This document discusses domestic violence and its relationship to mental health. It notes that domestic violence is associated with an increased risk of various mental disorders in both men and women. Experiencing domestic violence is also linked to poorer mental health outcomes. While the causal relationship is complex, domestic violence appears to increase the severity of mental health symptoms. The document then reviews prevalence rates of domestic violence among mental health patients and barriers to disclosure. It concludes by discussing interventions for domestic violence survivors with mental illness, including trauma-focused cognitive behavioral therapy and advocacy services integrated within mental health teams.
Sydney Sexual Health Centre Journal Club presentation by Kristen McCormack on AIDS and Behaviour Volume 20 Issue 7, published in July 2016.
AIDS and Behavior provides an international venue for the scientific exchange of research and scholarly work on the contributing factors, prevention, consequences, social impact, and response to HIV/AIDS. The journal publishes original peer-reviewed papers addressing all areas of AIDS behavioral research including: individual, contextual, social, economic and geographic factors that facilitate HIV transmission; interventions aimed to reduce HIV transmission risks at all levels and in all contexts; mental health aspects of HIV/AIDS; medical and behavioral consequences of HIV infection - including health-related quality of life, coping, treatment and treatment adherence; and the impact of HIV infection on adults children, families, communities and societies. The journal publishes original research articles, brief research reports, and critical literature reviews.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioni...Christine Wekerle
The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
Shannon Stewart, Yasmin Garad, Natalia Lapshini
Learning Telehealth in the Midst of a PandemicJohn Gavazzi
This presentation outlines the basics of beginning to work with patients via telehealth. The workshop offers both pragmatic and technical assistance to start working with patients at a distance or online
Sydney Sexual Health Centre Journal Club presentation by Kristen McCormack on AIDS and Behaviour Volume 20 Issue 7, published in July 2016.
AIDS and Behavior provides an international venue for the scientific exchange of research and scholarly work on the contributing factors, prevention, consequences, social impact, and response to HIV/AIDS. The journal publishes original peer-reviewed papers addressing all areas of AIDS behavioral research including: individual, contextual, social, economic and geographic factors that facilitate HIV transmission; interventions aimed to reduce HIV transmission risks at all levels and in all contexts; mental health aspects of HIV/AIDS; medical and behavioral consequences of HIV infection - including health-related quality of life, coping, treatment and treatment adherence; and the impact of HIV infection on adults children, families, communities and societies. The journal publishes original research articles, brief research reports, and critical literature reviews.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioni...Christine Wekerle
The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
Shannon Stewart, Yasmin Garad, Natalia Lapshini
Learning Telehealth in the Midst of a PandemicJohn Gavazzi
This presentation outlines the basics of beginning to work with patients via telehealth. The workshop offers both pragmatic and technical assistance to start working with patients at a distance or online
Introduction to Moral Injury, Theory & PracticeJohn Gavazzi
This presentation outlines how humans beings are moral animals. Our morality is a function of biological, psychological, and evolutionary processes. Moral Injury refers to longstanding emotional, psychological, social, and spiritual suffering related to an individual’s moral compass, conscience, or spiritual beliefs.
We review examples of moral injury and ways to work with moral injury in context of psychotherapy.
Ethical reasoning: decision science, biases, and errorsJohn Gavazzi
The workshop explores ways to teach ethical reasoning using decision science, cognitive errors, and biases as part of being human. Categories include: the need to act fast, too much information, insufficient evidence, faulty memory processes, and tribal knowledge.
The Effects of Trauma on Health Care Utilizationandreacamden
This webinar will discuss the effects of childhood trauma on health care utilization and chronic illness. Susan Lax is an Advanced Practice Nurse with a dual degree in psychiatry/mental health nursing and primary care nursing from the Institute of Health Professions at Massachusetts General Hospital. She is certified in Trauma Studies by the Trauma Center at JRI, trained by Bessel van der Kolk and his colleagues. She has completed trainings in Sensorimotor Psychotherapy, a mindfulness approach to treating trauma disorders. In all, she has completed more than 300 hours of training in the treatment of acute and developmental trauma. In 2010 Susan was awarded a leadership in nursing award for her success incorporating a trauma treatment as she worked in acute, residential, and community settings in the Greater Boston Area, including on a PACT team.
