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

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 Percentage 60 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: • • • 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 • • • 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 • • 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. • • • Worn down Shattered Isolated Disassociation Blocking out – having gaps in their lives Reality checking becomes poor

Why women thought they were mad • • • 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