, the ways in which society views people with disabilities affects these women in many ways – viewed and treated as children, considered to be non sexual and not given sex education, caregivers often seen as good people for taking on such a challenge
15The Number One Question Why Does She Stay?More appropriate questions would be…Why Does He Abuse Her orWhat Prevents Her From Leaving
16She believes he will change Fear Economic Reasons to Stay/Return Pressure from Community or Faith or FamilyGuilt or Self DoubtConcern for ChildrenLack of Community SupportDemands of Family Court ProcessStockholm SyndromeAbused women leave an average of 8 times before leaving for goodStockholm Syndrome: emotionally bonding with an abuser is actually a strategy for survival for victims of abuse and intimidation.Common Behaviours:Positive feelings by the victim toward the abuserNegative feelings by the victim toward family, friends, or authorities trying to rescue/support themSupport of the abuser’s reasons and behaviorsSupportive behaviors by the victim, at times helping the abuserInability to engage in behaviors that may assist in their release or detachmentUse example of Stockholm Syndrome: On August 23rd, 1973 two machine-gun carrying criminals entered a bank in Stockholm, Sweden. Blasting their guns, one prison escapee named Jan-Erik Olsson announced to the terrified bank employees “The party has just begun!” The two bank robbers held four hostages, three women and one man, for the next 131 hours. The hostages were strapped with dynamite and held in a bank vault until finally rescued on August 28th.After their rescue, the hostages exhibited a shocking attitude considering they were threatened, abused, and feared for their lives for over five days. In their media interviews, it was clear that they supported their captors and actually feared law enforcement personnel who came to their rescue. The hostages had begun to feel the captors were actually protecting them from the police. One woman later became engaged to one of the criminals and another developed a legal defense fund to aid in their criminal defense fees. Clearly, the hostages had “bonded” emotionally with their captors.Example: Elizabeth Smart, a 14 year old girl, was kidnapped from her home in Salt Lake City in June 2002 by two members of a fundamentalist polygamist sect, the homeless preacher Brian David "Emmanuel" Mitchell and his wife Wanda Barzee. At first Smart was kept tethered to a tree in a wooded canyon, dressed in white robes, and confined to a twenty-foot long trough with a lean-to over it, but after two months, the couple was able to take the girl with them to restaurants and other public places, her face veiled, and she no longer tried to escape. The trio travelled to San Diego, California and Las Vegas, Nevada, with Smart claiming to be the couple's daughter, but they eventually returned to Utah. By this time, Smart had become so attached to her captors that when she was finally approached by Utah law enforcement officials, who had been searching for her for nine months, she told them that she was 18 years old and Mitchell's polygamous wife. Only when she was shown a picture of herself as she had looked before her abduction did she admit she was, in fact, Elizabeth Smart.Millionaire heiress Patty Hearst was kidnapped by the Symbionese Liberation Army. After two months in captivity, she actively took part in a robbery they were orchestrating. Her unsuccessful legal defense was that she suffered from Stockholm syndrome and was coerced into aiding the SLA. She was convicted and imprisoned for her actions in the robbery, though her sentence was commuted in February 1979 by President Jimmy Carter, and she received a Presidential pardon from Bill Clinton.Every syndrome has symptoms or behaviors, and Stockholm Syndrome is no exception. While a clear-cut list has not been established due to varying opinions by researchers and experts, several of these features will be present:Positive feelings by the victim toward the abuser/controllerNegative feelings by the victim toward family, friends, or authorities trying to rescue/support them or win their releasePositive feelings by the abuser toward the victimInability to engage in behaviors that may assist in their release or detachment mightThe perception of threat can be formed by direct, indirect, or witnessed methods. Criminal or antisocial partners can directly threaten your life or the life of friends and family2. we look for evidence of hope — a small sign that the situation may improve. When an abuser/controller shows the victim some small kindness, even though it is to the abuser’s benefit as well, the victim interprets that small kindness as a positive trait of the captor. – can be as simple as a birthday card or one kind word3. In abusive and controlling relationships, the victim has the sense they are always “walking on eggshells” — fearful of saying or doing anything that prompt a violent/intimidating outburst. For their survival, they begin to see the world through the abuser’s perspective. They begin to fix things that might prompt an outburst, act in ways they know makes the abuser happy, or avoid aspects of their own life that may prompt a problem.4. In romantic relationships, the belief that one can’t escape is also very common. Many abusive/controlling relationships feel like till-death-do-us-part relationships — locked together by mutual financial issues/assets, mutual intimate knowledge, or legal situations.