1.1.7 AWHN Conference 6 2010 Federation:
Specialist Mental Health and Women’s HealthWorking In Partnership To Better Address the Intersection(s) of Mental Health and Violence and Abuse. Women’s Health Statewide Zhila Javidi, Centre for Anxiety and Related Disorders
The DSM-IV and ICD-10 have defined hundreds of mental disorders which vary in onset, duration, pathogenesis, functional disability, and treatability. The designation of gender identity disorders (GID) as mental disorders is not a license for stigmatization, or for the deprivation of patients' civil rights. The use of a formal diagnosis is often important in offering relief, providing health insurance coverage, and guiding research to provide more effective care.
DSM-5 Development Group indicate that GID can still be given to children who reject the assigned gender but who do not experience any anatomical dysphoria. To qualify as a mental disorder, a behavioral pattern must result in a significant adaptive disadvantage to the person or cause personal mental suffering. However, the removal of distress/impairment criterion can lead to over-diagnosis of children who do not meet criteria. Instead, it is argued that criterion should be kept based on distress resulting from living in the present gender as apposed to anguish stemming from societal prejudice and discrimination. It would be more appropriate and respectful if the diagnosis is written in language reflecting contemporary views of gender rather than views that are based on gender-specific games or clothing.
Goals: Psychotherapy often provides education about a range of options not previously seriously considered by the patient. It emphasizes the need to set realistic life goals for work and relationships, and it seeks to define and alleviate the patient's conflicts that may have undermined a stable lifestyle.
The Therapeutic Relationship: The establishment of a reliable trusting relationship with the patient is the first step toward successful work as a mental health professional. This is usually accomplished by competent nonjudgmental exploration of the gender issues with the patient during the initial diagnostic evaluation. Other issues may be better dealt with later, after the person feels that the clinician is interested in and understands their gender identity concerns. Ideally, the clinician's work is with the whole of the person's complexity. The goals of therapy are to help the person to live more comfortably within a gender identity and to deal effectively with non-gender issues. The clinician often attempts to facilitate the capacity to work and to establish or maintain supportive relationships.
Language is very important to indicate that a community is making an effort to be trans-friendly. It often makes the difference in whether a transgender person will approach a community and/or clinician and whether they will choose to stay.
This briefing overviews the research on the extent, consequences, risks and prevention strategies for family violence with a focus on preventing family violence in North Carolina.
Preventing Intimate Partner Violence Across the Lifespan: A Technical Package...InstitutodeEstadstic
Preventing Intimate Partner Violence
Across the Lifespan: A Technical Package of
Programs, Policies, and Practices
Developed by:
Phyllis Holditch Niolon, PhD
Megan Kearns, PhD
Jenny Dills, MPH
Kirsten Rambo, PhD
Shalon Irving, PhD
Theresa L. Armstead, PhD
Leah Gilbert, PhD
2017
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Georgia
Sexting and well being among Young Gay Men and MSM in the USYTH
Researchers at University of Michigan's SexLab looked at young adults experiences with sexting, and found no correlation with depression, anxiety or self-esteem. Findings are discussed with a particular emphasis on sexual health.
Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.
The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
Introduction to Moral Injury, Theory & PracticeJohn Gavazzi
This presentation outlines how humans beings are moral animals. Our morality is a function of biological, psychological, and evolutionary processes. Moral Injury refers to longstanding emotional, psychological, social, and spiritual suffering related to an individual’s moral compass, conscience, or spiritual beliefs.
We review examples of moral injury and ways to work with moral injury in context of psychotherapy.
Ethical reasoning: decision science, biases, and errorsJohn Gavazzi
The workshop explores ways to teach ethical reasoning using decision science, cognitive errors, and biases as part of being human. Categories include: the need to act fast, too much information, insufficient evidence, faulty memory processes, and tribal knowledge.
