{"id":19172,"date":"2021-12-06T08:47:31","date_gmt":"2021-12-06T08:47:31","guid":{"rendered":"https:\/\/womensaid.org.uk\/?p=19172"},"modified":"2024-02-06T15:13:25","modified_gmt":"2024-02-06T15:13:25","slug":"the-reality-of-the-barriers-to-mental-health-support","status":"publish","type":"post","link":"https:\/\/womensaid.org.uk\/the-reality-of-the-barriers-to-mental-health-support\/","title":{"rendered":"The reality of the\u00a0barriers to mental health support"},"content":{"rendered":"<h1 style=\"text-align: left;\" aria-level=\"1\"><strong>Survivors deserve to be heard: <\/strong><span data-contrast=\"none\">The reality of the\u00a0barriers to mental health support<\/span><\/h1>\n<p style=\"text-align: left;\" aria-level=\"2\"><strong><em>A Safe Blog<\/em> by Lizzie McCarthy and Jenny Birchall, Women\u2019s Aid<\/strong><\/p>\n<p><strong>6th December 2021: <\/strong>Today, Women\u2019s Aid has published two reports as part of our <strong><a href=\"https:\/\/womensaid.org.uk\/deservetobeheard\/\">Deserve\u00a0To\u00a0Be Heard<\/a>\u00a0<\/strong>campaign.\u00a0This\u00a0campaign aims to highlight the devastating impact of domestic abuse on the mental health of women and their children. Through\u00a0our\u00a0campaign, we will ensure that the mental health needs of women, who are all too often not listened to and not believed, are heard and responded to effectively.<\/p>\n<ul>\n<li><strong><a href=\"https:\/\/womensaid.org.uk\/evidence-hub\/research-and-publications\/\">Mental health and domestic abuse: A review of the literature<\/a> <\/strong>by Jenny Birchall and Lizzie McCarthy, Women\u2019s Aid<\/li>\n<li><strong><a href=\"https:\/\/womensaid.org.uk\/evidence-hub\/research-and-publications\/\">Reframing the Links: Black and minoritised women, domestic violence and abuse, and mental health &#8211; A Review of the Literature<\/a> <\/strong>by Ravi Thiara and Christine Harrison, University of Warwick<\/li>\n<\/ul>\n<p>In this blog we\u00a0highlight some key findings\u00a0from\u00a0these\u00a0reports on the barriers facing domestic abuse survivors in accessing appropriate and timely mental health support.\u00a0The reports\u00a0linked to above\u00a0look\u00a0at these barriers\u00a0in more detail,\u00a0as well as\u00a0exploring\u00a0the impact of domestic abuse on\u00a0survivors\u2019\u00a0mental health\u00a0and\u00a0the work of specialist domestic services\u00a0in meeting mental health needs.\u00a0The references\u00a0for\u00a0all\u00a0this evidence\u00a0can be found in the reports.<\/p>\n<p><strong>The mental health trauma caused by domestic abuse\u00a0<\/strong><\/p>\n<p>The evidence is clear; being subjected to domestic abuse\u00a0can have\u00a0devastating and long-term consequences for\u00a0mental wellbeing\u00a0and the\u00a0perpetration of domestic abuse is a key driver of women\u2019s mental ill health.\u00a0One study\u00a0referenced in\u00a0<em>Mental health and domestic abuse: A review of the literature\u00a0<\/em>describes\u00a0the impact of domestic abuse as having \u201c\u2026psychological parallels with the trauma of being taken hostage and subjected to torture\u201d\u00a0(Howard et al., 2010).<\/p>\n<p>However, survivors face a range of barriers in accessing\u00a0appropriate\u00a0mental health support, and\u00a0all\u00a0of\u00a0these barriers are\u00a0heightened for survivors from\u00a0minoritised\u00a0or marginalised groups. We\u00a0highlight\u00a0some of the main barriers\u00a0discussed in the reports\u00a0below.<\/p>\n<p><strong>Survivor\u00a0disclosure and help-seeking\u00a0<\/strong><\/p>\n<p>Putting the\u00a0burden\u00a0on the survivor herself\u00a0to disclose abuse or seek\u00a0out mental health support (rather than services reaching out to survivors or healthcare professionals safely and sensitively enquiring) is problematic.\u00a0The impact of\u00a0domestic abuse\u00a0often includes\u00a0lowered self-esteem and\u00a0feelings\u00a0of shame, meaning that survivors do not feel able to seek out support. Expecting them to do so is therefore often unrealistic.\u00a0Survivors also often fear that they will not be believed or taken seriously if they\u00a0talk about\u00a0abuse and\/or mental health concerns (sometimes because of\u00a0negative experiences\u00a0in the past).<\/p>\n<p>There is\u00a0sadly still\u00a0considerable stigma around being diagnosed as mentally ill, which is often\u00a0used\u00a0by perpetrators to discredit survivors.\u00a0Perpetrators may also use\u00a0a\u00a0survivor\u2019s insecure immigration status (or lack of clarity about immigration status) as the basis of threats that prevent survivors talking to domestic abuse or healthcare services.\u00a0In addition, survivors with children are often fearful that accessing mental health\u00a0or domestic abuse\u00a0support may mean that social services will get involved and they will be judged as \u201cfailing to protect\u201d their children from abuse; or it will be used against them in any child contact or child protection legal proceedings.