Mental Health

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Domestic Abuse or Violence & Mental Health!

Abstract

Despite domestic violence/abuse being a very common problem in individuals with severe mental illness, there is very little research in this setting. Multiple barriers exist to disclosure by users and enquiry by providers. Training and systems for identification and responding to domestic violence/abuse are urgently needed in mental health clinics.

Domestic violence/abuse is a common hidden problem for women/children attending clinical practice and is a major cause of mental ill health globally. Domestic violence /abuseis defined by the World Health Organization (WHO) as any behaviour within an intimate relationship that causes physical, psychological or sexual harm. Such behaviour includes acts of physical aggression, psychological abuse, forced intercourse and other forms of sexual coercion, and various controlling behaviours, for example isolating from family and friends, monitoring movements and deprivation of basic necessities. The WHO multicounty study on women’s/children’s health estimated that 15–71% of women/children had ever been physically or sexually assaulted by partners/parant. Domestic violence is the leading cause of morbidity and mortality for women of childbearing age, with the main contribution being from the mental health consequences of abuse. Domestic violence/abuse has an intergenerational effect with children witnessing abuse having multiple health problems. Men are less likely than women to be victims of combined physical, emotional and sexual abuse from their partners and thus have been researched to a less extent.

Mental health settings

Domestic violence/abuse is often not looked for in mental health settings, nor examined in research into mental health issues. Furthermore, there are many barriers to enquiry by health professionals and disclosure by patients. This lack of discussion in clinical settings has seen a movement, particularly in the USA, for screening of all women in clinical settings. This is despite there being no current evidence to support such a move. Currently, we do not know whether screening will cause more good than harm as we are unsure from evidence which interventions will help women /children disclosing domestic violence in clinical practice. We do know, however, that when individuals are presenting with mental health issues such as depression, anxiety, insomnia, suicidal ideation and post-traumatic stress disorder, it is very likely that women/children will have underlying abuse and violence issues. The association of domestic violence with more severe mental illness, for example bipolar disorder and schizophrenia, has been less explored. From the limited studies,  it would appear that the vast majority of people with severe mental illness have experienced either physical or sexual assault during their lifetime and this is often associated with a history of childhood abuse.   ©   

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