The Effects of Trauma on Health Care Utilizationandreacamden
This webinar will discuss the effects of childhood trauma on health care utilization and chronic illness. Susan Lax is an Advanced Practice Nurse with a dual degree in psychiatry/mental health nursing and primary care nursing from the Institute of Health Professions at Massachusetts General Hospital. She is certified in Trauma Studies by the Trauma Center at JRI, trained by Bessel van der Kolk and his colleagues. She has completed trainings in Sensorimotor Psychotherapy, a mindfulness approach to treating trauma disorders. In all, she has completed more than 300 hours of training in the treatment of acute and developmental trauma. In 2010 Susan was awarded a leadership in nursing award for her success incorporating a trauma treatment as she worked in acute, residential, and community settings in the Greater Boston Area, including on a PACT team.
1.1.7 AWHN Conference 6 2010 Federation:
Specialist Mental Health and Women’s HealthWorking In Partnership To Better Address the Intersection(s) of Mental Health and Violence and Abuse. Women’s Health Statewide Zhila Javidi, Centre for Anxiety and Related Disorders
The DSM-IV and ICD-10 have defined hundreds of mental disorders which vary in onset, duration, pathogenesis, functional disability, and treatability. The designation of gender identity disorders (GID) as mental disorders is not a license for stigmatization, or for the deprivation of patients' civil rights. The use of a formal diagnosis is often important in offering relief, providing health insurance coverage, and guiding research to provide more effective care.
DSM-5 Development Group indicate that GID can still be given to children who reject the assigned gender but who do not experience any anatomical dysphoria. To qualify as a mental disorder, a behavioral pattern must result in a significant adaptive disadvantage to the person or cause personal mental suffering. However, the removal of distress/impairment criterion can lead to over-diagnosis of children who do not meet criteria. Instead, it is argued that criterion should be kept based on distress resulting from living in the present gender as apposed to anguish stemming from societal prejudice and discrimination. It would be more appropriate and respectful if the diagnosis is written in language reflecting contemporary views of gender rather than views that are based on gender-specific games or clothing.
Goals: Psychotherapy often provides education about a range of options not previously seriously considered by the patient. It emphasizes the need to set realistic life goals for work and relationships, and it seeks to define and alleviate the patient's conflicts that may have undermined a stable lifestyle.
The Therapeutic Relationship: The establishment of a reliable trusting relationship with the patient is the first step toward successful work as a mental health professional. This is usually accomplished by competent nonjudgmental exploration of the gender issues with the patient during the initial diagnostic evaluation. Other issues may be better dealt with later, after the person feels that the clinician is interested in and understands their gender identity concerns. Ideally, the clinician's work is with the whole of the person's complexity. The goals of therapy are to help the person to live more comfortably within a gender identity and to deal effectively with non-gender issues. The clinician often attempts to facilitate the capacity to work and to establish or maintain supportive relationships.
Language is very important to indicate that a community is making an effort to be trans-friendly. It often makes the difference in whether a transgender person will approach a community and/or clinician and whether they will choose to stay.
This briefing overviews the research on the extent, consequences, risks and prevention strategies for family violence with a focus on preventing family violence in North Carolina.
Preventing Intimate Partner Violence Across the Lifespan: A Technical Package...InstitutodeEstadstic
Preventing Intimate Partner Violence
Across the Lifespan: A Technical Package of
Programs, Policies, and Practices
Developed by:
Phyllis Holditch Niolon, PhD
Megan Kearns, PhD
Jenny Dills, MPH
Kirsten Rambo, PhD
Shalon Irving, PhD
Theresa L. Armstead, PhD
Leah Gilbert, PhD
2017
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Georgia
Sexting and well being among Young Gay Men and MSM in the USYTH
Researchers at University of Michigan's SexLab looked at young adults experiences with sexting, and found no correlation with depression, anxiety or self-esteem. Findings are discussed with a particular emphasis on sexual health.
Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.
The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.
There are many misconceptions about harm reduction. In this presentation, we will debunk the myths, explain what harm reduction is and provide examples of harm reduction in action throughout our province and nation. This presentation also includes how individuals can become volunteers with our agency.
This presentation was part of Embody's Safe Healthy Strong 2014 conference on sexuality education (www.ppwi.org/safehealthystrong). Embody is Planned Parenthood of Wisconsin's education and training programs. Learn more: www.ppwi.org/embody
DESCRIPTION
Improve clinical assessment of and increase referrals for IPV- including reproductive coercion – through increased understanding of the prevalence and impact of IPV, acknowledging the role that reproductive coercion plays in IPV, utilizing clinical best practices for IPV assessment and referral, and considering use of a brief, evidence-based, brochure-based intervention to enhance IPV and reproductive coercion assessment and referral in clinical settings.