<\/p>\n<p><strong>Unhelpful\u00a0professional responses\u00a0<\/strong><\/p>\n<p>Unfortunately, when survivors do talk to healthcare professionals about domestic abuse and mental ill health, the response is not always helpful.\u00a0Victim-blaming,\u00a0disbelieving\u00a0attitudes and inappropriate responses\u00a0are significant barriers to accessing support.\u00a0It is also important to understand the context of oppression (including multiple intersecting forms of inequality and discrimination) in which survivors are experiencing domestic abuse, and the barriers that structural sexism, racism and other forms of inequality create in accessing mental health support. In Thiara and Harrison\u2019s report (published\u00a0by Women\u2019s Aid\u00a0today) the authors note that access to mental health support is lowest amongst\u00a0the most marginalised groups. They state that:<\/p>\n<blockquote><p><em>\u201cThe ways in which racism perpetuates health inequalities is evident in how Black and\u00a0minoritised\u00a0groups access, or are deterred from accessing, forms of help and support, especially through statutory\/mainstream mental health services\u2026\u201d<\/em><\/p><\/blockquote>\n<p>The issue of survivors not being asked about possible domestic abuse by healthcare professionals (including GPs and mental healthcare specialists) is a key theme in the literature on mental health and domestic abuse.\u00a0There is evidence of\u00a0some\u00a0healthcare professionals\u00a0not feeling confident in addressing domestic abuse and sometimes\u00a0treating\u00a0survivors\u2019\u00a0mental health concerns\u00a0as\u00a0completely\u00a0separate\u00a0from\u00a0their\u00a0experiences of abuse. This leads\u00a0healthcare professionals\u00a0to focus\u00a0solely\u00a0on physical injuries or\u00a0narrowly view\u00a0a survivor\u2019s\u00a0mental ill health as a\u00a0medical problem or\u00a0condition,\u00a0rather than\u00a0understanding it as the\u00a0result of being subjected to violence and abuse.<\/p>\n<p>There are examples of good practice\u00a0in the literature\u00a0too,\u00a0though, including healthcare services working in partnership with domestic abuse services and healthcare professionals receiving the tools and training\u00a0they need\u00a0to safely and sensitively enquire about domestic abuse.<\/p>\n<p><strong>Inaccessible\u00a0and re-traumatising\u00a0services<\/strong><\/p>\n<p>Mental health information and services are not\u00a0always\u00a0accessible to\u00a0all\u00a0and this creates another barrier to survivors accessing support. These inaccessibility barriers include communication barriers, cultural awareness barriers, and practical access barriers (e.g.\u00a0where\u00a0a venue is not wheelchair accessible). In addition, survivors who are denied recourse to public funds because of their immigration status do not have access to many publicly funded services, or fear accessing them due to hostile immigration\u00a0policies.<\/p>\n<p>Attempting to engage with some mental health services can\u00a0even\u00a0worsen survivors&#8217; mental health issues and create further\u00a0trauma;\u00a0for example if services<\/p>\n<ul>\n<li>Are not working with an understanding of the impact of domestic abuse on women\u2019s lives.<\/li>\n<li>Do not provide safe opportunities and spaces for survivors to tell their own stories.<\/li>\n<li>Do not understand the impact of intersecting forms of oppression (such as racism and sexism) or are themselves discriminatory.<\/li>\n<li>Or fail to keep survivors safe from sexual harassment or violence from other patients.<\/li>\n<\/ul>\n<p>Some studies\u00a0also\u00a0raise concerns\u00a0that survivors are being\u00a0medicated or\u00a0referred directly to\u00a0inappropriate\u00a0mental health services\u00a0which are not trauma-informed,\u00a0without any exploration of the abuse they are experiencing\u00a0or referral to specialist domestic abuse support.<\/p>\n<p><strong>Overstretched services\u00a0<\/strong><\/p>\n<p>When survivors do disclose mental health problems and are taken seriously, there are long waiting lists for mental health support. Mental health services are usually over-stretched and often can only offer short-term support. These waiting times have only been exacerbated by a surge in demand during the Covid-19 pandemic. The Royal College of Psychiatrists raised concerns in September 2021 about the backlog of patients waiting for mental health support, with an estimated figure of 1.6 million people waiting for treatment from mental health services (and the actual number is likely to be greater).<\/p>\n<p>Specialist domestic abuse services are well-placed to meet many of the mental health needs of survivors, sometimes working in partnership with health services and healthcare professionals.\u00a0Specialist domestic\u00a0abuse\u00a0services\u00a0\u2013\u00a0including\u00a0\u2018by and for\u2019 services\u00a0for Black and\u00a0minoritised\u00a0women, LGBT+, and disabled survivors\u00a0\u2013\u00a0work in\u00a0a\u00a0holistic way that addresses\u00a0many survivor needs,\u00a0including mental wellbeing. These\u00a0are\u00a0services\u00a0that\u00a0understand the impact of intersecting inequalities, build trusting and empowering relationships with survivors, and\u00a0recognise\u00a0the\u00a0extent of the\u00a0trauma caused by domestic abuse.