A report synopsis
Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 29-31
Violence and trauma have serious health impacts for women.iolence and trauma have serious health impacts for women.
In 2002 the BC Centre of Excellence for Women’s Health (BCCEWH) published a report, Violence and Trauma in the Lives of Women with Serious Mental Illness: Current Practices in Service Provisions in British Columbia.1 The report looked at how services are delivered to women with chronic and persistent mental health problems who are survivors of violence. The research team focused on five different mental health care settings in two BC health regions, using focus groups and interviews. They also surveyed programs across BC.
The report found that mental health programming and planning still doesn’t thoroughly attend to the broad psychological and social aspects of mental health, despite a commitment in the 1998 BC Mental Health Plan.2
Marina Morrow, the lead investigator on the report, told Visions in a recent interview: “The most consistent message I heard was that violence and trauma are seen as separate from mental illness and substance use, and more holistic forms of mental health care are needed.”
Relationship between mental health and trauma
The report discusses several views on the interrelationship of violence, trauma and mental illness.
Mental illness as precipitated by abuse
Many practitioners fail to identify violence and trauma symptoms as separate from symptoms of major mental illness; consequently, many victims of trauma enter the mental health system misdiagnosed with mental illness. It is suggested that when practitioners do view trauma symptoms discretely, some diagnoses may be revised to acknowledge PTSD, rather than, or in dual diagnosis with, major mental illness.
There are some practitioners who recognize that abuse in childhood can be an important cause in a number of psychiatric disorders.
Mental illness as a risk factor for abuse
Practitioners are more inclined to accept that mental illness is a risk factor for abuse. The risk can be a direct outcome of the woman’s illness and/or medication that she takes for her illness. Medication, as well as co-occurring substance use problems, may impair her judgment, making it difficult for her to protect herself from violent attackers and/or coercive sex.
Studies have demonstrated strong links between trauma and later substance abuse, suggesting that women may use substances to self-medicate the psychological symptoms arising from trauma. Not surprisingly, women with histories of repeated abuse are more likely to face homelessness, addiction and mental illness diagnoses, placing them at further risk for sexual and physical abuse. As a result, homelessness, substance abuse and being diagnosed with mental illness are both outcomes of, and risk factors for, future abuse.
Victimization in the mental health system
Trauma associated with the mental health care system in British Columbia—that is, the way services and treatment are provided in the province—has been recognized as a serious concern.
Retraumatization may arise from standard treatment practices. For instance, physical and chemical restraints can trigger feelings of powerlessness. Stigma and powerlessness are central to the experiences of trauma and psychiatric hospitalization. Betrayal is another dynamic of abuse. Even when treatment providers act in the ‘best interest of individuals, the treatment process may re-create previous patterns of abuse.
The need for gender analysis
That women are more often targets of intimate violence is a fact resulting from gender analysis (i.e., analysis that examines differences in men’s and women’s lives).
Many mental health professionals, however, downplay the significant role violence and trauma play in women’s lives. Or, professionals choose to see it as an issue separate from mental health; consequently, current assessment tools and treatment plans don’t regularly take violence and trauma into account. This severely limits the ability of the mental health system to respond effectively to people who have experienced violence and trauma.
Mandates and diagnoses
Service providers working in hospital settings, as well as those working on community mental health teams, stated that their treatment is driven by policy mandates. Policy directs most of system’s resources to people who primarily have Axis I diagnoses,3 such as mood disorders, anxiety disorders and psychotic disorders.
Many symptoms associated with histories of severe trauma and abuse, however, are consistent with symptoms that result in Axis II diagnoses,3 such as borderline personality disorder, dissociative identity disorder, eating disorders and post-traumatic stress disorder. An Axis II diagnosis can mean being refused hospital or community mental health services. This means that the practitioners were not able to adequately treat women with Axis II diagnoses. As a result, a screening process may unintentionally affect the ability for violence and trauma survivors to access services, resulting in overuse of emergency services.
Is addressing violence “counter-therapeutic”?
Trauma specialists suggest that women need sufficient ego strength and support to begin exploring traumatic life events. Thus, bringing up the past is damaging if she is unable to access long-term support. Pragmatically, many workers recognize that without specific programs and supports in place for women, it is not possible to begin addressing trauma histories.
About the authorShanti is an undergraduate student in communication studies at Simon Fraser University. She is currently on a co-op term at Canadian Mental Health Association, BC Division.
Morrow, M. (2002). Violence and Trauma in the Lives of Women with Serious Mental Illness: Current Practices in Service Provisions in British Columbia. Vancouver, BC: BC Centre of Excellence for Women’s Health. www.bccewh.bc.ca/PDFs/violencetrauma.pdf.
BC Ministry of Health and Ministry Responsible for Seniors. (1998). Revitalizing and rebalancing British Columbia’s mental health system: The 1998 Mental Health Plan. Victoria, BC: Queen’s Printer. www.healthservices.gov.bc.ca/mhd/pdf/mhpd.pdf
American Psychiatric Association. (2000). Multiaxial assessment. In Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: author.