0808 2000 247 Free phone 24 hr National Domestic Violence Helpline Run in partnership between Women’s Aid & Refuge
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Women's Aid - The Survivor's Handbook - DV and health
Domestic violence and your mental health
 
Domestic violence can have an enormous effect on your mental health. It is now well accepted that abuse (both in childhood and in adult life) is often the main factor in the development of depression, anxiety and other mental health disorders, and may lead to sleep disturbances, self-harm, suicide and attempted suicide, eating disorders and substance misuse. (See References.)
 
Some statistics:
  • Abused women are at least three times more likely to experience depression or anxiety disorders than other women.
  • One-third of all female suicide attempts and half of those by Black and ethnic minority women can be attributed to past or current experiences of domestic violence.
  • Women who use mental health services are much more likely to have experienced domestic violence than women in the general population.
  • 70% of women psychiatric in-patients and 80% of those in secure settings have histories of physical or sexual abuse.
  • Children who live with domestic violence are at increased risk of behavioural problems and emotional trauma, and mental health difficulties in adult life. (See also Children and domestic violence.)
An audit in Greenwich found that 60% of mental health service users had experienced domestic violence. Another survey of women using mental health services in Leeds found that half of them had experienced domestic violence and a further quarter had suffered sexual abuse.
 
How your mental health can be used to abuse you further
 
If you have a mental health diagnosis, your partner may have used this to abuse you even more. For example, by:
  • Saying you couldn't cope without him.
  • Saying you're 'mad'.
  • Not allowing you to go anywhere alone because he is your 'carer'.
  • Speaking for you: "You know you get confused/you're not very confident/you don't understand the issues".
  • Telling you you're a bad mother and cannot look after the children properly.
  • Forcing you to have an abortion because 'you couldn't cope'.
  • Threatening to take the children away.
  • Threatening to "tell Social Services" - the implication being they will take the children away.
  • Telling the children "Mummy can't look after you".
  • Deliberately misleading or confusing you.
  • Withholding your medication.
  • Withholding or coercing you into using alcohol or drugs.
  • Undermining you when you disclose the abuse or ask for help: "You can't believe her - she's mad".
These tactics will almost certainly add to your emotional distress and exacerbate any existing mental health issues.
 
Seeking help
 
If you have been diagnosed with a mental health disorder, you will be in a particularly vulnerable position, and are likely to find it even harder to report domestic violence than other women. You are likely to suffer from a sense of shame because of the stigma attached in our society to having mental illness of any kind, and you may feel even more powerless. Furthermore, the response of the service providers is also likely to be more problematic, due to the stigma of being 'mentally ill':
  • They may not believe you when you disclose abuse.
  • They may see you only when your partner is present.
  • They may accept your partner's account at face value.
  • They may feel sympathy for your partner - "After all he has had to put up with" - or blame you for the abuse.
  • They may judge you (particularly if you are self-harming or have attempted suicide, or if you use alcohol or drugs).
Don't blame yourself! Your mental health difficulties are not your fault, and you are not responsible for the abuse: the abuser is. You are entitled to help as much as any other abused woman, and if you have additional support needs, you should get help with them too.
 
Some refuge organisations are unable to offer accommodation to women with severe mental health needs because they have insufficient resources to provide suitable support. However, other refuges will be able to accommodate you - and all refuge organisations should be able to find you somewhere else to go. If you have decided to leave your abuser, you could ring the Freephone 24 Hour National Domestic Violence Helpline on 0808 2000 247, run in partnership between Women's Aid and Refuge, which will be able to put you in touch with a refuge organisation that can provide accommodation that meets your support needs.
 
Mental health services
 
Despite the frequent overlap between domestic violence and mental ill health, mental health professionals seem generally to ignore the issue of abuse. They are unlikely to ask you about it and may therefore be unaware of it. You yourself may feel unable to disclose the abuse to your GP or to your community psychiatric nurse (CPN) or your psychiatrist (if you have one). So you may find that the reasons for your depression or other difficulties are ignored. You may feel blamed for the abuse. And you are very likely simply to be offered medication (such as tranquillisers, anti-depressants or sleeping pills) instead of being given an opportunity to talk about what is happening or has happened to you.
 
When mental health professionals do take domestic violence into account, they may still disagree about the causes of your condition and how to treat it. For example, some psychologists believe that the diagnosis of post-traumatic stress disorder (PTSD), most often associated with wars or natural disasters such as fire or earthquake, or experiences such as torture or being held hostage, can be appropriately applied to survivors of domestic violence. Other people argue that anxiety and depression, and even self-harm or suicide attempts may be the normal response to the experience of long-term abuse.
 
While depression tends to ease when women are no longer being abused this will not happen immediately. It may take a long time for you to come to terms with what has happened. You may suffer continued abuse and harassment long after the relationship itself has ended - and you are likely to live in fear of it for much longer. You may also experience flashbacks long after the violence has ceased.
See Surviving after abuse: Looking after yourself and moving on for some suggestions on how to deal with this.
 