ABOUT THE PRESENTER
Meghan Benson, MPH, CHES has worked in the field of sexuality education since she was a teen peer HIV educator in high school. She completed her MPH in Community Health Sciences with a focus on adolescent health and development at the University of Illinois at Chicago, and is a Certified Health Education Specialist (CHES). As the Planned Parenthood of Wisconsin Director of Community Education, Meghan develops programming and coordinates educational opportunities throughout the state. Meghan is a board member for the Association of Planned Parenthood Leaders in Education (APPLE), a co-chair of the Policy and Action Subcommittee of the Wisconsin Maternal and Child Health Advisory Committee, and a member of the Dane County Youth Commission.
Доклад Александра Хози на Codefest-2013. "Как screenshot-based средство автом...Badoo Development
Мобайл — молодая и стремительно развивающаяся отрасль, где лидеры и правила игры меняются с огромной скоростью. В силу молодости подходы к разработке и тестированию еще не окончательно устоялись, и имеется целый набор «детских болезней».
Докладчик рассказывает про то:
• как началась автоматизация iOS-приложений в Badoo;
• как мы выбирали инструмент;
• как на самом деле «работают» ОЧЕНЬ платные инструменты автоматизации;
• как пришли к Screenshot-based модели автоматизации;
• как скомбинировали c «традиционными» инструментами автоматизации;
• к чему пришли и куда будем двигаться дальше.
Il nuovo catalogo Campania 2013 di Imperatore Travel. Dopo mesi di negoziazione e cura del prodotto abbiamo realizzato una programmazione 2013 ricca di proposte legate al territorio. Grazie al costante impegno e alla profonda conoscenza delle destinazioni, Imperatore Travel è in grado di offrire vacanze su misura nelle località più esclusive del sud Italia, tra bellezze naturali, mare, tradizioni, storia, arte e cultura.
Destinazioni esclusive come le isole del golfo di Napoli (Ischia, Procida e Capri), la città di Napoli, la penisola sorrentina, la costiera amalfitana e il Cilento.
Trasferimenti puntuali e veloci alle migliori condizioni di mercato e la possibilità di scegliere tra i tanti tour Imperatore Travel per scoprire le bellezze e le eccellenze del territorio campano. Non solo arte e cultura, ma anche enogastronomia, tempo libero, shopping, natura e tanto altro nei Gran tour e Mini tour Campania, Gran tour Regno delle due Sicilie, Tour delle isole del golfo.
www.imperatore.it
Risk Reduction Through Family Therapy (RRFT)BASPCAN
An integrative approach to treating substance use problems and PTSD among maltreated youth.
Carla Kmett Danielson PhD
Medical University of South Caolina
Assessing and managing risk for violence among juveniles is an important forensic task. Clinical judgement is never sufficient for this important job. This presentation outlines methods of assessing and managing risk of violence among young people.
Interventions for preventing elder abuse: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of interventions for preventing elder abuse.
Philip Baker, Australia Regional Director APACPH, School of Public Health and Social Work Queensland University of Technology led the session and presented findings from their review:
Baker PRA, Francis DP, Hairi NN, Othman S, Choo WY. (2016). Interventions for preventing abuse in the elderly. Cochrane Database of Systematic Reviews, 2016, CD010321
http://www.healthevidence.org/view-article.aspx?a=interventions-preventing-abuse-elderly-29428
Many older adults experience some form of abuse (psychological, physical, and sexual) that often goes unreported. Elder abuse is associated with morbidity and premature mortality. This review examines the effectiveness of interventions for preventing elder abuse in the home, institutions and community settings. Findings of the review suggest there is uncertainty in the effectiveness of educational interventions to improve knowledge of caregivers about elder abuse and uncertainty on its effect of reducing abuse. This webinar will examine the effectiveness and components of interventions that prevent elder abuse.
