Domestic abuse: The hidden factor

Mental Health Nursing,  Mar 2003  by Tummey, Francesca

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Last year the Department of Health (2002) produced a consultation document, focusing on the development of mental health services for women. There is recognition, throughout, that women's requirements need to be more gender-specific due to their role in society and their experiences of mental health services. Also, recommendations were included for women who present with experiences of violence and abuse and urging organisations to develop staff awareness by providing training, support and treatment interventions (DoH, 2002). The issue of ensuring staff awareness and the impact of domestic abuse (DA) on a woman's mental health is the focus of this paper by Fran Tummey using a case study and supporting literature

Awareness of DA has implications for ourselves, as workers, if we consider that the health service is predominantly made up of female staff and nursing is traditionally viewed as a female profession (Holland and Hogg, 2001). Indeed, statistics (1999) in a Home Office study that is thought to provide the most reliable findings to date on the extent of domestic abuse in England and Wales, suggest that one in four women would encounter some form of domestic abuse in their lifetime. Therefore, the phenomenon not only touches our service users but may also affect our colleagues or us. However, it is suggested that society is slow to recognise it as an issue at all. It is only since the 1960s that physical abuse of children and women has been widely recognised, despite the fact that DA is indiscriminate and can affect any woman from any walk of life in many different forms, (Blackburn 1993).

In the Home Office report Home Office (2000) on DA the term is defined thus: 'Any violence between current or former partners in an intimate relationship, wherever and whenever the violence occurs. The violence may include physical, sexual, emotional or financial abuse.'

Although this article focuses on women, as the quote shows, DA is not a phenomena that just affects women. Incidence has been reported within the male population although men are less likely to be subjected to a repeated pattern of abuse (Mirrlees-Black, 1999).

Mental health needs assessment is one of a mental health nurse's main roles and if we consider the above information it seems likely that we will encounter women who are currently or have been subjected to DA and emotionally affected by it. These women will be from all social groups, classes, of any age, race, disability, sexuality or lifestyle. Williams and Watson (1994) state 50 per cent of women who use our services have been sexually and/or physically abused. However, one of the dilemmas that arise for nurses is that DA is often hidden and there is a strong association with stigma and shame (DoH, 2002).

Watkins (2001) suggests that the patriarchal nature of mental health services often reinforces this by failing to respond to, or sometimes disempowering, women by not hearing their distress. He urges workers to address disclosure with sensitivity so as not to replicate the abuse that these women have experienced, sometimes all through their lives. Awareness needs to be raised in order for effective intervention to be an outcome of our assessment process. Basic information and guidance procedures should be given to staff for them to feel supported when working with women who disclose and so hopefully, preventing any further violence while instilling confidence within the worker (DoH, 2000). Fear itself is a great silencer and sometimes women keep quiet, as they do not think they will be believed or will even be blamed.

Health care professionals also need to address their own feelings about DA in order to offer advice or listen to women in a way that does not perpetuate the abuse or reinforces a societal belief that blames women for the abuse they experience (Williamson, 2000).

To illustrate, a case study will highlight one worker's experience. It will analyse some of the reasons that entrenched the client in her situation and the subsequent effects on her mental health. Care has been taken to ensure that no one can be recognised from the material and any association is purely co-incidental. Names and some details have also been changed to protect the individual's identity.

Case study

Mary (not her real name) is a woman in her fifties, of Irish origin, who has been married to Jim for 35 years. She moved from Ireland in her teens. Most of her extended family remained in Ireland although her parents are now dead.

She has adult children who live locally. She was close to her children as they grew up but since they left home she saw them less frequently. She has never had employment outside the home and most of her social activities are orientated around her home and the Church.

Her husband retired on health grounds and became depressed, requiring treatment within the mental health system. As a community mental health nurse, I received a referral for Jim (not his real name) who was due to be discharged from an in-patient unit.