1. Domestic violence and mental illness - challenging stigma and stereotype Debbie Hager 2008

2. There is a group of women - most of whom will remain unidentified - who are not only abused by their partners, but are also experiencing severe mental distress This mental distress is: Compounding these women’s difficulty accessing help Used by abusive partners to further abuse women Preventing services responding appropriately to women who are attempting to access help

3. Domestic violence and mental illness/substance abuse At least 257 women each year are unable to access refuge services because they are perceived to have mental health and/or substance abuse problems. Many more women remain unknown to researchers or services These women – and their children – are trapped in abusive relationships, with all of the attendant long- term effects of experiencing violence.

4. Domestic violence and mental illness/substance abuse If women in this circumstance access mental health or drug and alcohol services they run the risk of losing custody of their children to either the state or the abusive partner, and of their partner gaining even more control over them because of the stigma attached to their diagnosis.

5. “Male control works by coercion. Men violate their partners to coerce them into control. Male role control works by physically, verbally or emotionally destroying your partner’s physical, intellectual and emotional integrity so that she will be afraid to be herself, will control herself, and therefore be available to be controlled by you.” Man Alive, 1995

6. Power and control wheel

7. Long Term Effects of Domestic Violence On going fear Lack of volition Diminished ability to deal with stress Being superwoman Vigilance – constantly watchful Suspicious Afraid – including for the children Depression

8. Long term effects cont. Worn down Shattered Isolated Disassociating Blocking out – having gaps in their lives Reality checking becomes poor

9. Why women thought they were mad. Wanted to burn down the house – with the children in it Tried to commit suicide Running away No sense of reality Put into a psychiatric hospital (three of the women) Labelled schizophrenic, paranoid schizophrenic, bi- polar, depressed, having post traumatic stress disorder

10. Why women thought they were mad. Wanted to give her child away Told over and over again they were mad Feeling “crazy” Committed under the act Being given a diagnosis Being given psychiatric drugs

11. Effects of dv from the literature  Suicide Studies from around the world put the statistics of suicide related to domestic violence at: 1/4 of suicides of women in America, 1/2 of all suicides by African American women and 41% among Fiji Indian women.

12. Effects of dv from the literature  Alcohol abuse. About one third of abused women will abuse alcohol or drugs. Most abused women only begin drinking heavily after the abuse has started.

13. Effects of dv from the literature  Mental illness diagnoses Women who have been abused are commonly diagnosed as suffering from: major depression trauma anxiety disorders including panic attacks eating disorders obsessive compulsive disorder multiple personality and personality disorders.

14. Effects of dv from the literature sleeping disorders self-neglect malnutrition aggression towards ones-self and/or others including repeated self injury dissociative states chronic pain compulsive sexual behaviours sexual dysfunction or pain poor adherence to medical recommendations

15. Key themes Abuse, especially emotional abuse, makes women think they are crazy. Services deepen and reinforce the feelings of abuse. Being labeled results in problems with stigma and discrimination and lowered self esteem and can decrease women’s grasp of reality Women’s explanations of their own experience are either not believed or reinterpreted. Abuse must be named DV is more confusing because of socialised expectations of love and and marriage

16. Abuse, especially emotional abuse, makes women think they are crazy. They, (mental health services) need to understand… that… the most damaging part of domestic violence is actually the unseen part, the emotional. I think that’s where the connection is (with mental health). If you can imagine if someone is taking abuse all the time, and someone is telling you you’re no good and someone is telling you you can’t do something, how are you going to end up? You’ll end up feeling…I’m just here to be used and abused, I’m not worth anything else, I can’t do that so I won’t do it. You’ll have no goals, no thoughts, you’ll just get by day by day. For me that was the connection, it wasn’t physical…the worst part is the words, the words are really cruel…Sticks and stones will break your bones but names will never hurt you…but it does hurt. (C1)

17. The effects of being labelled When I went to Carrington I had a physical illness, I had pleurisy, I was totally worn out. I was bringing up two children on my own because we had separated, and I had just finished a relationship with someone I was in love with for the first time in my life, so I wasn’t really sure about my emotions and that kind of thing. My husband came on the scene because I rang him and said I need your help with the kids because I’m not well. He rang Carrington because I wasn’t sleeping well and he said I was acting strange – but acting strange was I was crying a lot…and I can’t see he had any reason to put me in Carrington (J5)

18. Services deepen and reinforce the feelings of abuse. No-body asks you about your relationship and if there ’ s violence and stuff... ” (J5) “ What really fucks me off... is that these men never get brought to justice, while the likes of myself have to go through all the... stuff that ’ s around because of what ’ s supposed to be wrong with us and yet there ’ s nothing wrong with these people who are causing it... ” (J5)

