19th May 2016
Charities, campaigners and a small but growing number of MPs have done a brilliant job over the last fifteen years in raising awareness of mental health: tackling the myths, encouraging people to talk, and reducing the stigma. We know now that anyone can experience mental health problems, or have a friend or family who is struggling. That one in four stat has stuck.
Mental Health Awareness Week is a considerable campaign that illustrates this progress and moves it along further. Just one look at Twitter shows you thousands of people are sharing content, insight and stories. They are talking to one another. All with the hashtag #MHA2016.
We could learn a lot from these campaigns in the domestic abuse sector. How do we reduce stigma and tackle stereotypes? How do we encourage people to be comfortable talking to one another? To know what to do if you're worried about a friend or family member? How do we lift the lid on another painful, difficult and very personal subject?
We could also do a great deal more to highlight the interrelated issues of mental health and domestic abuse. The teams behind Mental Health Awareness Week decided this year to have a particular focus on relationships, something we greatly welcome.
Despite evidence indicating a direct relationship between experiences of domestic abuse and heightened rates of depression, trauma and self-harm, signs of domestic abuse are often missed when providing mental health support. Mirroring this, mental health issues may not be acknowledged and effectively addressed when a person discloses domestic abuse to a service or support worker.
Our data has found that 16% of those living with serious abuse have considered or attempted suicide as a result of abuse. There is an urgent need to acknowledge abuse and mental health as interrelated issues, and enable people to access to support they require. People don't live their lives in siloes, and it's therefore crucial that we break down the silos in our responses to different problems people might face in their lives.
Domestic abuse comprises any incident or pattern of controlling, coercive, threatening or violent behaviour - whether it be physical, psychological, sexual, financial or emotional. This causes significant psychological consequences, including anxiety, depression, suicidal behaviour, low self-esteem, inability to trust others, flashbacks, sleep disturbances and emotional detachment. Abuse within an intimate or familiar relationship also leaves victims particularly susceptible to post traumatic stress disorder (PTSD).
The collective evidence of the impact abuse has on mental health means we now know that as many as 60% of psychiatric in-patients are experiencing (or have experienced) domestic abuse. However, due to real or perceived barriers such time pressure, lack of training and limited resources, professionals and frontline staff are not always able to spot, assess and address abuse. Not only does this inadequately address the needs of patients in a holistic way, but an exclusive focus on a patient's mental health can make the abuser, and their impact, invisible, or even lead to blame for a situation being wrongly assigned to the victim. This hides abuse under multiple layers of misunderstanding or incomplete understanding, and makes patients - people - more vulnerable to domestic abuse.
Training of frontline professionals needs to be high quality and consistent. Yesterday, the Home Secretary addressed over 100,000 police officers about the need for them to keep improving their response to abuse and vulnerability. That must include the ability to recognise mental health issues when attending incidents of abuse, and understanding that when they go to a scene where someone is in a high state of distress, abuse may be a factor. Healthcare professionals must recognise both physical and psychological experiences of control, coercion and abuse when dealing with patients, and links must be forged between health specialists and domestic abuse specialists.
An effective approach to mental health and domestic abuse must address the often complex needs of those suffering abuse. We cannot respond to one issue a person is facing effectively without recognising, acknowledging and dealing with others - if we want to see people well, happy and safe.
Time and money continue to be tight. However, to provide wraparound support for people that actually responds to the complex nature of people's situations is not only the right response, it is the most rational. The public health sector must be part of the solution to domestic abuse; it cannot be a police or judicial response only. Many people feel more comfortable disclosing in a health setting; later this year, we will be publishing research to show the impact of including health in the response to domestic abuse.
Providing a holistic response, that is as tailored as people are complex, we greatly increase the chances of them becoming safe, and crucially - staying safe.
Follow Diana Barran on Twitter: www.twitter.com/dianabarran