Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 4-5
It is a pleasure to introduce this issue of Visions, with its focus on women’s mental health and sub stance use concerns. This issue is a testament to the many steps we have taken toward understanding the connections between these issues, and to the big leaps still needed to provide integrated, womencentred prevention, harm reduction and treatment.
Since 1993, I have worked on substance use programming, evaluation and research in British Columbia. In that time period, much progress has been made, but at the same time, we continue to learn more about the complexities of the links between women’s mental health, substance use and other health concerns.
I have had the opportunity to collaborate with many of the contributors to this issue of Visions through my involvement with BC Women’s Hospital and Health Centre and the Vancouver and Area Women’s Addictions Services Providers Network. Others I have met on collaborative research teams on substance use, fetal alcohol spectrum disorder, disordered eating, and mental health and violence issues, with the British Columbia Centre of Excellence for Women’s Health.
Many of the articles and narratives here illustrate just how difficult the lives of many women are. So often, our addictions and mental health systems have forced women to focus on only one, or more recently two, problems at a time—at great cost to the women who need to understand their experience of multiple burdens and to receive more holistic support.
Bringing in the voices of women who are consumers of mental health services, survivors of trauma and/ or who are reducing harm from substance misuse or are in recovery helps us see the ways we can be compassionate to women carrying multiple burdens, and see how to make our programs and policies much more flexible and comprehensive. These stories also remind us of how, within our experiences as women, there is so much difference. The challenge is to recognize both our oneness and our diversity.
The evidence of need for a women-centred health care response continues to mount. Marina Morrow’s article discusses the benefits of research that investigates how sex and gender interact to produce conditions that are unique to, more prevalent among, or more serious for a particular sex, or that have different risk factors or interventions for women and men.1,2 And in November 2004 alone, news of new research poured in: on associations between marital quality, social support and depressive symptoms in women;3 on increase in date rape drugging;4 on the connection between women’s work stress and greater vulnerability to anxiety (see p. 12); and increased alcohol consumption after the terrorist events of September.
It is striking how often violence and sexual assault is mentioned as linked to mental health and substance use. The Canadian Research Institute for the Advancement of Women reports that half of Canadian women have survived at least one incident of sexual or physical violence, that over a quarter of Canadian women have been assaulted by a spouse, and that girls, more so than boys, are targets of abuse within the family (79% of family-related sexual assaults are on girls).6 Thus it is very encouraging to see the articles here from BC-based services that have been able to integrate ‘trauma-informed’ care.7 Integrated services for women with co-occurring disorders and trauma histories are being developed in other countries as well.8 This integration of issues is definitely an important and longoverdue direction in responding to women’s mental health and substance use issues.
Women’s experience of substance use, mental health and violence in pregnancy is another theme in the articles here. Nichole Fairbrother illustrates how far we have yet to go to provide care for pregnant and postpartum women with mental health problems. Other articles, however, describe the hopeful programming being developed by BC Women’s Hospital, Sheway, the Northern Family Health Society and the 40-plus Pregnancy Outreach Programs across BC. These service providers all recognize and address the multiple connections between women’s physical health, nutrition, mental health, income security, roles as mothers, discrimination, experience of isolation, and violence and substance use. They also continue to explore how we can best provide harm reduction-oriented and holistic care in this critical period of women’s lives, in a way that focuses equally on women’s and fetal health—honouring their inextricable nature. These are important steps toward creating a welcoming treatment system for pregnant women.
Many contributors have been long-term advocates of women’s health, and, like Carol Savage, are concerned about maintaining and expanding a focus on women’s addictions and mental health services. Two recently released provincial frameworks support system-wide change in this direction. Every Door is the Right Door, a provincial strategic planning framework on addiction, advocates a more comprehensive, genderand diversity-sensitive service system, built on the foundations of population health, health promotion, harm reduction and community involvement. Advancing the Health of Girls and Women, the recently released women’s health strategy for British Columbia, identifies “supporting women-centred approaches to mental health and problem substance use and addiction for girls and women” as one of three initial priorities.
Now our interdependent work as researchers, policy makers, program providers and women’s health advocates becomes even more crucial in order to realize these visions in policy and service system design. As this edition of Visions reveals, much has been accomplished in improving our research, programs and policy regarding women’s mental health and substance use issues, but there remains a giant leap to be taken to truly provide a comprehensive and positive response to women.
About the Author
Nancy has over 20 years experience in knowledge translation, research, policy and practice relating to women and substance use issues. She currently works as Provincial Research Consultant on women’s substance use issues, based at the Aurora Centre at BC Women’s Hospital, a role which involves evaluative research and knowledge translation efforts on the provincial and national levels on women’s substance use and its treatment. Nancy also works with the BC Centre of Excellence for Women’s Health on research related to women’s health and substance use that is designed to inform policy and service provision. She also teaches on substance use issues through the Justice Institute of BC
Greaves, L., Hankivsky, O., Amaratunga, C. et al. (2000). CIHR 2000: Sex, gender and women’s health. Vancouver, BC: BC Centre of Excellence in Women’s Health.
Pinn, V. & La Rosa, J. (1992). Overview: Office of Research on Women’s Health. Bethseda, MD: National Institutes of Health.
Spotts, E., Neiderhiser, J., Ganiban, J. et al. (2004). Accounting for depressive symptoms in women: A twin study of associations with interpersonal relationships. Journal of Affective Disorders, 82(1), 101-111.
Picard, A. (2004, November 5). ‘Date-rape drugging’ increases dramatically. Globe and Mail, p. A13.
Richman, J.A., Wislar, J.S., Flaherty, J.A. et al. (2004). Effects on alcohol use and anxiety of the September 11, 2001, attacks and chronic work stressors: A longitudinal cohort study. American Journal of Public Health, 94, 2010-2015.
Morris, M. (2002). Violence Against Women and Girls. Retrieved November 8, 2004, from www.criaw-icref.ca
Harris, M. & Fallot, R.D. (2001). Using Trauma Theory to Design Service Systems. San Francisco, CA: Jossey-Bass.
Moses, D.J., Huntington, N. & D’Ambrosio, B. (2004). Developing Integrated Services for Women with Co-occurring Disorders and Trauma Histories. Retrieved November 15, 2004, from www.wcdvs.com/pdfs/LessonsFinal.pdf
BC Ministry of Health Services. (2004). Every Door is the Right Door: A British Columbia Planning Framework to Address Problematic Substance Use and Addiction. Victoria, BC: Author.
BC Women’s Hospital and Health Centre and BC Centre of Excellence for Women’s Health. (2004). Advancing the Health of Girls and Women: A Women’s Health Strategy for British Columbia. Vancouver, BC: Authors.