Robert W Ball, Service and Workforce Development,
HIV/AIDS & Related Programs (HARP)
This presentation will discuss the focus testing of the same-sex domestic violence identification tool for health and community care workers developed by the HARP Unit of Sydney South West Area Health Service. Now in its final design, the screening tool is
flexible enough to be used both within government health care settings and throughout non-government support and care organisations.
Domestic Violence and Same-Sex Domestic Violence in an HIV Ambulatory Care Se...ACON
Ruth Hennessy, Psychology Unit Manager/Senior Clinical Psychologist, Albion Street Centre
In response to the gaps in the 2006 NSW Health Domestic Violence Screening Policy, Albion Street Centre developed a research project to explore clients’ experience of DV, helpseeking behaviours and whether HIV was a factor in any abuse experienced.
Anonymous surveys were completed by 102 clients attending the Albion Street Centre, over two separate four week periods. This
podium presentation will report the findings of the survey and contribute to improving health care worker’s understanding of
DV and SSDV within HIV positive clients’ relationships.
Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G.docxturveycharlyn
Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G., . . . Howard, L. M. (2014). Linking abuse and recovery through advocacy: An observational study. Epidemiology and Psychiatric Sciences, 23(1), 99-113. http://dx.doi.org.saintleo.idm.oclc.org/10.1017/S2045796013000206 Retrieved from https://saintleo.idm.oclc.org/login?url=https://search-proquest-com.saintleo.idm.oclc.org/docview/1494106370?accountid=4870
Linking abuse and recovery through advocacy: an
observational study
K. Trevillion1*, S. Byford2, M. Cary2, D. Rose3, S. Oram1, G. Feder4, R. Agnew-Davies5 and
L. M. Howard1
1 Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
2 Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry,
King’s College, London, UK
3 Service User Research Enterprise, Health Service and Population Research Department, Institute of Psychiatry, King’s College, London, UK
4 School of Social and Community Medicine, University of Bristol, Bristol, UK
5 Domestic Violence Training Ltd, Surbiton, Surrey, UK
Aims. High numbers of psychiatric service users experience domestic violence, yet limited interventions exist for these
victims. We piloted a domestic violence intervention for community mental health services to explore the feasibility of a
future cluster randomized controlled trial.
Methods. Quasi-experimental controlled design within five Community Mental Health Teams (three intervention and
two control teams). The intervention comprised domestic violence training for clinicians’ and referral to domestic violence
advocacy for service users. Clinicians’ (n = 29) domestic violence knowledge, attitudes and behaviours were assessed
before and 6 months post-training. Service users’ (n = 34) safety behaviours, unmet needs, quality of life and frequency/
severity of abuse were examined at baseline and 3 months follow-up. Process evaluation data were also collected.
Results. Clinicians receiving the intervention reported significant improvements in domestic violence knowledge, atti-
tudes and behaviours at follow-up (p < 0.05). Service users receiving the intervention reported significant reductions in
violence (p < 0.001) and unmet needs at follow-up (p < 0.05).
Conclusions. Interventions comprising domestic violence training for clinicians and referral to domestic violence advo-
cacy may improve responses of psychiatric services. Low rates of identification among teams not receiving training
suggest that future trials using service user outcomes are unlikely to be feasible. Therefore, other methods of evaluation
are needed.
Received 30 October 2012; Revised 14 March 2013; Accepted 18 March 2013; First published online 30 April 2013
Key words: Community mental health services, Domestic violence, intervention studies.
Introduction
Domestic violence – threatening behaviour, violence or
ab ...
One of the problems with coercion is that it is not apparent to the casual observer, especially when the victim has a mental disorder. This slide show illustrates the dynamics of this stealth-like characteristic characteristic of coercive abuse and why it is important that law enforcement and attorneys recognize coercive abuse in legal proceedings.
ISPCAN Jamaica 2018 (CIHRTeamSV) - Improving Health and Behavioral Outcomes a...Christine Wekerle
Improving Health and Behavioral Outcomes among Sexually Victimized Male Youth: A Qualitative Investigation Among Trauma Treatment Providers
Ashwini Tiwari, Christine Wekerle, Andrea Gonzalez (CIHRTeamSV)
Larry K. Brown, M.D., Professor, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island - presenting on the topic of Adolescent Sexual Behavior: What Does Reserch Say and What Can Clinicians Do? -- at the Sheppard Pratt Health System Wednesday Grand Rounds Series for Mental Health Professionals (in Towson, MD). Presentation delivered on January 20, 2010. Contact info@sheppardpratt.org for more information on CME presentations at Sheppard Pratt.