Counselling
 
All women who are experiencing or have experienced domestic violence will need emotional support of some kind, but their needs will vary. All women need to be listened to with respect and without being judged when they choose to talk about their experiences. They want to be believed - and to feel they have been understood. Mutual support from other women who have had similarly abusive experiences can be very valuable: it will help you to feel less isolated and to recognise that none of the abuse you experienced was your fault. You will get this kind of support if you go into a refuge, or if you use a Women's Aid outreach service, or join a support group.
 
Some women may benefit from more formal counselling or psychotherapy - though not usually while they are still living with their abuser or immediately after escaping from the violence, when physical safety and practical issues are likely to be of greater concern. If you decide you would like some counselling, the following information may help you.
 
Counselling is a two-way relationship, in which the counsellor listens to whatever you want to say, in confidence and without making judgements. Counsellors are not supposed to give advice, but they may ask questions or challenge you in ways which may help you to look more carefully at some of the assumptions you may have taken for granted. Usually you will have regular sessions, for an hour or slightly less, each week or every two weeks. Psychotherapy tends to be more intensive than counselling, and may continue for a longer period of time, as issues are explored in more depth. Some people, however, use these terms interchangeably.
 
The aim of counselling is to help you understand yourself better and come to terms with what has happened to you. Good counselling will help you to break away from past abusive relationships and work towards living in a way which is more satisfactory and fulfilling for you. It can also help you to build up your self esteem. However, counselling is not for everyone - and you have to decide whether it is right for you and whether this is the right time for it.
 
If you decide you want some counselling, it is important that the counsellor or therapist you choose is right for you, and that she is appropriately qualified and experienced. She should also have a good understanding of domestic violence and its effects, and should take care not to appear to blame you or make you feel guilty in any way for the abuse you experienced. Styles of counselling differ a lot - depending in part on the theoretical approach of the counsellor or therapist - and you may find some approaches more helpful then others.
 
In some parts of the country, there are counselling services specifically set up by women for women, and many of these have a particular focus on issues of violence and abuse. Some also offer support groups for survivors of domestic violence. Some of these are listed at the end of this section. If you contact your local Women's Aid organisation, they may be able to put you in touch with a counselling service or support group in your area. Some counselling organisations offer sessions that are free of charge; others charge a fee dependent on your income.
 
Your GP surgery may have a counsellor to which your doctor could refer you, or he or she might refer you to an NHS psychologist - though there could be a long waiting list. NHS services will be free of charge, but may be time-limited. Alternatively, you could contact an organisation such as the British Association for Counselling and Psychotherapy (BACP) which can give you a list of trained and accredited counsellors in your area. These will charge an hourly fee, though some may have concessionary rates for those on low incomes. In each case, it is important that you feel happy with your counsellor, and are able to build up a rapport and a sense of trust in the relationship.
 
Further information
 
Freephone 24 hour National Domestic Violence Helpline on 0808 2000 247, run in partnership between Women's Aid and Refuge: They will be able to put you in touch with your local Women's Aid organisation or other domestic violence service.
 
Saneline: For anyone concerned about their own mental health or that of someone else. Local rate helpline: 08457 678 000, open 1pm - 11pm every day. Website: www.sane.org.uk
 
Samaritans: Provides a listening service for those in distress or considering suicide. 24 hour helpline: 0845 790 9090.
 
Rethink (formerly the National Schizophrenia Fellowship): Rethink provides a wide range of services throughout the UK, including supported housing, helplines, employment projects and support groups. To contact the Rethink National Advice Service, please call 020 8974 6814. The Service is available from Monday to Friday 10am – 3pm, except Tuesday and Thursday 10am - 1pm. Website: www.rethink.org
 
Mind: Mind offers information and support on mental health issues, and where to get help. The national information line can put you in touch with local Mind groups, which may run local helpines, support groups and other activities. Mind also produces a wide variety of leaflets and other publications on mental health issues. Mindinfoline: 08457 660 163, Monday - Friday 9:15am - 5:15pm (not bank holidays). Typetalk for callers with hearing or speech problems who have access to minicom: 0800 959 598. Email: contact@mind.org.uk. Website: www.mind.org.uk
 
Threshold: The helpline, due to lack of funding, can only provide information and a signposting service to women, their carers and workers during 10am - 1pm on Tuesdays. Women's Mental Health Infoline: 0808 808 6000, Answerphone at other times. Email: infoline@thresholdwomen.org.uk. Website: www.thresholdwomen.org.uk
 
No Panic: Provides a free information pack, and their answerphone refers callers to other numbers where they can talk to one of their volunteers for support. Also refers to local services when available. Freephone: 0808 808 0545, 10am - 10pm, for those suffering from anxiety disorders and panic attacks.
 