17Common Effects of Abuse-Related Trauma: • Fearing people and relationships• Substance misuse and abuse (includes self medicating)• Difficulty sleeping or over sleeping• Flashbacks of the abuse• Dissociation• Having panic attacks or uncomfortable amounts of anxiety• Low self-esteem and self-loathing• Depression• Repeated experiences of being revictimized (continued abusive relationships)• Suicidal ideation or suicide attempts• Nightmares• Memory Gaps (especially from childhood)• Self-harm• Eating Disorders(Adapted from: What do these signs have in common? Recognizing the effects of abuse-related trauma - CAMH, 2004)
19Adult Sexual AssaultSexual assault is a crime of power, control and anger. It is one person’s attempt to hurt or humiliate another through sex and/or violence
20What is Sexual Violence It is any form of unwanted sexual activity that is forced upon a person without that person’s consent. Sexual Assault can range from unwanted sexual touching to forced intercourse. While most sexual assault are perpetrated against women, both women and men are sexually assaulted
21Sexual Assault of Women Is far more prevalent than sexual assault of menAlmost 40% women have reported at least one assault from age 16Statistical Trends 2006 Ottawa: Statistics Canada, 2006
22Sexual Assault of Women Women make up more than three quarters of all reported sexual assaultsYoung women ages making up more than halfMajority of all reported sexual assaults on women are perpetrated by men they are acquainted withSexual Offences in Canada, Ottawa: Statistics Canada,2003
23Statistics 25% of women experience unwanted sexual touching Another 24% experience violent SA38% SA by husband, partner, boyfriend54% of girls under 16yrs experience unwanted sexual attention24% experience rape/coercive sex17% experience incestOnly 6% SA reported to police – of these, 63% are girls under 18 yrsOnly 1% date rapes are reported80% of aboriginal women have been sexually assaulted83% of developmentally challenged women have been sexually assaulted1 in 7 males SAStatistical Trends 2003, Sexual Offences in Canada 2003, Canadian Crime Statistics 2003
24Vulnerable to Violence Girls and young womenWomen living with disabilitiesFirst Nation womenWomen of colorWomen living in povertyWomen at war
25Physical Health Effects Irritable bowel syndromeChronic pelvic painVaginal bleedingSTI’s including HIV infectionUrinary Track InfectionsUndetected cervical disease
26Possible Impact of Sexual Violence Trauma has an impact on the entire person. The possible consequences to sexual violence are exhibited as symptoms within the context of individual experiences. Symptoms are guideposts for intervention to reduce human suffering and to restore well-being for the individual.
27Impact of Sexual Violence Rape Trauma Syndrome (RTS)Post Traumatic Stress (PTS)Psychological ManifestationsRelationship ManifestationsAlcohol and Drug Use
28Rape Trauma SyndromeRTS is expressed in a complex, entangled lifestyle when an individual lacks adequate coping skills or social or medical support, or is subject to ongoing trauma in his or her environment. As time goes on the physical, emotional, social and sexual categories impacted by the sexual assault become less segregated and more intertwined, making the exact nature of a particular problem less obvious.
29Rape Trauma SyndromeRTS is associated with risk-taking behavior, increased substance abuse, lowered self-esteem, depression and anxiety and a wide range of physical and sexual dysfunction.
30Substance Abuse Studies 30.7% of women in a methadone maintenance treatment program had been sexually abused by a partner in the past 6 months and cocaine use increased this violence (EL-Bassel, 2004)59% of substance abusers had symptoms consistent with PTSD, yet were undiagnosed at the time they were admitted for detoxification and had not received any treatment (Fullivore et al.,1993)97% of women with PTSD reported one or more violent traumas compared to 73% women without PTSD (Fullivore., 1993)
31Post Traumatic StressPersistent frightening thoughts and memories of their ordealRecurring distressing dreams of the eventFeeling emotionally numbAvoidance of stimuli associated with the eventMay not show up until years after the event
32Psychological Manifestations Difficulty concentrating, hopelessness, anger, depression, eating problems, decreased self-esteemDenial1/3 of rape victims will contemplate suicide17% actually attempt suicide1/3 of all sexual assault victims will develop PTS sometime during their life
33Relationship Manifestations Problems in relationships – family friends, spousesShame and guilt – blaming themselves, feeling different from all other human beingsSocial problems – difficulty with trustSexual problems - avoidance of sexual activity, decreased interest and desire
34Substance AbuseSubstance abuse, especially with alcohol, cigarettes and cocaine, is common when victims desire to numb or cope with the pain of sexual traumaIn drug treatment programs, 46.4% of patients had a history of sexual assault as adults and 38% in childhood (El-Bassel, Gilbert, & Fry et al., 2004)
35Trauma and Substance Abuse Data collected from substance abusing women from nine treatment centres across Ontario85.7% of 98 women in her sample were victimized56.1% adult physical abuse56.3% childhood sexual abuse56.1% childhood physical abuse45.4 adult sexual abuseCormier, R, A; 2000
37Child Sexual Abuse (CSA) Child sexual abuse occurs when a child under the age of 16 is used for sexual purposes by an adult or adolescent. It is emotionally abusive and is a betrayal of trust and an abuse of power over the child. Sexual abuse is often accompanied by other forms of mistreatment.
