8 results
8 - Domestic abuse
- from Part II - Women and society
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- By Roxane Agnew-Davies, Director of Domestic Violence Training Ltd and an Honorary Research Fellow, Louise M. Howard, Professor of Women's Mental Health at King's College London
- Edited by Kathryn M. Abel, Rosalind Ramsay
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- Book:
- The Female Mind
- Published online:
- 02 January 2018
- Print publication:
- 01 October 2017, pp 51-56
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Summary
Kim's story
‘My mother was always critical of me and my father left when I was a child. When John and I started going out, he was attentive and I felt I had found someone who cared for me at last. Looking back, his interested questions always turned into an interrogation about who had talked to or texted me, especially men. He became jealous and possessive, even though I was totally in love. Things got worse when I became pregnant. When I didn't feel like sex, he accused me of having an affair and called me a whore. Basically, I often had sex to keep the peace, even when I didn't feel well. I really didn't like oral sex, but as my belly got bigger, John insisted it was my job to give him pleasure. It really hurt a few times. I got more and more depressed, and John got angrier. I felt too ashamed to ask anyone about it, and I could never have told my mother something like that. Even if it was embarrassing, it was a relief when my midwife asked me if things were okay between me and my partner, and if we had any sexual problems during pregnancy. When I told her, she explained that it was sexual abuse if John did not take ‘no’ for an answer when I did not really want to have sex. She referred me to a Relate counsellor and that really helped. The counsellor saw us separately at first, and thinking about my rights and that I was not to blame really helped my self-confidence. I realised that I was a good person and I would rather be on my own than be put down or forced into things, by Mum or John. I left John for a while and that gave us both some breathing space. When Gemma was born, John promised that he would respect me and protect us both. It's good to have a family at last.’
What is domestic abuse?
Domestic abuse (or domestic violence) is a pattern of coercive and controlling behaviour by a partner or family member that can include physical violence, sexual violence, emotional/ psychological abuse (such as humiliation) and financial exploitation.
3 - Identifying domestic violence experienced by mental health service users
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- By Roxane Agnew-Davies, University of Bristol
- Edited by Louise Howard, Gene Feder, Roxanne Agnew-Davies
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- Book:
- Domestic Violence and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 29-48
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5 - Interventions for mental health service users who experience domestic violence
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- By Kylee Trevillion, King's College London, Roxane Agnew-Davies, University of Bristol
- Edited by Louise Howard, Gene Feder, Roxanne Agnew-Davies
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- Book:
- Domestic Violence and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 64-77
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Summary
The current evidence base on interventions to support mental health service users who experience domestic violence is limited. Three systematic reviews have examined the evidence on the effectiveness of interventions in improving mental health outcomes and safety for victims in community and healthcare settings (Ramsay et al, 2002, 2009; World Health Organization & London School of Hygiene and Tropical Medicine, 2010). Existing interventions include individual and group psychological therapies, psychosocial support and advocacy programmes. The methodological quality of many of these studies, however, is low (owing to small sample sizes, lack of randomised controlled trial evidence, etc. – see Feder et al (2009) for details) and this limits the strength of evidence for these interventions. We summarise the more robust evidence, suggest good clinical practice based on our clinical experience and the international literature, and then provide recommendations on referral pathways for clinicians following patient disclosures of domestic violence victimisation. Although there is no reason to think that victims of domestic violence who have mental disorders will not benefit from evidence-based interventions for those disorders, clinical interventions may not be as effective if domestic violence is not addressed. There is a striking lack of evidence on this issue, so this chapter focuses on the evidence for psychiatric interventions that do also address domestic violence.
Psychological interventions
Evidence-based psychological interventions should be implemented within care planning. However, well-evidenced interventions such as cognitive– behavioural therapy (CBT) and lower intensity interventions including guided self-help seem unlikely to improve outcomes for mental health patients with a history of domestic violence unless they address the abuse experienced, both by assessing risk and promoting patient safety, but also by direct acknowledgement of the psychological impact of abuse in the therapy itself. More research is needed to help guide psychological treatments for victims of violence (Nicolaidis, 2011), but clearly, therapists need to ask about and explore the acute and chronic effects of violence on their patients. It is worth remembering that the formation and maintenance of a therapeutic relationship will be more complex and subjected to greater challenges than usual if the patient is or has been a victim of domestic violence (Wilson & Lindy, 1994; Turner et al, 1996; Herman, 1998), because the interpersonal aspects of the trauma, such as mistrust, betrayal, dependency, love and hate tend to be replayed within the therapeutic dyad.
