Mental health services must address family violence response

The Family Violence Death Review Committee (FVDRC) is calling for mental health and addiction services to act as allies for family violence victims. The FVDRC is an independent committee that reviews and advises the Health Quality & Safety Commission on how to reduce the number of family violence deaths.

Between 2009 and 2015, there were 92 intimate partner violence deaths in NZ. Where there was a recorded pattern of abuse, in 98 percent of the relationships, the woman was identified as the primary victim.

In a paper published by the International Journal of Mental Health Nursing, co-author Dr Jacqueline Short says there is a strong association between family violence and mental health and addiction issues in Aotearoa NZ which requires a comprehensive and equitable health system response.

‘People who experience and use violence within their whānau are often known to mental health and addiction services.'

Constructed from 28 in-depth New Zealand family violence death reviews, the paper highlights how responses to family violence within health care settings is generally poor and discusses alternative responses that could create safer lives for people and families.

‘Currently, if someone contacts mental health and addiction services and is looking for help, the mental health practitioner will often go through a safety check with them that will focus on safety in the immediate and short term,’ she says. ‘Things like making sure they have a bag packed, have some money, know where they can go, have contact numbers.

‘But we are not understanding the obstacles and difficulties the person faces in trying to follow that advice. They may have tried so many of those things so many times before and found that, not only have they not worked, but they may have made their situation even more precarious and put them in greater danger.

‘What we would like to see at this point is mental health and addiction services linking in the network of family violence support services, which would result in a whole new level of specialist safety and support services being available and activated.’

Dr Short says health system responses that focus on empowerment and offer simplistic safety advice for the victim are not only ineffective at addressing the serious safety issues, structural inequities and health burdens faced by many victims, but they also worsen victim’s social entrapment and expose them to further, potentially life-threatening, harm.

‘Social entrapment is when the partner controls the victim’s life such as attending all health care appointments with the victim and revealing the inadequacy of services’ responses to the victim’s help-seeking.

‘Reframing intimate partner violence as a form of social entrapment acknowledges it as a complex social problem that requires collective steps to secure people’s safety and well-being.’

The paper says mental health and addiction services need to work in partnership with specialist family violence services and contribute to local family violence multi-agency review processes.

‘If mental health and addiction services do not partner with specialist family violence services to address men’s use of violence and the ongoing safety and well-being needs of victims, their families and whānau, the violence will not stop, and the harm will continue.

‘For Māori, this also includes the harm caused by westernised treatment systems in mental health and addiction services.’

Dr Short says Te Tiriti o Waitangi must be at the heart of all solutions for Māori.

The paper provides discussion points for organisations and practitioners to reflect on how they can improve safety for victims.

The full paper can be read here: https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12641

Questions for mental health and addictions practitioners

- Have I assessed the risks of her partner’s coercive and controlling behaviours towards her and the children?

- How do his coercive and controlling behaviours constrict her and her children’s lives and her ability to do what she wants to do, including her ability to formulate and engage in any mental health and addiction care plans?

- What do I know about what safety strategies she previously tried, how these worked, if services were helpful, her partner’s reactions, and what if any access she has to financial, family and whānau, social and cultural supports?

- Are she and her family and whānau experiencing systemic barriers, such as a lack of stable housing, limited access to money and transport, poverty, and dismissive racist responses from services? How is this impacting her, her children and whānau and family’s safety and wellbeing?

- What are her biggest fears for her and her children?

- Who is working with her partner? What strategies are in place to support him and address his use of violence?

- Comprehending all of this, what actions can I take as a ‘safety ally’, as part of my treatment plan?

- How and with who will I review whether what we are doing is supporting creating safety for her, the children and her family and whānau?

- What local Māori and Tauiwi (New Zealand non-Māori) family violence organizations and networks could we develop relationships, and work in partnership with?

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