People with mental illness

Australia

  • Australia’s National Research Organisation for Women’s Safety. Violence against women and mental health- Research Synthesis (ANROWS Insights, 04/2020). Sydney: ANROWS.

    This paper provides a synthesis of evidence on violence against women and mental health, examining the way that mental health intersects with trauma, complex trauma, disability, coercive control, access to justice and parenting. This paper is not intended to be a comprehensive literature review—it focuses on ANROWS research and other research, while also drawing on recent grey literature for further supporting evidence. Some of the key issues identified include:

    • For women experiencing violence, mental health problems can overlap with trauma, complex trauma and disability, making simple diagnoses and treatment difficult.
    • Mental ill health can be a compounding factor, a barrier, an outcome and a tool used by perpetrators of violence against women.
    • Access to justice can be impacted at the intersection of mental health and violence against women, because the criminal justice system is not designed to accommodate trauma.
    • The co-occurrence of violence against women and mental health concerns can have parenting impacts, damaging the mother–child relationship and impacting the child’s mental health.
  • Braaf, Rochelle, and Isobelle Barrett Meyering, ‘Domestic Violence and Mental Health’ (Fast Facts 10, Australian Domestic & Family Violence Clearinghouse, 2013).
    This two-page overview reviews literature on the relationship between mental health, domestic violence and sexual abuse. Referencing relevant studies and reports it identifies key issues including higher rates of: depression, post-traumatic stress disorder, anxiety, alcohol abuse, non- prescription drug use and a tendency towards suicide for those who have experienced domestic violence and sexual assault.
  • Douglas, Heather, ‘Domestic and Family Violence, Mental Health and Well-Being, and Legal Engagement’ (2017) Psychiatry, Psychology and Law (online).

    This article draws from interviews with a group of diverse women who have engaged with the legal system after experiencing domestic and family violence (DFV). The study sought to investigate how women’s experiences of legal processes ‘affected their mental health and well-being’ (p 1). Almost all the women experienced some type of mental health issue directly attributable to DFV (p 5). Many women engaged preventative measures prior to attending court, including pre-court counselling, contacting mental health practitioners, and taking prescribed medication (p 2). Other women self-medicated and avoided seeking help fearing that proof of mental health concerns may lead to negative court outcomes (p 2). Many women highlighted attending court (pp 5-6), having to face the perpetrator in court (pp 6-8), and giving evidence (pp 8-9) as negatively affecting their mental health (p 10). A number of suggestions are made for improving women’s experiences in court, including:

    • minimising the frequency with which victims are required to attend court (p 10);
    • allowing women to give evidence remotely (p 10);
    • minimising contact between the victim and abuser, through ensuring there are safe waiting spaces (p 10), and staggering attendance and departure times of the parties (p 11);
    • providing effective training to court personnel regarding the dynamics of DFV (p 11); and
    • ensuring cross-examination, and legal proceedings in general, are not misused by the abuser (p 11).
  • Hegarty, Kelsey, et al, ‘Association between Depression and Abuse by Partners of Women Attending General Practice: Descriptive, Cross Sectional Survey’ (2004) 328(7440) The BMJ 621.
    This article reports on a survey of female patients within a general practice setting in Australia, which sought to investigate the connection between depression and physical, emotional, and sexual abuse of women by partners or former partners. The researchers surveyed1257 female patients of 30 general practitioners in Victoria between August and December 2000. The authors found that 18.0% of women were scored as currently probably depressed and 24% as having experienced some type of abuse in the past 12 months, while 37% had ever experienced some form of abuse while in an adult intimate relationship. Of women who were probably depressed, more were likely to have experienced some form of abuse as a child and also were more likely to have experienced partner abuse.
  • Holden, Libby, et al, ‘Mental Health: Findings from the Australian Longitudinal Study on Women’s Health’ (Final Report, Women’s Health Australia, May 2013).

    This report draws on data from The Australian Longitudinal Study on Women’s Health (examining data on about 5,766 Australian women). See pp76-83. Key finding from this examination include:

