Women who have experienced abuse may have mental health concerns and substance use issues which are closely linked to their experiences of abuse (i.e. increasing their risk and exposure to the violence, developing or exacerbating as a result of abuse, or in response as a coping mechanism).
It is important for shelters to understand the linkages between women’s experience with violence and their mental health and/or any substance abuse in order to effectively support them to manage and overcome these related issues.
Substance Abuse
Substance use among women who have experienced violence occurs within a context which is commonly characterized by:
- Women being introduced to drugs by their intimate partner and partners manipulating women's substance use to maintain control over them.
- Patterns of substance beginning or developing in association with prescriptions provided by doctors.
- Patterns of substance use developing in association with increased severity of injuries and/or risk of lethality.
- Partners abusing women addicted to IV drugs by:
- Forcing them to trade sex for drugs or money
- Controlling the woman's supply or access to drugs
- Injecting drugs for woman
- Deliberately using dirty needles
Additional considerations for working with survivors who have substance abuse issues:
- Women may stay in an abusive relationship due to dependence on drugs supplied by her partner.
- Perceptions/stigma by service providers that women using substances are less credible, result in reduced levels of support.
- Substance use may reinforce women's self-perceptions that they deserve the abuse and slow or limit healing from past abuse.
- Women may experience specific barriers to leaving abusive situations due to their use, such as:
- Reluctance to seek assistance from police due to fears of arrest or child welfare involvement
- Fear of not being believed when reporting violence due to substance use
- Fear of relapse due to the stress of facing an unknown future
The British Columbia Society of Transition Houses (Canada) implemented a two and a half year project designed to reduce barriers and address the challenges facing women who are working through mental wellness and substance use issues as they cope with experiences of violence. Specifically, women in these situations may be turned away from transitional housing programmes, which are often abstinence-based or must seek support from agencies who are working in isolation from one another. They may also be labelled by service providers as difficult to work with if their behaviour is seen as disruptive, or stigmatized because of past or current levels of mental wellness and substance use. Through action-oriented research, training of service providers and pilot implementation of identified practices, the iniative resulted in the roll of out key changes in service delivery within six transitional housing programmes across the province of British Columbia between January and June 2011. The research contributed to the development and evaluation of a promising practices toolkit which focuses on essential approaches for supporting women and examples of how these approaches might be implemented; and curriculum for services to improve support for survivors with mental health and substance abuse issues.
See the full Case Study.
Sources: BC Society of Transition Houses (2011) Reducing Barriers To Support: A Discussion Paper; BC Society of Transition Houses (2011) Report on Violence Against Women, Mental Health and Substance Use; Buote, Denise (2011) Reducing Barriers to Services and Supports for Substance Use and Mental Wellness Concerns Among Women Fleeing Violence: Key Findings.
Women may prioritize protection supports over seeking substance use treatment or believe that they cannot receive support for both issues, which can prevent them from accessing appropriate assistance;
Women with substance abuse may face additional risks which need to be considered in interventions:
- Stopping substance use may result in more danger for some women (i.e. the abuser may find new ways to control or sabotage women's recovery from substance use if they perceive that they are less able to control her).
- Women's judgment about their risk may be impaired by substance use.
- Women may struggle to recall and implement their safety plan when under the influence of substances (Parkes, 2007 as cited in Alberta Council of Women's Shelters, 2006).
Programmes assisting women who use substances should:
- Reduce shame associated with substance use, by training staff in working with substance users and promoting a culture of understanding and respect within the shelter.
- Promote understanding of substance use and its risks, while recognizing the challenges that women may experience in their efforts to stop substance use.
- Elicit hope that change is possible and engaging other women who successfully manage their use as models and peer supports within the shelter
(Poole & Coalescing on Substance use, 2007 as cited in Alberta Council of Women's Shelters, 2006; Alberta Council of Women's Shelters. 2009. Sheltering Practices: Module 3 - Danger Assessment and Safety Planning)
Mental Health
Experiences with violence may lead to a variety of negative mental health impacts, among the other consequences of violence. Mental health conditions are also an additional risk factor for women to experience abuse.
Shelters should consider the following practices in supporting women’s mental health:
- Train staff to understand the range of mental health issues that survivors may be experiencing, the symptoms that my be associated with different mental health conditions, and provide them guidance for working sensitively with women who may have varying levels of mental wellness.
- Promote discussion of mental health issues and build trust with survivors to encourage them to disclose any mental health needs they might have. This includes asking them about their concerns.
- Educate women about the connections between violence, trauma, mental health and/or substance use. This may involve providing information to help women view their responses to abuse and trauma as normal, and better understand the social framing of these issues.
- Provide referrals and linkages to trauma and mental health professionals so that women can receive appropriate specialized support as needed.
- Collaborate with mental health services to ensure survivors seeking mental health assistance can safely access abuse/ assault services (adapted from Ontario Woman Abuse Screening Project. 2010 How Woman Abuse and Sexual Assault Staff Can Provide Mental Health-Informed and Addiction-Informed Services).
Example: Supporting women with mental health and substance issues (Canada)
Through cross-sectoral collaboration and training, shelters in seven regions of Ontario (Canada) have increased their capacity to support abused women with complex mental health and/or substance use issues in accessing relevant services. As part of the Ontario Woman Abuse Screening Project, domestic violence and sexual assault organizations, mental health and addiction agencies, as well as survivors are collaborating to:
- Assist women with mental health challenges and/or substance use issues to overcome barriers accessing shelters and other services related to violence.
- Provide women with complex mental health challenges and/or substance use issues improved services within shelters and within other agencies dealing with abuse.
- Ensure that abused women accessing mental health and addiction supports receive services that are trauma-informed and reflective of their experiences as domestic and sexual assault survivors; and
- Promote routine, universal, comprehensive screening by mental health and addiction agencies for domestic violence, sexual assault and other forms of abuse-related trauma (i.e. related to institutional violence or a humanitarian setting).
The collaboration has supported efforts such as the provision of fulltime services by two mental health professionals from the Canadian Mental Health Association in London-Middlesex to abused women residing at the Women’s Community House shelter for abused women. This increased engagement and training on the linkages between women’s experiences of violence and trauma with their mental health and substance use also improves the capacity and comfort of shelter staff and other sexual assault and domestic violence service providers to provide services to women with mental health and/or substance use issues, and increases the accessibility of those services to very marginalized women.
Tools:
Trauma and Trauma-Informed Care author. This course will explore the causes, impact, experience, and types of trauma as it relates to domestic violence survivors, and delve into the nature, application and implementation of trauma-informed care. Available in English.
Understanding Trauma & Mental Health in the Context of Domestic Violence: An Integrated Framework for Healing and Social Change (Carole Warshaw for the National Center on Domestic Violence, Trauma & Mental Health, 2012). This webinar provides advocates with an integrated framework for responding to trauma and mental health in the context of domestic violence. It includes a brief overview of research on domestic violence, trauma, mental health, and substance abuse, based on the context in the United States; information on the impact of trauma on development and the brain; and recommendations for policy and practice. Available in English.
The Trauma-informed Toolkit (Klinik Community Health Centre, 2008). Available in English.
See also the section on Emotional Care and Support within the Health Module.