Domestic Violence and Mental Health: Facilitating Change for Survivors

Transcription

1 Domestic Violence and Mental Health: Facilitating Change for Survivors Barbie Brashear Executive Director Harris County Domestic Violence Coordinating Council

2 Program Objectives: Raise awareness of barriers and challenges experienced by survivors who have mental illness Identify strategies to increase safety for survivors of domestic violence who also have mental illness. Encourage participants to go back to their agency and assess current practice and examine how they are working to increase safety for survivors who have mental illness.

3 "Intimate partner violence, rape, stalking all of these forms of violence can create toxic stress on the body that is long-lasting and cumulative, and can negatively impact a person's health and well-being for the rest of their life." Dr. Howard Spivak, Director Violence Prevention, CDC

4 Types of Stress Positive Brief increases in heart rate, mild elevations in stress hormone levels Tolerable Serious, temporary stress responses, buffered by supportive relationships Toxic Prolonged activation of stress response systems in the absence of protective relationships.

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6 What is crisis? A time of Uncertainty Difficulty Pain Action must be taken to avoid complete disaster or breakdown

7 Emotional Reactions: Anger/ Irritability Mood Swings Overwhelmed Fear/ Powerless Guilt Numbness Intense Sadness

8 Cognitive Reactions: Confusion Poor decision making Memory Problems Inability to focus

9 Behavioral Reactions: Low Energy Exhaustion Withdrawn from others Appetite changes Sleep Disruption Outbursts of anger Aches and pains

10 How Does Crisis Affect our Ability to Plan?

11 What is Trauma?

12 Experiences or situations that are emotionally painful and distressing, and that overwhelm people s ability to cope, leaving them powerless.

13 Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Judith Herman, Trauma and Recovery Center for Nonviolence and Social Justice

14 Mental illnesses such as depression, post traumatic stress disorder, and substance abuse occur in 60% to 90% of battered women. (Warshaw 2003)

15 As compared to women without a mental health diagnosis... o Women with depression were 2.7 times as likely to be victims of IPV o Women with an anxiety disorder were 4.1 times as likely to be victims of IPV, o Women with PTSD were 7.3 times as likely to have experienced IPV. National Center on Domestic Violence, Trauma and Mental Health September 2014

16 We know that abusers often use their partner s mental health status against them as a tactic of coercion, control, and intimidation; interfere with mental health treatment; and undermine their credibility with friends, family, and the courts. National Center on Domestic Violence, Trauma and Mental Health September 2014

17 Exposure to ongoing abuse can exacerbate symptoms and precipitate mental health crises, making it more difficult to access resources and increasing abusers control over their lives. National Center on Domestic Violence, Trauma, and Mental Health

18 Intimate partner violence(ipv) can play a significant role in the development and exacerbation of mental health conditions, lead to poorer physical health, and influence the course of recovery from psychiatric illness National Center on Domestic Violence, Trauma, and Mental Health

19 Meeting Survivors Needs Through Non-Residential Domestic Violence Services & Supports: Results of a Multi-State Study: by Eleanor Lyon, PhD, Jill Bradshaw, PhD, and Anne Menard over 1/3 of survivors (40%) stated that they wanted help with mental health services 88.5% responded that they wanted information about counseling options. 21% of survivors responded yes, When asked if they considered themselves to have a disability or disabling condition and described physical and mental health conditions including anxiety, depression, and posttraumatic stress disorder.

20 Questions to Consider: Does mental health affect ability to plan? What elements should plan include? Are there more limited options? Concerns about losing child custody? Vulnerability to assaults? Increase in isolation? How might partner manipulate to further control?

21 What kinds of Mental Health Issues are we seeing?

22 Experiencing multiple types of abuse may significantly magnify the risk of developing mental health symptoms; one study suggests that experiencing multiple forms of abuse can increase the odds for depression, PTSD, and suicidality by 6-17 times National Center on Domestic Violence, Trauma and Mental Health September 2014

23 PTSD 80% of women who experienced rape, stalking, or physical violence by an intimate partner reported significant short- or long-term effects including posttraumatic stress disorder Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

24 PTSD Behavioral Reactions startle easily become emotionally numb lose interest in things have trouble feeling affectionate be irritable become more aggressive or violent avoid situations

25 Challenges that impact interventions: Refusing to go somewhere Hearing or seeing things Over-reacting to normal situations In-ability to sleep Nightmares Exhaustion Uncontrollable crying

26 What are the barriers for safety?

27 Strategies for Coping Find others to go places with them Practice patience before trying to take care of business Let them talk Offer support with daily planning Suggest the option of counseling