38Child Sexual AbuseCSA involves exposing a child to any sexual activity or behavior, whether directly or indirectly. Examples include sexual touching, sexual acts, exhibitionism, pornography and prostitution. The law does not differentiate between the actions performed on a child and those performed by a child.
39Child Sexual Abuse Historically Children are responsible for their own molestationMothers are to blameChild sexual abuse is rareSexual abuse does no harmChildren always tellChildren feel negatively about the abuserAll abusers are maleThere is little impact for the survivor
40Who are the VictimsFound in all classes and ethno-cultural communitiesChildren who have physical or mental disabilities are especially vulnerable to sexual abuseChildren who are isolated – little contact with friends, siblings or adults whom they can trustSome abusers manage to isolate the child by manipulating people or situations
41Child Sexual Abuse CSA is largely a hidden crime Children often afraid to reportOften fear consequences of disclosing informationOften convinced no one will believe themVery young children are unable to articulate or understand their experiences
42StatisticsChildren and youth account for 61% of reported sexual assaults50% of sexual assaults on children under the age of 6 are perpetrated by a family member86% of all reported child sexual assaults are perpetrated by an individual known to the childStrangers are implicated in only 5% of reported child sexual assaults, and the majority of these are against older teens67% of reported CSAs take place in a private dwellingChildren and Youth as Victims of Violent Crime, Ottawa, Statistics Canada, 2005
43Internet Child Exploitation These are relationships initiated online that result in a child or adolescent being lured or misled into a situation that results in attempted or completed sexual abuse or assault or “compliant” sexual activity (“cyber-enticement”)
44Internet Child Exploitation Child/adolescent who was sexually abused and photos taken for distribution over the internetUsing online porn images to seduce, groom or desensitize a child/adolescent for the purpose of engaging in sexually abusive behavior with the child/adolescentChild/adolescent who experiences unwanted online sexual activityPeer victimization (images shared between peers)Sexual activity transmitted over the internet via webcam
45Child Sexual Abuse Decreased self-esteem Depression Increased risk taking behaviorDissociationPoor boundary settingSubstance abuse, including alcohol and prescription drugsSelf-harming behaviorsSuicide
46Lifestyle of Victims of CSA UnemploymentHomelessnessIncreased risk takingIncarceration, 55% -73%Abusive relationships
47Consent May 1st, 2008 –changes to Age of Consent Criminal Code was amendedConsent increased from 14 to 16yrsClose in age exceptions12-13yrs - no more than 2 yrs older14-15yrs - someone less than 5 yrs older
49Vicarious Trauma (VT)VT is described as the cumulative transformative effect of the helper working with survivors of traumatic life events
50Vicarious TraumaIt affects many aspects of the helpers life not just within the professional settingIncludes typical symptoms of PTSAlso encompasses symptoms of disruptive frame of reference, including disruption in identity, worldview, and spirituality
51Causes of VTThe causes of VT, compassion fatigue, secondary traumatic stress are all connected with providing services and care to individuals who have experienced some form of traumatic event. Sexual assault/abuse and domestic violence are examples of the type of primary trauma that people might experience
53Professional Impact of VT Low motivationChanging roles from caregiver to victimWithdrawal from colleaguesDecrease in confidenceNegative attitudePoor communicationFaulty judgmentBurn-out
54Self-Care for Caregivers Develop own self- care planBuild on strengthsMake goals that enrich your lifeCheck out available resourcesCommit to replenish yourselfIdentify healing activities that work for you