19. Services deepen and reinforce the feelings of abuse. They were treating me for all these things, bipolar, schizophrenia,… but I wasn’t responding…I was on fifteen drugs, three times a day…I became an addict because of the drugs… (B1) That’s when they put me on a whole heap of drugs that made me really out of it (after she was raped in the psychiatric hospital)…that’s when they gave me the diagnosis of bi- polar… (J5) I haven’t had any sign from any psychiatrist … that my anxiety and fear are normal and are linked to other people’s behaviour and actions towards me (S1)

20. What compounded these feelings? Institutional abuse, such as: Not being heard, not believed by the people they accessed for help Being given psychiatric drugs Being released into the care of the abuser – from hospital No-one asking women why they were in the state they were in Power and control behaviour of professionals

21. What compounded these feelings? Being labelled – the stigma of being crazy Being seen as a stereotype Being told that you are the cause of your own problems Being counselled about how to change their behaviour so that they wouldn’t upset their partners

22. Abuse must be named Knowing what I know now, would have been to tell me I was being raped which I didn’t know - and to have told me what I could do about that which I didn’t know either. I didn’t know there were women’s refuges and I didn’t know I was being raped and I didn’t know I was being abused and I didn’t know that what was happening to me was called domestic violence and any of that information would have been useful to me...” (B2) You can’t solve your problems if you don’t know what they are. But once you know what they are, or understand what they are, you can make the healing process start. (C1)

23. Domestic violence is more confusing because of socialised expectations of marriage and romance. This man is the man you love, he’s the man – if you married him – it’s the man you chose to spend your whole life with. He’s the father of your kids, he professes daily that he loves you and your mind cannot comprehend, if this is the man I love or he loves me – how can he do this to me, to our children? And that’s what hurts, you know? I’ve listened to that man for an hour telling my father and me how he was going to slice up our son in front of us and put him in a bag and he’d be so cut up he wouldn’t be recognisable. That this child was a bastard – and it was his son. I loved this man I married, I loved the man I chose to have a child with – that man is no longer here, if that makes sense. I love the man who offered me the world, who offered me a white wedding and a home and lots of children, and I honestly believe that when he made those promises, he meant them. (D1)

24. Women’s explanations of their own experience are either not believed or reinterpreted. I would have liked to have been listened to…but really listened to. Not just the thing that seems to happen, where people seem to want to talk at me rather than collect what I’m saying (S1) I’m very nervous about going through court. He’s a very powerful, plausible man and I just shrink when I’m in the room with him – not always of course…but in that sort of setting I feel beaten before I start. He’s got custody of two sets of daughters before. The fact that he’s got this far when he’s not her father just astonishes everybody – it doesn’t astonish me – he’s impressed the professionals all the way along (R2)

25. What women want  Sleep.  To be asked, specifically and comprehensively, about domestic violence.  To be heard and believed.  Information and language to describe their experiences and make informed choices.  To be safe – to be offered and encouraged to use appropriate support services.  Time to think and reflect.  Not to be pathologised, stereotyped, stigmatised.

26. What helps Don’t pathologise a woman’s behaviour - it may be a reasonable response to a dangerous and traumatic situation Screen for domestic violence Listen to women and believe their stories Never minimise or disregard what a woman is saying Help women develop a safety plan Help women access appropriate support and information groups

27. What helps Never send women home to an abusive partner - unless she insists Remember - medication can make her less able to protect herself and the children Don’t judge her parenting by the abuse she has put up with - it may have kept the children as safe as possible Provide information - like the power and control wheel and the cycle of violence - to help her understand her situation

28. What we’re doing about it!! Website - for more information www.homeworkstrust.org.nz Seminars and education Lobbying and advocacy A documentary - inspired and part funded by the 2007 New Zealand Mental Health Media Grants

29. Aims of the documentary  raise the issue of the needs of women, and their children, who are unable to access conventional refuges and other domestic violence, legal and other services because of mental health and drug and alcohol problems  suggest constructive service responses  increase the knowledge of a wide audience of government and social service providers, medical professionals, child care workers, teachers, police, prosecutors, family law lawyers, and family court judges and others about this issue  enhance the skills and strategies, of agency staff, for advocacy and appropriate assistance for these women and children,

30. The script presents:  dramatised experiences of women who have been abused – and who are mentally unwell or drunk – attempting to get help  information about mental illness and domestic violence and the size and scope of the problem in New Zealand

31. Costs The ongoing costs, to the state, associated with this issue include:  Years of life lost because of suicide and homicide  The time that women are unable to function without support  The cost of service responses to abused women – CYF, social services, child and family services  Diminished realisation of educational, employment and personal potential  The long-term effects on the children and wider family, including the perpetuation of intergenerational violence, and a wide range of ongoing health problems for the children as adults.

32. Costs  Placing and keeping children in foster care or in the care of the state  Ongoing judicial costs related to the Family and Criminal Courts  Women and children’s ongoing use of mental health and substance abuse services  Rehabilitation and long term care  Personal health services such as A&E and GP services for ongoing physical health problems and problems associated with self harming behaviours  The inappropriate care of women who have been abused – i.e., placed in mental health services when they really require domestic violence services