Part 1 of the series on the special mental health needs of victims of Intimate Partner Violence (IPV) explained the relationship between IPV, depression, and an increased risk of suicide. In Part 2 CFYM provides actionable steps readers can take to address the disparity of services.
Robin Axelrod Sabag, LCSW, MFT
Jewish Family & Children’s Service
Even women in abusive relationships who do not have a pre-existing mental health issue may find it difficult to leave the relationship. Factors such as finances, child care, and shame, combined with the cyclical nature of the abuse, contribute to the challenge of leaving.
Having a mental health condition can make a person even morelikely to stay in an abusive relationship because the victim may be dependent on the abusive partner in a number of ways. An abuser may exploit the victim’s vulnerability by using the mental health diagnosis to control her behavior. He may convince the victim that others will not believe her accounts of abuse because, for example, she is “crazy,” has a history of past hospitalizations, or uses psychotropic medication. He can also use the diagnosis to convince the victim that the court will not grant her custody of their children, adding to her reluctance to leave the relationship. If the victim is experiencing anxiety, has panic attacks, or is feeling suicidal, the perpetrator may force her into hospitalization.
Barriers to care
Another control tactic used by perpetrators is to interfere with the victim’s psychotropic medication either by over- or under-medicating her. Abusers can also control access to treatment and insurance coverage.
Women who do try to leave abusive relationships also must face the issue that some shelters have strict rules regarding women with a mental health condition. They may not allow entrance or, if they do, they may have rules regarding medication use. These rules may not align with the woman’s current situation and create a barrier to her reaching a safe place.
Where can women find support to deal with these concerns and find safety? What can we expect from health providers, especially mental health professionals?
One would hope that a woman could find help and support from her health providers. But can they be expected to help with something they don’t know about? A woman involved in IPV may be uncomfortable or afraid to raise the topic. When practitioners are passive and don’t make inquiries, they remain unaware of IPV. Because they are not asking the appropriate questions, they treat only the psychiatric symptoms and do not address the larger issues at hand.
What can advocates do?
Know your rights.
The Affordable Care Act (ACA) requires many insurance plans to include preventive health services for women, including domestic and interpersonal violence screening and counseling. If you believe your or your loved one’s insurance plan is not complying, contact them to find out if these services are covered. If not, demand that they do so. If they are, revisit the issue with your provider.
Advocate to have support services in place.
IPV can lead to sadness, isolation, and depression. Victims should be connected to resources to get support and mental health care as soon as possible. The National Network to End Domestic Violence provides education and resources to motivate advocates to demand national funding for these services.
Educate mental health and medical professionals about the linkage between IPV and mental health problems.
Providers must ensure that victims be treated for the mental health impact of such abuse and use best practices in assessing everyone for intimate partner violence. If your health insurance plan does not have adequate mental health coverage, it may not be complying with the ACA. We want to hear from you. Tell us your story.
Work to implement appropriate and consistent screening.
Professionals who treat women with mental health issues should determine whether intimate partner violence is underlying the presenting problem. Health care professionals who do not screen their patients are not doing their jobs properly; all health-care workers should get a full history of past and present episodes of abuse. Everyone should get screened!
Urge and facilitate collaboration among all disciplines.
Mental health specialists, medical practitioners, and legal advocates must collaborate to develop a standard approach to effectively screen and treat mental health problems in all women.
Include post-screening and follow up care.
Victims and IPV survivors may need ongoing mental health care. Medical providers should continue with appropriate screening and care.
When discussing IPV in the mental health field, here are some important questions to ask:
- What can we do to encourage or make it easier for women with mental health conditions to leave abusive relationships?
- How will you advocate that adequate mental health resources are available to victims of IPV?
- What do you think are good ways to get this information about mental health care to women impacted by IPV?
Robin Axelrod Sabag is the Clinical Supervisor and Coordinator of the Domestic Violence Program at Jewish Family and Children’s Service of Greater Philadelphia and an adjunct professor at Temple University. Upon attaining her graduate training in Social Work, she completed a post graduate training program in Marriage and Family Therapy at the Council for Relationships. Her clinical training has prepared her to assist clients with a variety of problems, including domestic abuse, eating disorders, addictions, depression, anxiety, relationships, grief, transition through the life cycle, and self esteem.