Health professionals have marginalised the issue of domestic or intimate partner violence (IPV) with many survivors being retraumatised when interacting with mental health services a new report from the Lancet Psychiatry Commission has found.
The design and settings of mental health services concentrated too much on symptoms rather than establishing what happened to women and how they can be best supported, the Commission found.
Professor Kelsey Hegarty, a key author for the Commission’s findings, says one in three women and girls aged 15 or over worldwide have experienced either physical or sexual intimate partner violence and that tackling intimate partner violence could lower rates of mental illness, something that requires transforming the way mental health services approach IPV.
“Trauma and violence informed care would help to provide more targeted responses so that we are not asking patients ‘What is wrong with you?’ but ‘What has happened to you?’,” Professor Hegarty says.
She cites a comment from the report by one survivor advocate, who said: “I wish mental health practitioners would stop judging us as ‘survivors’ and see us for how strong and resilient and courageous we are. I fought the hardest to protect myself and my family from being murdered, and I should be seen as a hero for that—not pathologised by a mental health system that sees me as a problem and a victim.”
Professor Hegarty is Chair of Family Violence Prevention in the Department of General Practice at the University of Melbourne. She leads the NHMRC Safer Families Centre of Research Excellence, co-chairs the Melbourne Research Alliance to End Violence again Women, and led writing the report for the Commission on the need for trauma-informed care to be co-produced by people with direct experience of IPV.
She said practitioners worldwide needed to be trained in how to ask IPV patients about their trauma, provide a first line response, and for practitioners to work within a clear referral network. There was also a need for mental health settings to provide system support of leadership, policies, protocols, clinical champions and support for staff experiencing IPV. These should all be part of a standard part of mental health care.
“Given how common this issue is in mental health care, addressing IPV in mental health reform is urgently needed and has not been adequately addressed by the recent Australian Royal Commission into family violence and mental health recommendations to any great extent,” Professor Hegarty says.
The Commission was made up of internationally renowned experts in IPV and mental health, including those with personal experiences. It states that while the relationship between IPV and mental illness was complex, women and girls were overwhelmingly bearing the burden of society and mental health services marginalising the relationship between IPV and mental health. A root cause was gender inequality and societal norms that promote violence.
It recommended more effective policies and legislation, adequate funding for specialist services and schools creating and promoting an ‘ethos that models gender equality and respectful relationships’ to help educate both boys and girls from an early age that people are to be respected. It also suggested that stable housing, high quality education, and employment opportunities could also help to reduce levels of gendered violence.
It said doing this could help reduce levels of IPV experienced by women and witnessed by their children and go a long way to bringing down the number of people who experience illnesses like depression, anxiety, and post-traumatic stress disorder (PTSD).
First published on 19 May 2022.
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