4 - Responding to disclosures of domestic violence
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- By Roxane Agnew-Davies, University of Bristol
- Edited by Louise Howard, Gene Feder, Roxanne Agnew-Davies
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- Book:
- Domestic Violence and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 49-63
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Summary
Many clinicians either respond inappropriately or feel ill equipped or lacking in training to respond to disclosures about domestic violence from service users. Because the healthcare system may be the victim's first or only point of contact with professionals (Donaldson & Marshall, 2005), the initial response of a mental health professional after any disclosure is crucial to promote the person's safety, access to appropriate support and recovery. As in Chapter 3, most of this chapter is based on good practice guidelines for female victims of domestic violence, as there is a very limited evidence base on the optimal response of mental health professionals and most literature refers to women, reflecting the higher prevalence and severity of violence and abuse experienced by women. This work also draws from feedback from service users on what they found helpful or unhelpful about mental health professionals’ responses to initial disclosures of experiences of abuse (Feder et al, 2006; Rose et al, 2011; Trevillion et al, 2012). As in Chapter 3, the good practice guidance refers to clinicians working with colleagues in the multidisciplinary team. Healthcare professionals should not attempt to manage a disclosure of domestic violence alone; discussion of the complex issues involved is helpful, and multidisciplinary support in the assessment, formulation and management of patients is essential.
What service users want to hear
Women who have experienced domestic violence have been asked to identify what would be a positive initial response to disclosure (Rodriguez et al, 1996). They came up with several issues: creating a supportive environment, providing continued support, developing trust and reassurance of confidentiality. From other studies, it emerged that what is also important is information-giving, making referrals to community resources or providing resources on site; talking about the violence in a compassionate and sensitive manner; promoting safety; documenting the abuse; and a nonjudgemental response (McNutt et al, 1999; Rose et al, 2011). Women have emphasised the need for health professionals to listen to their concerns, respond in a non-judgemental and non-directive way and work at a pace at which they felt comfortable, without pressing for a quick resolution of the problem (Feder et al, 2006). Body language and facial expressions were subtle but important ways of showing concern and developing trust (Rodriguez et al, 1996).
Chapter 14 - Domestic violence and women’s mental health
- from Section 3 - Violence, self-harm and substance misuse
- Edited by David J. Castle, University of Melbourne, Kathryn M. Abel, University of Manchester
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- Book:
- Comprehensive Women's Mental Health
- Published online:
- 05 March 2016
- Print publication:
- 07 March 2016, pp 161-173
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5 - Interventions for mental health service users who experience domestic violence
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- By Kylee Trevillion, Researcher, Institute of Psychiatry, King's College London, Roxane Agnew-Davies, Director, Domestic Violence Training Ltd, Mental Health Advisor, AVA (Against Violence & Abuse), and Honorary Research Fellow, Department of Social and Community Medicine, University of Bristol
- Edited by Louise M. Howard, Gene Feder, Roxanne Agnew-Davies
-
- Book:
- Domestic Violence and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 May 2013, pp 64-77
-
- Chapter
- Export citation
-
Summary
The current evidence base on interventions to support mental health service users who experience domestic violence is limited. Three systematic reviews have examined the evidence on the effectiveness of interventions in improving mental health outcomes and safety for victims in community and healthcare settings (Ramsay et al, 2002, 2009; World Health Organization & London School of Hygiene and Tropical Medicine, 2010). Existing interventions include individual and group psychological therapies, psychosocial support and advocacy programmes. The methodological quality of many of these studies, however, is low (owing to small sample sizes, lack of randomised controlled trial evidence, etc. – see Feder et al (2009) for details) and this limits the strength of evidence for these interventions. We summarise the more robust evidence, suggest good clinical practice based on our clinical experience and the international literature, and then provide recommendations on referral pathways for clinicians following patient disclosures of domestic violence victimisation. Although there is no reason to think that victims of domestic violence who have mental disorders will not benefit from evidence-based interventions for those disorders, clinical interventions may not be as effective if domestic violence is not addressed. There is a striking lack of evidence on this issue, so this chapter focuses on the evidence for psychiatric interventions that do also address domestic violence.
Psychological interventions
Evidence-based psychological interventions should be implemented within care planning. However, well-evidenced interventions such as cognitive– behavioural therapy (CBT) and lower intensity interventions including guided self-help seem unlikely to improve outcomes for mental health patients with a history of domestic violence unless they address the abuse experienced, both by assessing risk and promoting patient safety, but also by direct acknowledgement of the psychological impact of abuse in the therapy itself. More research is needed to help guide psychological treatments for victims of violence (Nicolaidis, 2011), but clearly, therapists need to ask about and explore the acute and chronic effects of violence on their patients. It is worth remembering that the formation and maintenance of a therapeutic relationship will be more complex and subjected to greater challenges than usual if the patient is or has been a victim of domestic violence (Wilson & Lindy, 1994; Turner et al, 1996; Herman, 1998), because the interpersonal aspects of the trauma, such as mistrust, betrayal, dependency, love and hate tend to be replayed within the therapeutic dyad.
