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Partnerships Between Domestic Violence & Mental Health Organizations
WRITTEN BY JASMYN BROWN, AURORA SMALDONE & REBECCA HOFFMANN FRANCES
Strengthening partnerships between Domestic Violence (DV) programs and local mental health organizations increases accessibility and responsiveness and can make a crucial difference for many survivors. Learn more about developing strong partnerships to enhance your services for parent and child survivors.
The relationship between DV and mental health is complex. DV is the most common form of violence worldwide, causing increased risk of depression, anxiety, suicidal ideation, and other mental health concerns (WSCADV, 2009).
Despite the correlation between DV and mental health issues, partnerships between DV programs and mental health organizations aren’t common and services have often operated in silos. While not all parent and child survivors want or can benefit from clinical mental health services, those that wish to access care should be able to easily engage with a supportive and knowledgeable provider. Although a large percentage of people receiving mental health services have experienced DV, many survivors report finding services unhelpful, harmful or even re-traumatizing. Often, mental health providers don’t have formal training in how to address the impacts of DV on parent and child survivors, including dyadic approaches to working with parents and children together, or how to address safety concerns. A cross-disciplinary and multi-generational approach is vital in order to meet the full scope of the needs of parent and child survivors, and the communities they live in (Oram et al., 2022).
Strengthening the partnership between DV programs and mental health organizations can make a crucial difference for many survivors. Other potential advantages of such cross-disciplinary partnerships are (King County Coalition Against Domestic Violence, 2016):
Stronger policies and services that prevent and respond to DV (World Health Organization, 2022)
Overall improved mental health for parent and child survivors (World Health Organization, 2022)
Increased access to effective, empathic and person-centered mental health care for survivors (Oram et al., 2022)
Shared commitment to providing direct services and advocacy on behalf of individuals and families impacted by violence (King County Coalition Against Domestic Violence, 2016)
Awareness raised of the impact of DV on individual and community health and shared leadership fostered across systems to promote positive health outcomes and healthy relationships (King County Coalition Against Domestic Violence, 2016)
Movement to creating services that are fully accessible, gender responsive, culturally attuned, trauma-informed and grounded in the needs of survivors, their families and their communities (Wilson, 2020)
Better equipped to meet the needs of families impacted by DV by working together (Wilson, 2020)
“At their best, strong DV and health care partnerships develop relationships, rapport, and a high level of mutual trust between organizations that enables bidirectional learning, more comprehensive and aligned care, and better client outcomes.”
History and Considerations
Although it is clear that DV can negatively impact the mental health of parent and child survivors, a rift has historically existed between mental health and DV advocacy spheres. This is for a number of reasons:
DV survivors sometimes face significant obstacles in accessing culturally relevant and appropriate mental health supports (Birchall and McCarthy, 2021)
Parent survivors can be fearful of asking for mental health services out of fear of child welfare involvement and child removal to foster care
Survivors often face barriers such as insurance issues, economic hardship, and long waiting lists for mental health treatment because of a lack of clinical resources available to them (especially for children)
Survivors may also receive treatment that falls short of addressing their needs or that causes harm because it is not culturally relevant or trauma-informed (Birchall and McCarthy, 2021)
Providers do not always understand how to respond to survivors or know how to work with parents and children together. They may react to a parent in a way that minimizes the violence or places blame on them
Language barriers and cultural differences within the practices in the separate systems may lead to stigma, ineffective care, misunderstandings, and harm (La Piana Consulting, 2016)
DV advocates sometimes challenge the appropriateness, and safety, of psycho-medical approaches to addressing harm caused by DV (Moulding et al., 2021). This is because the pathologization of a survivor’s response to DV can carry stigma and indicate that reactions to violence and abuse are abnormal in some way. In addition, a mental health diagnosis resulting from the experience of DV can be used against survivors by abusers, particularly in the context of child custody disputes (Birchall and McCarthy, 2021).
“Recognition of the association between intimate partner violence and mental health conditions has grown in the past 10 years, but huge gaps and areas for improvement remain… Improving understanding of the links between violence and mental health, is the first step. The next step is to train people in how best to address these often severe, ongoing issues.”
Problematic responses to the mental health concerns of survivors can include (Birchall and McCarthy, 2021):
Victim-blaming attitudes
Separation of mental health concerns from experiences of violence
Separation of coping strategies from experiences of violence
Misattributing mental health concerns to disability rather than as a result of violence
Placing the entire onus on a parent survivor to seek support
Questioning a survivor’s capacity as a parent as a result of a mental health disclosure or substance misuse
Lack of knowledge about safety and the use of power and control, which may put the survivor at risk of further violence
Inappropriate and unsafe practices of utilizing couples counseling or family counseling in cases where DV is occurring
Strategies for strengthening the relationship between DV programs and mental health organizations
Historically, systems that support DV survivors and mental health systems have been siloed from each other. This, along with differences in philosophies and practices have caused these systems to work independently, and even sometimes in opposition to one another (WSCADV, 2009). By working in partnership, these two systems can increase the positive outcomes they have on reducing DV, or the impact of DV on families. The following are some strategies for strengthening these partnerships:
Center lived expertise of parent and child survivors. Survivors are fundamental to the development and assessment of support services at every level, from grassroots survivor-led services to statutory mental health services (WSCADV, 2009)
Begin by exploring the strengths that both systems bring to the collaboration. Mental health systems typically emphasize client empowerment and are sensitive to trauma-informed care. DV programs are skilled in supporting survivors, understanding the ways that control and power have been used, and they foster the ability for survivors to take back control in their lives (WSCADV, 2009)
Understand the importance of the other system. For example, ask the mental health organization to provide training to local DV program staff on trauma-informed care, and invite DV advocates to train on the dynamics of DV and how power and control is used in relationships and the impacts on parents and children. This knowledge is essential for protecting the safety of the survivor and family (Department of Health and Human Services Information Memorandum, 2019)
Find common ground through mission, vision, and framework. For example, the framework of trauma theory shifted the notion of “psychopathology” to the understanding that mental health symptoms in the survivor were actually adaptations as a result of being abused. In addition, the theory sees empowerment and connection as central to the healing process, which is a notion shared by DV advocates (Warshaw et al., 2003)
Develop shared goals. For example, co-lead a community collaborative with the goal of creating “no wrong door” to services for survivors and families. Bring the important organizations to the table to develop a community-wide safety net and work together toward this common goal (Warshaw, 2003)
Introduce legislation. Work together to create legislation that advocates for the needs of survivors and families
Co-locate services. DV advocates can be embedded within community–based medical and behavioral health centers to provide easy access to advocacy and safety planning for survivors. DV programs can hire or contract trained clinicians to provide clinical mental health (or physical health) services for parent and child survivors at the DV program or shelter. Clinicians and providers should be trained in culturally relevant and evidence–informed models including individual, dyadic, multigenerational approaches that are specific to addressing the impact of DV