Barriers to Mental Health Services for Domestic Violence Survivors

Problem Statement

Referral to outside services remains the most common practice of North Carolina domestic violence shelters and agencies for addressing mental health issues among survivors. However, practitioners estimate that only 5-20% of survivors actually receive services. This number is low considering 47.6% suffer from depression, 63.8% have PTSD, 17.9% exhibit suicidality, 18.5% struggle with alcohol abuse, and 8.9% live with substance abuse problems. The gap between women who need services and women who receive services is the result of a cultural divide between mental health services and the battered women’s movement.

1. Differing beliefs about mental health’s connection to domestic violence

The North Carolina Coalition Against Domestic Violence (NCCADV) and researchers at Duke’s Center for Child and Family Policy hold opposite views regarding mental health’s interaction with domestic violence.  Researchers from Duke take the stance that mental health services may be necessary for recovery for some survivors.  They believe that the population affected by domestic violence may need services more than the general population.  On the other hand, the NCCADV 2012 Best Practices Manual asserts that simply being in a domestic violence relationship does not increase a person’s need for mental health care.1  This manual is out of date and does not account for psychological research that has demonstrated a higher need for mental health care in domestic violence survivors than the general population.

2. Opposing models of care

The mental healthcare industry was modeled after the medical model of care where a patient seeks an expert for diagnosis and treatment.  On the other hand, the Battered Women’s Movement grew out a strong belief in the empowerment model, which emphasizes the survivor’s right to choose her/his own paths for recovery and take the initiative as the expert on her/his life.  These models oppose one another because the medical model can take away a patient’s empowerment by imposing expert opinions and advice, especially if the practitioner misdiagnoses the patient or administers treatment that the survivor would not choose on her own.

3. Antagonistic history between the mental healthcare and the Battered Women’s Movement

The mental healthcare field has a history of “blaming the victim” for the perpetrator’s violent actions.  Psychology has labeled women as the “mad” sex since the emergence of Western thought in Greece.  The phenomenon continued into modern American psychology when Freud misdiagnosed sexual assault victims as women whose repressed sexual fantasies were driving them insane.  Various forms of “blaming the victim” theories emerged after Freud including “battered women syndrome,” “learned helplessness,” “self-defeating personality disorder,” and “masochistic personality disorder.”  Even today, psychologists operate under a diagnostic system that does not recognize the difference between an anxiety disorder and symptoms of anxiety that appear after a person has been living in a dangerous situation.  Jane Allen Wilson, training and technical assistance specialist at the NCCADV, states that, “If someone is working on the empowerment model they would be reluctant to talk about mental health in many ways because they [survivors] have been mislabeled too much.”  Jane Allen also believes that these cultural divides prevent cross-trainings between the mental health and domestic violence advocate communities on the local level.