Sunflower seeds of progress

Mental Health Nursing,  Mar 2003  by Pollock, Laurence

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Many women experiencing domestic abuse and suffering from mental illness can fall between different support networks. But the Sunflower Centre in Northampton has set out to tackle this by making a unique appointment. Laurence Pollock reports

I couldn't believe they asked him to section me...he was the reason I was in there.' Years later, Alison (not her real name) still chokes back the indignation as she recalls the treatment she received from her former partner.

Alison suffered from domestic abuse. But she also has a diagnosis of mental illness and this often masked the torment she endured in an oppressive, one-sided relationship.

For mental health professionals, there is a challenge to see the brutal reality behind the appearance of a psychotic episode or a period of severe depression. Many - consultants, doctors, nurses - never see the signs. The health staff who treated Alison believed she was self-harming.

Yet the National Service Framework for Mental Health states: People who have been abused or been victims of domestic violence have higher rates of mental health problems.'

And the recent strategy for women's mental health states 'experience of domestic violence [is] a significant factor in the development of mental ill health and poorly provided for in all settings'.

The strategy says a lead person needs to be identified in every NHS trust to generate local expertise and ensure that the impact of violence and abuse is addressed as a core mental health issue. Responsibilities should include facilitating appropriate interagency working, ensuring access to staff training and monitoring assessment and care planning processes to ensure that violence and abuse are sensitively addressed.

The appointment of Karen Kelly to work at the Sunflower Centre in Northampton is a pioneering bid to help those affected by domestic abuse who suffer from mental illness. As a mental health worker, Karen is there to help separate out the two problems while recognising the links between them.

The Sunflower model, now at several centres around the UK, is itself setting new standards in helping those who are terrorised or degraded out of their homes. It seeks to offer any referral or any client a suite of support, from accommodation and legal to health, children's needs and voluntary support agencies.

The creation of Karen's post, funded by Northamptonshire county council, is a recognition that mental health needs must also be represented. Currently some refuges for abuse survivors may not take a woman who acknowledges a mental illness diagnosis. It could mean referral to in-patient settings which might not be appropriate.

In other cases, reporting domestic abuse is seen as a symptom of the illness - and, therefore, not taken seriously. Karen will help clients with mental health problems who are not accessing services. She does not have a professional nursing background and does not carry a caseload - the aim is short term intervention.

Karen is well placed to pick up on those with mental illness problems. The Sunflower's web based Virtual access' centre is a good portal for those with internet facilities. Nevertheless, many clients come through the traditional routes. This can include the police officer on the local domestic violence forum.

'We find it really useful that the officer, if called out to an incident, will file a report and send us a copy,' says Karen. 'We can then offer a service.'

GP surgeries held at the Sunflower centre will also pick up on mental health problems, while recording evidence, including photographic, that may play a part in future proceedings.

Karen is supervised by Tracey Palmer, CPN team leader for Northampton Community Healthcare Trust. They meet up on a monthly basis for Tracey to give Karen clinical supervision and discuss any problems she may have at a Trust Level about accessing mental health services.

'Karen can contact me anytime as I am identified as the mental health lead and I am well known within the services,' says Tracey.

'In addition, the steering group still meets monthly to ensure that Karen's workload is manageable and to identify work priorities.'

With support Karen can triage patients and recognise severity of illness: 'Nearly everyone will have reactive depression at some time or another,' she points out.

Tracey Palmer says the development of the post has enabled a 'true partnership' to develop between voluntary and statutory agencies, due to her visibility and accessibility.

This in turn has raised awareness and communication, both with service users and professionals about the quality of services available to victims of domestic abuse and mental health problems.'

Surveys have shown that the phenomenon of domestic abuse is disturbingly widespread stretching across social classes and often persisting through long, unhappy marriages and relationships. Women on men and men on men domestic abuse have also been recognised, though more recently.

Past generations may have tolerated and acknowledged men's casual assaults on their partners and declined to intervene. But today, such experience is denied and it is stigmatic for a woman to talk about. When this is added to inhibition about disclosing mental illness, seeking and obtaining help can be extremely difficult.