Are mental health services providing ethical responses to women whose mental health is compromised by domestic violence? Debbie Hager Homeworks Trust May 2011

Social justice is a vision of society where rules are just and fair and resources are shared equitably among the members of the community, in the interest of the common good

Domestic violence Domestic violence is a set of behaviours designed to gain power and control over another person. “Male role control works by physically, verbally or emotionally destroying your partner’s physical, intellectual and emotional integrity so that she will be afraid to be herself, will control herself, and therefore be available to be controlled by you.” Man Alive, 1995

Power and Control Wheel

Domestic violence is a gendered issue “The predominant pattern is one of male violence directed at a female partner…” Ministerial taskforce for action on violence within families (2006)

Domestic violence and mental illness/substance abuse If women access drug and alcohol/mental health services, they run the risk of losing custody of their children to either the state or the abusive partner, and of their partner gaining even more control over them because of the stigma attached to their diagnosis.

Long Term Mental Health Effects of Domestic Violence  On-going fear Lack of volition Diminished ability to deal with stress Being superwoman Hyper-vigilance Suspicion Ongoing severe trauma responses Exhaustion Isolation Disassociation Reality checking becomes poor Depression Obsessive compulsive behaviour

Mental Illness diagnoses Anxiety disorders including panic attacks Eating disorders Obsessive compulsive disorder Multiple personality and personality disorders Bi-polar disorder Schizophrenia Post traumatic stress disorder Clinical depression Sleeping disorders Self-neglect Malnutrition Aggression towards ones-self and/or others including repeated self injury Dissociative states Chronic pain Compulsive sexual behaviours Sexual dysfunction or pain

IPV and Mental Health: NZ VAW Study

Percentage of disease burden attributable to IPV in Victorian women

Ethical issues Not asking Asking and having nowhere appropriate for women to go Only having refuge services for some of the population who require them - excluding others

Women with mental illness Abused mentally ill women are significantly disadvantaged As women As people who experience mental health problems As targets of violence

Credibility Abuser Charming Sane Care giver Articulate Credible Abused Chaotic Incoherent Mad Defensive Angry Inarticulate Afraid Disassociating

What to do? You need to work with both issues at the same time - don’t try to just deal with the mental health and/or drugs and alcohol Medication can make women less able to protect themselves and their children SO….

What to do? Services Drug and alcohol/mental health support workers to support women in mainstream refuges Specialised 24 hour refuges with separate units for each women/family Women only in-patient services – drug and alcohol, mental health Provide specialised refuge services for women with and without children Develop partnerships between clinical and domestic and sexual violence services so that they understand and respond appropriately to abused women Provide a range of options

Women only services “Not all men in in-patient units are abusers - but the women are very vulnerable and there are predatory man in the units…..” Jackie Patiniotis, Joint Forum Women’s Group, Liverpool, 2010

What to do? Therapeutic initiatives Train domestic violence service advocates in specific interventions to help women with psychological problems associated with domestic violence Remember - most women will have PTSD - but it’s not post - it’s current – current recurring trauma symptoms - help women find safety and treat PTDS Assess for suicide risk and develop a prevention strategy with each woman Work with grief – the grief of losing relationships, children, of potential lost to the effects of abuse… Don’t pathologise women’s behaviour - it may be a reasonable response to a dangerous and traumatic situation

Work in the political context Talk about violence against women! Funding for specialist services Funding for training and qualifications in specialist areas Policies in health services to enhance partnership development for women with complex needs Stronger legislation to protect women and hold men accountable Better policies in all services (justice, police, health, social services etc) to recognise and respond to women with complex needs