28 WHAT SHOULD BE INCLUDED IN A SAFETY PLAN? or WHAT SAFETY CONSIDERATIONS SHOULD BE MADE?

29 DEPRESSION

30 Compared to women who have not experienced IPV, survivors have nearly double the risk for developing depressive symptoms, and three times the risk for developing major depressive disorder Mothers who experience IPV are nearly twice as likely to develop postpartum depression Beydoun, H.A., Beydoun, M.A., Kaufman, J.S., Lo, B, Zonderman, A.B. (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: A systematic review and meta-analysis. Social Science & Medicine, 75(6),

31 Depression Persistent sad, anxious, or "empty" mood Hopelessness, pessimism Helplessness Loss of interest Decreased energy Difficulty concentrating, remembering, making decisions Thoughts of death or suicide; suicide attempts Restlessness, irritability

32 Challenges that impact interventions: Inability to get out of bed, leave the room, go about normal tasks Negative or scary talk with others Trouble thinking about the future Sickness Missed appointments Refusal to set goals Sees questions or suggestions as criticism

33 What are the barriers for safety?

34 Strategies for coping: Regular check ins Focus on the present Frequent reminders Set priorities Set small goals Encourage rest, relaxation, etc... Assess for suicide

35 WHAT SHOULD BE INCLUDED IN A SAFETY PLAN? WHAT SAFETY CONSIDERATIONS SHOULD BE MADE?

36 BI POLAR DISORDER

37 Bi Polar Disorder Dramatic mood swings from overly "high" and/or irritable to sad and hopeless Episodes of mania and depression

38 Depressive Episodes Hopelessness - Helplessness Loss of interest Decreased energy Difficulty concentrating, remembering, making decisions Irritability Change in sleep or appetite Chronic pain not caused by physical illness Suicide thoughts or attempts

39 Mania Episodes Increased energy, activity, and restlessness Extreme irritability Racing thoughts Unrealistic beliefs in one's abilities and powers Poor judgment Spending sprees Abuse of drugs, particularly cocaine, alcohol, and sleeping medications Aggressive behavior Denial that anything is wrong

40 What are the barriers for safety?

41 Challenges that impact intervention: Difficulty in communicating Unexplainably argumentative Inconsistency on follow through with tasks Panic attacks Sleep patterns disruptive

42 Strategies for Coping Patience is critical Wait out the manic episode for problem solving Establish a routine Monitor extremes Medication is helpful, but has side effects

43 WHAT SHOULD BE INCLUDED IN A SAFETY PLAN? WHAT SAFETY CONSIDERATIONS SHOULD BE MADE?

44 Strategies for Confronting Situations with Survivors: Suspend judgment Resist need to diagnose Focus on the behavior Reduce outside stimulus Be Direct, Firm, and Specific Implement silence Be willing to attempt several strategies and know that it may take some time

45 Strategies for Confronting Situations with Survivors: Use written agreements Lighten the load Limit interaction with others All staff on the same page Consider different strategies for safety

46 Questions to Consider o How might her mental health affect her ability to plan? o What elements to include in safety plan? o Are there more limited options? o Concerns about losing child custody? o Is she more vulnerable to physical assaults? o Increase in isolation? o How might partner manipulate to further control?

47 Safety Planning o Understand a battered woman s perspective o Listen o Validate o Understand o Identify the effect of staying or leaving on those risks

48 Using a trauma-informed approach has come to mean that everyone working in a service setting understands the impact of trauma in a similar way and shares certain values and goals, and that all the services and supports that are offered are designed to prevent retraumatization and to promote healing and recovery.

49 How can your programs provide survivors with de-stigmatizing information about the traumatic effects of abuse? Discuss the link between lifetime trauma, and mental health. Discuss some of the common emotional or mental health effects and ways that these responses can interfere with accessing safety, processing information, or remembering details. Discuss the ways that trauma can disrupt our ability to trust and to manage feelings and can affect the ways we feel about other people, ourselves, and the world. Discuss the things that abusers may do to make their partners feel crazy. Discuss the ways that abusers use mental health issues to control their partners.

50 CASE STUDIES

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52 CREATING TRAUMA-INFORMED SERVICES 5 CORE COMPONENTS Providing survivors with information about the traumatic effects of abuse Adapting programs and services to meet survivors trauma- and mental healthrelated needs Creating opportunities for survivors to discuss their responses to trauma Offering resources and referrals to survivors Reflecting on our own and our programs practice

53 QUESTIONS?