Transcript Hager domestic violence and mental illness

Domestic violence and
mental illness
Debbie Hager
2009
There is a group of women - most of whom will remain
unidentified - who are not only abused by their partners, but are
also experiencing severe mental distress
This mental distress is:
• Compounding these women’s difficulty
accessing help
• Used by abusive partners to further abuse
women
• Preventing services responding
appropriately to women who are
attempting to access help
Percentage of disease burden attributable to
IPV in Victorian women
Cervical Cancer
Femicide
Suicide
Physical Injuries
Depression
Anxiety
Eating Disorders
Tobacco
Alcohol
Illicit Drug Use
STDs
Domestic violence and mental
illness/substance abuse
• At least 257 women each year are unable to
access refuge services because they are
perceived to have mental health and/or
substance abuse problems.
• These women – and their children – are
trapped in abusive relationships, with all of the
attendant long-term effects of experiencing
violence.
Domestic violence and mental
illness/substance abuse
• If women access mental health/drug and
alcohol 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.
Domestic violence is:
Physical effects of Domestic
Violence
• High rates of injury - broken bones, head
injury, cuts, stab wounds, other wounds
from weapons, burns, strangulation,
bruising…
• Physical illness from stress and lack of
medical care
Injuries
• Victims of domestic violence have the highest
rates of internal injuries and unconsciousness
of any assault victims. Assaults can result in
loss or partial loss of hearing and sight,
damage to internal organs, musculoskeletal
disorders and other permanent disabilities.
Burns can cause permanent disfigurement
• Head injuries
Sexual and reproductive health
consequences
• Pregnancy complications
• High rates of Sexually Transmitted Infections, including
HIV
• Unwanted pregnancy
• Abortions
• Delays in pre-natal care
• Miscarriage
• Babies can have lower birth weights
• New information suggests that babies suffer trauma
effects which affect brain development
(Unable to use contraception/choose when to have sex/ practice
safe sex)
Mental health effects
• Suicide and suicide attempts
• Drug and alcohol abuse
• A variety of mental illness
diagnoses
IPV and Mental Health: NZ VAW
Study
Indicators of Mental Distress by Experience of IPV
60
Percentage
50
40
No phys viol
30
Moderate phys viol
20
Severe phys viol
10
0
SRQ Scores >7
Suicidal Thoughts (ever)
Indicator of Mental Distress
Suicidal Attempts (ever)
Alcohol and drug abuse
• About one third of abused women will abuse alcohol
or drugs. Most abused women only begin drinking
heavily after the abuse has started.
Women start using drugs or alcohol
• As a way of coping with the abuse
• Because they are forced to drink or use
• Because they are forced to deal (and/or commit other
crimes)
• Their partner is their dealer
Effects of domestic violence
from the literature
Women who have been abused are commonly
diagnosed as suffering from:
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major depression
trauma
anxiety disorders including panic attacks
eating disorders
obsessive compulsive disorder
multiple personality and personality disorders.
Effects of domestic violence
from the literature
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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
poor adherence to medical recommendations
Women I spoke to had been
diagnosed with:
•Bi - polar disorder
•Schizophrenia
•Major depressive illness
•Finally Post traumatic stress
disorder
Long Term Effects of Domestic
Violence
• On going fear
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Lack of volition
Diminished ability to deal with stress
Being superwoman
Vigilance – constantly watchful
Suspicious
Afraid – including for the children
Depression
Long term effects cont.
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Worn down
Shattered
Isolated
Disassociation
Blocking out – having gaps in their lives
Reality checking becomes poor
Why women thought they were mad
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Wanting to give children away
Told over and over again they were mad
Feeling “crazy”
Committed under the act
Being given a diagnosis
Being given psychiatric drugs
Why women thought they were mad.
• Wanted to burn down the house – with the children in
it
• Tried to commit suicide
• Running away
• No sense of reality
• Put into a psychiatric hospital (three of the women)
• Labelled schizophrenic, paranoid schizophrenic, bipolar, depressed, having post traumatic stress disorder
Key themes
• Abuse, especially emotional abuse, makes women
think they are crazy.
• Services deepen and reinforce the feelings of abuse.
• Being labeled results in problems with stigma and
discrimination and lowered self esteem and can
decrease women’s grasp of reality
• Women’s explanations of their own experience are
either not believed or reinterpreted.
• Abuse must be named
What women want
 Sleep.
 To be asked, specifically and comprehensively,
about domestic violence.
 To be heard and believed.
 Information and language to describe their
experiences and make informed choices.
 To be safe – to be offered and encouraged to use
appropriate support services.
 Time to think and reflect.
 Not to be pathologised.
What you can do
• Don’t pathologise women’s behaviour - it may be
a reasonable response to a dangerous and
traumatic situation
• Screen for domestic violence
• Listen to women and believe their stories
• Never minimise or disregard what a woman is
saying
• Help women develop a safety plan
• Help women access appropriate support and
information groups
What you can do
• Never send women home to an abusive partner
- unless she insists
• Remember - medication can make women less
able to protect themself and the children
• Don’t judge women’s parenting by the abuse
she has put up with - it may have kept the
children as safe as possible
• Provide information - like the power and control
wheel and the cycle of violence - to help women
understand their situation
Costs
The ongoing costs, to the state, associated with this
issue include:
 Years of life lost because of suicide and homicide
 The time that women are unable to function without
support
 The cost of service responses to abused women – CYF,
social services, child and family services
 Diminished realisation of educational, employment and
personal potential
 The long-term effects on the children and wider family,
including the perpetuation of intergenerational violence,
and a wide range of ongoing health problems for the
children as adults.
Costs
 Placing and keeping children in foster care or in the care
of the state
 Ongoing judicial costs related to the Family and
Criminal Courts
 Women and children’s ongoing use of mental health and
substance abuse services
 Rehabilitation and long term care
 Personal health services such as A&E and GP services
for ongoing physical health problems and problems
associated with self harming behaviours
 The inappropriate care of women who have been abused
– i.e., placed in mental health services when they really
require domestic violence services