3 - Identifying domestic violence experienced by mental health service users
-
- By Roxane Agnew-Davies, Director, Domestic Violence Training Ltd, Mental Health Advisor, AVA (Against Violence & Abuse), and Honorary Research Fellow, Department of Social and Community Medicine, University of Bristol
- Edited by Louise M. Howard, Gene Feder, Roxanne Agnew-Davies
-
- Book:
- Domestic Violence and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 May 2013, pp 29-48
-
- Chapter
- Export citation
-
Summary
This chapter explores issues to be considered when identifying domestic violence. A ‘best practice’ approach has been taken to the advice given, based on evidence where available, with guidelines for health and mental health professionals supplementing the evidence base (e.g. Department of Health & Home Office, 2000; Department of Health, 2005, 2009; British Medical Association, 2007; Foreign & Commonwealth Office, 2007; Greater London Domestic Violence Project, 2008; Ethnic Alcohol Counselling in Hounslow (EACH), 2009).
Indicators of domestic violence
As discussed in previous chapters, people attending mental healthcare services are more likely than the general population to be victims of domestic violence and professionals therefore need to be aware of current and previous domestic violence their patients may be experiencing. In addition to physical and mental health symptoms there are other indicators of possible domestic violence which should alert healthcare professionals (Box 3.1, p. 30). These are likely to occur across all in-patient and outpatient settings as there is a high prevalence of both previous and recent domestic violence in all mental health service users (Oram et al, 2013). Evidence to date suggests that women are at greatest risk of domestic violence (Barnish, 2004) and most of this chapter therefore refers to women rather than men. However, similar principles apply to men suffering from domestic violence and of course they too deserve appropriate support.
Barriers to disclosure
Only 10–30% of recent violence is asked about and identified in clinical practice (Howard et al, 2010). There may be powerful barriers preventing disclosure, which include the stages of change in victims’ understanding of their experiences. Disclosure can seem an insurmountable challenge in the context of intimidation by the perpetrator/perpetrators, pressure to remain in the relationship from the wider family or community and suffering consequent on the abuse. A perpetrator may have tried to enforce secrecy and silence by threats, shaming and humiliation. They may control medication and undermine the victim's credibility with her social network, including her fitness as a parent.
4 - Responding to disclosures of domestic violence
-
- By Roxane Agnew-Davies, Director, Domestic Violence Training Ltd, Mental Health Advisor, AVA (Against Violence & Abuse), and Honorary Research Fellow, Department of Social and Community Medicine, University of Bristol
- Edited by Louise M. Howard, Gene Feder, Roxanne Agnew-Davies
-
- Book:
- Domestic Violence and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 May 2013, pp 49-63
-
- Chapter
- Export citation
-
Summary
Many clinicians either respond inappropriately or feel ill equipped or lacking in training to respond to disclosures about domestic violence from service users. Because the healthcare system may be the victim's first or only point of contact with professionals (Donaldson & Marshall, 2005), the initial response of a mental health professional after any disclosure is crucial to promote the person's safety, access to appropriate support and recovery. As in Chapter 3, most of this chapter is based on good practice guidelines for female victims of domestic violence, as there is a very limited evidence base on the optimal response of mental health professionals and most literature refers to women, reflecting the higher prevalence and severity of violence and abuse experienced by women. This work also draws from feedback from service users on what they found helpful or unhelpful about mental health professionals’ responses to initial disclosures of experiences of abuse (Feder et al, 2006; Rose et al, 2011; Trevillion et al, 2012). As in Chapter 3, the good practice guidance refers to clinicians working with colleagues in the multidisciplinary team. Healthcare professionals should not attempt to manage a disclosure of domestic violence alone; discussion of the complex issues involved is helpful, and multidisciplinary support in the assessment, formulation and management of patients is essential.
What service users want to hear
Women who have experienced domestic violence have been asked to identify what would be a positive initial response to disclosure (Rodriguez et al, 1996). They came up with several issues: creating a supportive environment, providing continued support, developing trust and reassurance of confidentiality. From other studies, it emerged that what is also important is information-giving, making referrals to community resources or providing resources on site; talking about the violence in a compassionate and sensitive manner; promoting safety; documenting the abuse; and a nonjudgemental response (McNutt et al, 1999; Rose et al, 2011). Women have emphasised the need for health professionals to listen to their concerns, respond in a non-judgemental and non-directive way and work at a pace at which they felt comfortable, without pressing for a quick resolution of the problem (Feder et al, 2006). Body language and facial expressions were subtle but important ways of showing concern and developing trust (Rodriguez et al, 1996).