    • ‘Women in their 20s and 30s who report Intimate Partner Violence (IPV) experience a subsequent decrease in mental health.
    • Women in their 20s and 30s who report IPV experience poorer mental health prior to IPV, suggesting an inter-connected relationship; that is, IPV affects mental health status and likewise mental health affects IPV.
    • An analysis of data from women in the mid-aged cohort (born 1946-51) found that after the cessation of IPV, women experience an improvement in mental health. However, even after 12 years, their mental health is significantly poorer than that of women who have never lived with IPV’ (at 83).
  • Loxton, Deborah, Margot Schofield and Rafat Hussain, ‘Psychological Health in Midlife Among Women Who Have Ever Lived With a Violent Partner or Spouse’ (2006) 21(8) Journal of Interpersonal Violence 1092.
    This study examines the psychological health correlates of domestic violence in a large random sample of mid-aged Australian women (N = 11,310, age 47 to 52 years). The research investigated the associations between domestic violence and depression, anxiety, and psychological wellbeing, and adjusted for demographic variables (marital status, income management, area). Results indicate increased odds of having experienced domestic violence for those who had: ever experienced a diagnosis of depression, anxiety, or an 'other' psychiatric disorder; recent symptoms of depression and anxiety; used psychoactive medication for depression or anxiety in the 4 weeks prior to the survey; and who reported current depression. Current psychological well-being had an inverse association with a history of domestic violence, that is, as psychological well-being decreased, the odds of having ever experienced domestic violence increased. The results indicate that a history of domestic violence is associated with decreased psychological well-being in mid-aged Australian women.
  • Ogbo, Felix Akpojene, John Eastwood, Alexandra Hendry, Bin Jalaludin, Kingsley E Agho, Bryanne Barnett and Andrew Page, ‘Determinants of Antenatal Depression and Postnatal Depression in Australia’ (2018) 18(49) BMC Psychiatry (online).
    This article considers the causes of antenatal and postnatal depression in Australia. The results of the study indicate that a history of intimate partner violence, both physical and psychological, is associated with depressive symptoms (p 3). Further, IPV was one of the ‘strongest risk factors for antenatal depressive symptoms’ (p 5).
  • Purdie Nola, Pat Dudgeon and Roz Walker, eds. Working together: Aboriginal and Torres Strait islander mental health and Well-being Principles and Practice, 2nd edition (2014, Telethon Kids).
    This book includes chapters on a wide range of issues associated with Aboriginal and Torres Strait Islander mental health. The editors identify that the purpose of the book is to provide an appropriate resource for a range of health professionals who work with Aboriginal and Torres Strait Islander people, including Aboriginal and Torres Strait Islander health workers, counsellors, and other staff of Indigenous health services. Chapter 1 ’Australian Aboriginal and Torres Strait Islander Mental Health: An Overview’ by Robert Parker provides a good summary of relevant issues, see especially from p5-7. See also chapter 10 ‘Trauma, Transgenerational Transfer and Effects on Community Well-being’ by Judy Atkinson et al.
  • Roberts, Gwenneth, et al, ‘How Does Domestic Violence Affect Women's Mental Health?’ (1998) 28(1) Women and Health 117.
    This study compares the mental health of women who reported domestic violence and those who reported no domestic violence in their lifetime. Women between the ages 16 and 74 years (n = 358), who attended the emergency department of a major public hospital in Australia, were the subjects of this study. The results of the study showed that women who had experienced domestic violence had experienced more ill-effects to their mental health than women who had never experienced violence (including PTSD, phobias, depression, dysthymia, anxiety, somatisation, harmful alcohol consumption and drug dependence.)
  • This report is focussed on health outcomes associated with intimate partner violence. This paper presents a helpful review of relevant literature about the relationship between poor mental health and the experience of violence. It notes that previous literature has found that (at 20):

    • ‘Shock, fear and feeling numb are common psychological responses to intimate partner violence. However, the mental health effects persist long after a violent episode.
    • Middle-aged women are significantly more likely to experience anxiety and depression.
    • The effects of violence can persist for many years. Women who have experienced violence in the past have lower rates of mental health problems than women reporting current intimate partner violence, but significantly higher rates than those who have never experienced this type of violence.
    • Women reporting intimate partner violence are more likely to use medication for depression and anxiety.
    • Some other psychiatric disorders (namely phobias, somatisation and dissociative disorders) are more common in women reporting intimate partner violence than those not affected.’ (references omitted).
    Drawing on existing studies this report identifies mental health outcomes associated with intimate partner violence: attempted suicide, self-harming behaviours, depression, anxiety, eating disorders, traumatic and post-traumatic stress symptoms and other psychiatric disorders such as phobias and dissociative and somatisation disorder (involving the physical expression of psychological symptoms) (p21).

International

  • Cerulli, Catherine, Kenneth R Conner and Robert Weisman, ‘Bridging Healthcare, Police, and Court Responses to Intimate Partner Violence Perpetrated by Individuals with Severe and Persistent Mental Illness’ (2004) 75(2) Psychiatric Quarterly 139.