<\/p>\n<p>Despite facing high demand and many funding challenges, specialist domestic abuse services are doing important work in meeting survivors\u2019 mental health needs. In her book on the experiences of survivors living in refuges, Hilary Abrahams (2007) sums up the importance of adequately resourcing the work of specialist domestic abuse services:<\/p>\n<blockquote><p><em>\u201cThe value of this complex and demanding work needs to be fully appreciated and properly funded,\u00a0taking into account\u00a0its one-to-one nature and the requirement for extended support within the community. Combining practical and emotional assistance in this way enhances the prospect of a successful transition to a new life for the woman and may also lessen future demands on health and social care provision and possible expensive crisis interventions.\u201d<\/em><\/p><\/blockquote>\n<p><strong>Opportunities for change\u00a0<\/strong><\/p>\n<p>The reforms proposed in the Health and Care bill and the forthcoming Women\u2019s Health Strategy are key opportunities to recognise and take action on the mental health consequences of domestic abuse. In response to the evidence found in the reports published today, Women Aid\u2019s Deserve To Be Heard campaign is calling for the following:<\/p>\n<ul>\n<li>Tackling domestic abuse must be explicitly recognised as a public health priority, with greater emphasis on the mental health impacts of domestic abuse in healthcare policy and funding.<\/li>\n<li>Services and professionals responding to survivors\u2019 mental health must work in a trauma-informed way.\u00a0Greater partnership work between health services and specialist domestic abuse services and specialist training of healthcare professionals are\u00a0key ways\u00a0of achieving this aim.<\/li>\n<li>The intersecting forms of structural oppression that survivors face must be considered in any policy or strategy relating to women\u2019s health.<\/li>\n<li>Investment in mental health services\u00a0is important and\u00a0must be accompanied by investment in specialist domestic abuse support services, including ring-fenced funding for specialist services led by and\u00a0for Black and\u00a0minoritised\u00a0women, Deaf and disabled women and LGBTQ+ survivors.<\/li>\n<li>Medical students and\u00a0professionals responding to domestic abuse (including healthcare professionals, police, legal professionals) need specialist domestic abuse training that strengthens their understanding of perpetrator tactics in\u00a0weaponising\u00a0mental ill health.<\/li>\n<\/ul>\n<p>Domestic abuse survivors\u00a0deserve to be heard by healthcare professionals, they deserve to be heard\u00a0in healthcare\u00a0policy-making,\u00a0and\u00a0they deserve to be heard\u00a0in healthcare decision-making structures.\u00a0Campaign with us to make this happen!<\/p>\n<p>For more information about the Deserve To Be Heard campaign and how you can get involved, please <a href=\"https:\/\/womensaid.org.uk\/deservetobeheard\/\">click here<\/a>. <span data-contrast=\"none\">Thank you to all the survivors whose expertise and stories have informed the literature reviewed in the reports published today.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">For information and support, please <a href=\"https:\/\/womensaid.org.uk\/information-support\/\">click here.<\/a><\/span><\/p>\n<p><span data-contrast=\"none\">Thank you to\u00a0<\/span>Ravi Thiara and Christine Harrison<span data-contrast=\"none\">\u00a0for their important contribution to the evidence base for this campaign.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"none\">Thank\u00a0you to\u00a0the\u00a0Gamesys<\/span><span data-contrast=\"none\">\u00a0<\/span><span data-contrast=\"none\">Foundation<\/span><span data-contrast=\"none\">\u00a0<\/span><span data-contrast=\"none\">for\u00a0funding\u00a0the\u00a0<\/span>Deserve\u00a0To\u00a0Be\u00a0Heard<span data-contrast=\"none\">\u00a0campaign.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:240,&quot;335559740&quot;:276}\">\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/womensaid.org.uk\/research-and-publications\/safe-blog\">Back to Safe Blog<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Survivors deserve to be heard: The reality of the\u00a0barriers to mental health support A Safe Blog by Lizzie McCarthy and Jenny Birchall, Women\u2019s Aid 6th December 2021: Today, Women\u2019s Aid has published two reports as part of our Deserve\u00a0To\u00a0Be Heard\u00a0campaign.\u00a0This\u00a0campaign aims to highlight the devastating impact of domestic abuse on the mental health of women [&hellip;]<\/p>\n","protected":false},"author":881,"featured_media":18368,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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