Anna’s Blog – Domestic Violence and Mental Health

1.2 million women in the UK report experiencing domestic violence each year according to the Office for National Statistics, although the real figures are likely to be much higher. According to research, women experiencing domestic abuse are more likely to experience mental health issues such as depression, anxiety, PTSD and substance abuse.

It is alarming but sadly not surprising to read that violence and abuse is a major cause of mental ill health amongst women. A survey conducted by the Royal College of Psychiatrists (RCPsych) reported violence and abuse as the top issue contributing to poor mental health in women and girls, closely followed by relationship issues and home and family pressures. The survey is a clear indicator of the high demand for mental health support as a result of abuse.

“We have long been aware of the serious harm violence and abuse can do to women and girl’s mental health,” said Dr Catherine Durkin, Joint Presidential Lead for Women and Mental Health and RCPsych. “Tragically, it is not uncommon for female patients to experience long-term abuse that causes serious symptoms, including suicidal ideation or symptoms of psychosis.”

In a report titled ‘A Mentally Healthier Nation’, the Centre for Mental Health stated that women who have suffered domestic violence are more than six times more likely than other women to be treated for psychological problems. However, it is also true that those with mental ill health are more likely to be domestically abused due to perpetrators weaponising their vulnerability. This inescapable cycle leaves women feeling trapped as their mental ill health is worsened by the abuse, in turn making it more difficult to escape the situation with numerous barriers to accessing support. They may also be less able to recognise an abusive situation, as it can heavily impact a person’s self-esteem and increase self-blame. In a study from The British Journal of Social Work, one survivor quoted “I didn’t see it as violence, being shouted at. I just thought I was too weak.”

The effects of violence and abuse on mental health are not to be understated. Survivors are four times more likely to experience PTSD than women who have not been abused by their partner, and it is one of the two most prevalent mental health issues associated with domestic abuse, along with depression. In a 2015 study, researchers found that women living in abusive relationships were two to three times more likely to be diagnosed with depression or psychosis. In 2021, 45% of women in refuge services reported feeling depressed or having suicidal thoughts as a direct result of their situation.

Women face a number of barriers when seeking support. In many services a ‘one size fits all’ approach is common, which fails to recognise the diversity among groups of women, many of which face additional forms of structural oppression. This includes survivors from Black and other minority groups, those who are pregnant or new mothers, LGBTQ+ and disabled survivors. Racist stereotypes can exclude people from accessing appropriate mental health support, with Womens Aid citing that “there is strong evidence that Black and minoritised women take longer to seek help and suffer abuse for longer.” A number of studies have also found that women from Black and minority communities are less likely than white women to be offered talking therapies or other non-drug treatments. Other groups disproportionately affected include those in the transgender community, set out in a 2016 report on transgender people’s experiences. They describe how transphobic reactions from partners, along with further pressures to hide their gender identity can profoundly impact their mental health.

In 2020, the Office for National Statistics (ONS) reported 14.7% of disabled women were affected by domestic abuse in England and Wales compared to 6% who were not disabled. Partners or family members often assume act of carers, which leads to power imbalances that can result in abuse through coercive control. Disabled victims are much more likely to be suffering abuse from a current partner than non-disabled victims, and over a third are more likely to be living with the perpetrator of abuse, according to a report by SafeLives in 2017. They were also twice as likely to experience abuse from an adult family member. One international study reported the effects of abuse on mental health for disabled survivors is “catastrophic”, often being a major cause of physical and cognitive impairments. “Assumptions may be made about disabled women: that bruising is not a result of abuse but of the person’s impairment, and that they do not know their own minds and are ‘imagining’ abuse,” reports Stay Safe East in 2021.

As well as this, there are a number of accessibility barriers, including limitations in communication that affect those from Deaf and visually impaired communities, those who are neurodivergent or those who have learning difficulties. Physical barriers affect people who may struggle to travel or access physical locations. Only 1.1% of refuge vacancies in 2021-22 were suitable for women with limited mobility, and just 0.9% of these could accommodate women requiring a wheelchair accessible space, according to Routes to Support 2022. As a result of these inadequacies, many disabled women are forced to experience trauma or the effects of trauma for longer than those who do not have disabilities.

There is a huge issue of stigma affecting people coming forward for support, which affects the response of mental health professionals. Moreover, perpetrators often weaponise survivors’ mental ill health as part of their coercive and controlling behaviour, and as a way of discrediting survivors. Hailes et al (2018) reports “Some women were unable to engage with services as life felt too chaotic… the expectation for women to reach out puts the onus on women to be responsible for their own protection and support.” Survivors may not feel strong enough to ask for help, and professionals should be able to reach out and ask the right questions for those in need of support.

Addressing stigma in communities, workplaces and with professionals, should be a priority. This should include providing training in identifying domestic abuse and strengthening their understanding of the link between abuse and mental ill health. This includes services led by and for marginalised communities.

Resources:

Domestic violence and severe psychiatric disorders: prevalence and interventions – PubMed (nih.gov)

Violence and abuse are driving mental illness in women and girls, psychiatrists warn (rcpsych.ac.uk)

A mentally healthier nation – Centre for Mental Health

(PDF) Mental Health and Domestic Violence: ‘I Call it Symptoms of Abuse’ (researchgate.net)

Disabled_Survivors_Too_Report.pdf (safelives.org.uk)

FINAL-Reframing-the-links.pdf (womensaid.org.uk)