    This US study explores the appropriateness of criminal justice responses to dealing with perpetrators of intimate partner violence (IPV) who suffer from severe and persistent mental illness. It is suggested that a singular legal response may miss the opportunity for detection and assertive treatment of the illness so as to promote safety and reduce the likelihood of violence. It is also suggested that perpetrators in this group may have difficulty comprehending court procedures. This article discusses the potential for a more flexible approach to IPV through interdisciplinary coordination and training of police, judges, attorneys, legal advocates, mental health professionals and substance abuse providers.

    Although New York-specific, the section ‘Court response to IPV’ (from p145) is very relevant, discussing the need to for judges to consider mental health in the context of issuing protection orders, as ‘the effectiveness of a protection order may be reduced with mentally ill offenders, particularly those receiving inadequate treatment (due to gaps in the system or noncompliance). Alternative responses to violations of protection orders, including an assessment of comprehension of the order, referrals for psychiatric care for those not in treatment (or enriched care for those that are), and innovations that serve to coordinate and formalize the efforts of psychiatric/social and legal systems should also be considered’ (p145).
  • Cimino, A., Yi, G., Patch, M., et. al., ‘The Effect of Intimate Partner Violence and Probable Traumatic Brain Injury on Mental Health Outcomes for Black Women’ (2019) Journal of Aggression, Maltreatment & Trauma (online first).
    Severe intimate partner violence (IPV) can result in traumatic brain injury (TBI), cognitive impairment, and mental health disorders, such as depression and PTSD. The purpose of this study is to examine the relationship between IPV, injuries associated with TBI (a loss of consciousness from a blow to the head and/or strangulation), and their effect on mental health disorders among Black women, who experience higher rates of IPV and greater mental health burden than White and Latina women. The study examined data on 95 Black women with a history of abuse, such as IPV, forced sex, and childhood maltreatment. Results showed that approximately one-third of women had probable TBI. 38% were hit on the head, 38% were strangled to unconsciousness, and 25% were strangled and hit on the head. A significant percentage of abused Black women who sustained probable TBI injuries were found to have a greater chance of experiencing comorbid PTSD and depression. These results highlight a need for healthcare professionals to assess women who lost unconsciousness due to IPV for TBI, and allow referrals to IPV interventions and mental health treatment.
  • Emily Brignone, Anneliese Sorrentino, Christopher Roberts and Melissa Dichter, ‘Suicidal ideation and behaviors among women veterans with recent exposure to intimate partner violence’ (2018) 55 General Hospital Psychiatry 60-64.
    Female veterans are at a disproportionately high risk for suicide and intimate partner violence (IPV) compared to female non-veterans. Suicide rates increased by 32.7% among veterans between 2005 and 2015. There is evidence that female veterans differ from non-veterans in terms of IPV-related experiences. The authors examined the US Veterans Health Administration (VHA) electronic medical records for 8427 female veterans who completed screening for past-year IPV between April 2014 and 2016. Results showed a strong connection between IPV and suicidal ideation, and self-harm behaviours among VHA female veterans.
  • Farzan-Kashani, Julian and Christopher Murphy, ‘Anger Problems Predict Long-Term Criminal Recidivism in Partner Violent Men’ (2017) 32(23) Journal of Interpersonal Violence 3541-3555
    Anger problems are not only an important correlate of IPV, but may also be an important factor underlying treatment response for IPV perpetrators. Of 132 men receiving treatment services at a community-based DV agency, those with serious anger problems had more charges for general violence offences and more ongoing problems with protection orders than did those with ‘normal’ anger levels. Further, low anger control and high anger expression predicted general violence recidivism. The results demonstrate that new intervention approaches are necessary for partner violent men with serious anger dysregulation, as a standard cognitive-behavioural treatment program may not suffice.
  • Humphreys, Cathy, and Ravi Thiara, ‘Mental Health and Domestic Violence: “I Call It Symptoms of Abuse”’ (2003) 33 British Journal of Social Work 209-226.
    A UK research project based in Women's Aid outreach services shows a direct link between women's experiences of domestic violence and heightened rates of depression, trauma symptoms, and self-harm. The study also shows that women’s experiences of mental health services were often negative due to some unhelpful practices within the medical model of mental health, including: lack of recognition of trauma or provision of trauma services; a focus on the woman's mental health rather than the actions of the abuser and her experiences of abuse; victim blaming; offering medication rather than counselling support; labelling the woman with mental health problems, and thereby enabling adverse consequences in child contact and child protection.
  • This study investigates the linkages between interpersonal violence, mental health, and sexual identity (pp 2-3). The results indicate that:

    • Compared to exclusively heterosexual women, mainly heterosexual and bisexual women were significantly more likely to report physical, sexual, and emotional abuse (p 4);
    • Mainly heterosexual and lesbian women were more likely to report severe physical abuse (p 4);
    • Mainly heterosexual women were more than three times as likely to have been in a violent relationship in the past three years (p 4);
    • All sexual minorities were two to three times as likely to have experienced harassment (p 4);
    • Bisexual women reported significantly higher levels of depression and scored lower on mental health than did exclusively heterosexual women (pp 6, 7);
    • Interpersonal violence strongly predicted poorer mental health for lesbian and bisexual women (p 6);
    • Mental health indicators were similar for exclusively heterosexual and sexual minority women who did not report interpersonal violence (pp 6, 7);
    • Experiencing multiple types of interpersonal violence was the strongest predictor of stress, anxiety and depression (p 6).
    Interpersonal violence is a significant contributor to mental health disparities for women, particularly for those belonging to sexual minorities (pp 7-8).
  • May, Barbara A, et al, ‘Are Abused Women Mentally Ill?’(2003) 41(2) Journal of Psychosocial Nursing & Mental Health Services 21-29.

    This study attempted to profile the psychological distress symptoms of community-based abused women who were participating in a larger intervention study and compare them to normative samples using the same measure (Derogatis Brief Symptom Inventory (BSI)) to better understand the effects of intimate partner violence on their mental health. The study sample (N = 50) experienced complex trauma and various psychological manifestations consistent with [cited] literature on victims/survivors of intimate partner violence; contrary to the researchers’ implicit assumption, they profiled more like the psychiatric adult female outpatients than the adult female nonpatients.

    The authors note that studies have shown a hesitancy to diagnose abused women as mentally ill because the stigma of "being crazy" tends to be used to rationalize their situations, resulting in victim blaming and revictimization. They observe also that these studies may have minimized the likelihood of self-disclosure or help-seeking, and explained health care providers' reluctance to consider this diagnosis.

    ‘In the community of health care providers for abused women, there is a strong need to refrain from "pathologizing" or labeling victims/survivors of abuse as mentally ill. However, the BSI findings in this study do indicate symptomatology in this nonclinical, community-based sample of abused women is very high in all dimensions and in the global indexes, which suggests serious mental distress.

    Abused women are fearful of being labeled as "sick" and further stigmatized by the situations for which they actively seek answers…However, mental illness, regardless of origin, must be diagnosed so it can be treated properly…Health care providers then must educate the abused women about possible benefits of diagnosis using a "social contextual advocacy-based model" … However, it is important to remember that for many women in abusive situations a diagnosis of mental illness can work against them in a court case. In particular, when children are involved, this diagnosis may be detrimental, and the women may lose custody of their children because of it.’ (pp 25-27)
  • Mechanic, Mindy, Terri L Weaver and Patricia A Resick, ‘Mental Health Consequences of Intimate Partner Abuse: A Multidimensional Assessment of Four Different Forms of Abuse’ (2008) 14(6) Violence Against Women 634.
    This article explores the independent contributions of physical violence, sexual coercion, psychological abuse, and stalking on symptoms of posttraumatic stress disorder (PTSD) and depression among a sample of 413 severely battered, help-seeking women. The authors test the unique effects of psychological abuse and stalking on mental health outcomes, after controlling for physical violence, injuries, and sexual coercion. The research finds, among other things, that ‘harassing behaviours and emotional and verbal abuse both emerged as significant individual predictors in the full model, suggesting their unique contribution to post-traumatic stress symptoms among battered women.’(p649)
  • Siegel, Judith P, ‘An Expanded Approach to Batterer Intervention Programs Incorporating Neuroscience Research’ (2013) 14(4) Trauma, Violence and Abuse 295.
    This article reviews findings of neurobiological research that have informed the treatment of disorders that are strongly represented among perpetrators of intimate violence, such as addiction, posttraumatic stress disorder, mood, anxiety, and personality disorders. The author argues for an expanded perspective and approach that recognize the relationships among childhood trauma, emotional regulation impairment, and intimate partner violence.
  • Shorey, Ryan C et al, ‘The Prevalence of Mental Health Problems in Men Arrested for Domestic Violence’ (2012) 27(8) Journal of Family Violence 741.
    This US study examines self-reported psychopathology among men arrested for domestic violence (N = 308). Results replicated past research showing high rates of PTSD and depression. In addition, the prevalence of generalized anxiety disorder, panic disorder, social phobia, and alcohol and drug disorders were very high. All types of mental health problems were positively associated with aggression perpetration. The authors acknowledge the need for further research investigating the mechanisms responsible for this association. (p746)