Depression Alliance: Depression Alliance has a national network of self-help groups. It also offers a correspondence scheme. It does not offer a helpline scheme. Phone: 0845 123 2320 (local call rates) for a free information pack and to find out contact numbers for services locally. Email: information@depressionalliance.org. Website: www.depressionalliance.org
 
National Self-harm Network: For those who self-harm or for those supporting them. The network offers information (and debunks myths) about self-harm and lists organisations which provide support. Website: www.nshn.co.uk
 
Bristol Crisis Service for Women: This service is for women in emotional distress, particularly those who injure themselves. The service provides a range of booklets on topics such as self-help for self-injury. Although Bristol-based, it serves the whole of the UK, and can refer to local services if needed. Address: PO Box 654, Bristol, BS99 1XH. Helpline: 0117 9251119, Friday and Saturday 9pm -12:30am; Sunday 6pm - 9pm.
 
Rape and Sexual Abuse Support Centre (RASASC): Helpline will take calls from women nationwide, and refers to local services if appropriate. Also offers face-to-face counselling and group counselling for women in Croyden who have been raped or sexually abused. P.O.Box 383, Croydon, CR9 2AW. Helpline: 0845 122 1331, weekdays 12 noon - 2:30pm and 7:00pm -9:30pm; weekends and bank holidays 2:30pm - 5pm. Minicom: 020 8239 1124. Email: info@rasasc.org.uk. Website: www.rasasc.org.uk
 
Young Minds Parents' information service: Provides help for parents concerned about a young person's mental health. Has a variety of leaflets and booklets, including one which explores how divorce and separation affect children and young people. Phone: 0800 018 2138, Monday - Friday 10am - 1pm; Tuesday and Thursday 1pm - 4pm; Wednesday 1pm - 4pm and 6pm - 8pm. Website: www.youngminds.org.uk
 
Counselling services for women
 
British Association for Counselling and Psychotherapy: This is the professional body for general counselling services, and can give you names of qualified and BACP-accredited counsellors in your area. The website includes a note on 'Finding the right therapist', as well as a directory of therapists throughout the UK. Phone: 0870 443 5252. Email: bacp@bacp.co.uk. Website: www.bacp.co.uk

Womankind Helpline: Offers face-to-face counselling and support groups for women in the Bristol and South Gloucestershire areas. Phone: 0845 458 2914, Monday - Friday 10am - 12 noon; Tuesday and Wednesday 1pm - 3pm; Monday and Tuesday 8pm - 10pm. Answerphone at other times. Website: www.womankindbristol.org.uk
 
The Maya Centre for women living with violence: Services are provided free for women on benefits or low incomes who have not had the opportunity to use other counselling services and have not had the benefit of degree-level education. Phone 020 7281 2728. Address: Unit 11, City North Trading Estate, Fonthill Road, London N4 3HN. Email: info@mayacentre.org.uk

Women's Therapy Centre: For psychotherapy by women, in the London area. Phone: 020 7263 6200. Address: 10 Manor Gardens, London N7 6JS. Email:
 
Woman's Trust: Woman’s Trust is an independent and confidential  service providing mental health and support services for women who have been or are affected by domestic violence. All our services are free and are aimed at women who cannot afford to pay for this kind of support themselves. We are a women-only  organisation and offer one-to-one counselling, personal development workshops and support groups as well as support to front line services.
Phone: 020 7034 0303/0304 
Address: Lighthouse West London, 111-117 Lancaster Road, London, W11 1QT
 

References
 
Barron, J. (2004) 'Struggle to survive: Challenges for delivering services on mental health, substance misuse and domestic violence' (Bristol: Women's Aid Federation of England).
Bowstead, Janet (2000) 'Mental health and domestic violence: Audit 1999' (Greenwich Multi-agency Domestic Violence Forum Mental Health Working Group).
Department of Health (2002) 'Women's Mental health: Into the Mainstream: Strategic Development of Mental Health Care for women'.
Department of Health (2003) 'Mainstreaming Gender and Women's Mental health: Implementation Guidance'.
Golding, Jacqueline (1999) 'Intimate partner violence as a risk factor for mental disorders: A meta-analysis' Journal of Family Violence Vol.14 (2) pp.99-132.
Herman, Judith (1994) 'Trauma and recovery: From domestic abuse to political terror' (London: Pandora).
Humphreys, Cathy and Thiara, Ravi (2003) 'Mental Health and Domestic Violence: "I call it symptoms of abuse"' British Journal of Social Work 33, pp.209-226.
Mullender, A. and Morley, R. (1994) 'Children living with domestic violence' (London: Whiting and Birch).
ReSisters (2002) 'Women speak out' (Leeds: ReSisters).
Stark, Evan and Flitcraft, Anne (1996) 'Women at risk: Domestic violence & women's health' Thousand Oaks, California: Sage.