1. Domestic Violence and mental health
Louise Howard
Professor & Head of Section of Women’s Mental Health
2. Domestic violence
“Any incident of threatening behaviour violence
or abuse (psychological, physical, sexual,
financial or emotional) between adults who are
or have been an intimate partner or family
members, regardless of gender or sexuality”
(Home Office 2006)
New definition to include coercive behaviours
and age 16/17 (HO 2013)
3. Domestic violence
Global Burden Disease 2010 project:
• 200 000 deaths/yr attributable to IPV
• 1·5% (1·0—2·1) of DALYs
WHO multi-country study:
• Up to 69% of women report that an intimate
partner has physically abused them at least 1x
• Up to 59% of women report forced sex, or
attempted force, by an intimate partner
• Up to 28% of women report they physical abuse
during pregnancy by an intimate partner
Garcia-Moreno et al 2006; Lozano et al 2013; Murray et al 2013
4. Domestic violence prevalence
British Crime Survey
• Lifetime prevalence rates of isolated domestic
violence are comparable for men and women in
general population
• Women are at greater risk of repeated coercive,
sexual or severe physical assault
• Two women are murdered by their partner or ex-
partner every week in England and Wales
• Higher risk when, or soon after, leaving partner
• 40% female (7% male) homicide victims killed
by current or former partner
Tjaden & Thoennes 2000; Walby & Allen 2004
5. Figure 1. Flow Diagram of Screened and Included Papers.
Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review
and Meta-Analysis. PLoS ONE 7(12): e51740. doi:10.1371/journal.pone.0051740
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051740
6. Table 1. Characteristics of included studies (n = 41).
Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review
and Meta-Analysis. PLoS ONE 7(12): e51740. doi:10.1371/journal.pone.0051740
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051740
7. Figure 3. Pooled odds estimates for past year intimate partner violence among women with
depressive disorders.
Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review
and Meta-Analysis. PLoS ONE 7(12): e51740. doi:10.1371/journal.pone.0051740
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051740
8. Figure 5. Pooled odds estimates for past year intimate partner violence among women with
anxiety disorders.
Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review
and Meta-Analysis. PLoS ONE 7(12): e51740. doi:10.1371/journal.pone.0051740
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051740
9. Figure 6. Pooled odds estimates for lifetime intimate partner violence among women with post-
traumatic stress disorder.
Trevillion K, Oram S, Feder G, Howard LM (2012) Experiences of Domestic Violence and Mental Disorders: A Systematic Review
and Meta-Analysis. PLoS ONE 7(12): e51740. doi:10.1371/journal.pone.0051740
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051740
10. Other findings of Systematic Reviews
• Association found for all diagnostic categories
• In men and women
• More prevalent in women
• More studies in women
• Few longitudinal studies
• In longitudinal studies of perinatal populations,
Population Attributable Fraction for PND=12%
Howard et al In Press; Trevillion et al 2012
11. Prevalence of domestic violence
in mental health service users
Median prevalence of lifetime domestic violence
(in high-quality papers):
30% (IQR 26% - 39%) female inpatients
33% (IQR 31% - 53%) female outpatients
One high quality study for male patients:
18.4% for inpatients ;4.4% for outpatients.
Low rates of detection (10-30%)
Howard et al, 2010; Oram et al, In Press
12. Domestic violence and mental health - ?causal
• No diagnostic specificity – increased prevalence
for all disorders
• Severity of abuse ass with severity of symptoms;
symptoms when abuse stops
• Pre-existing mental health problems associated
with being in unsafe environments and
relationships
• Prospective data shows women who are involved
in abusive relationships have higher risk of
subsequent psych morbidity
• Antenatal DV associated with subsequent child
psychological morbidity and adult mental
disorders
• Women who experience domestic violence are
less likely to receive mental healthcare
Ehrensaft et al. 2006; Golding 1999; Howard et al 2010; Trevillion et al 2012
15. How should services respond?
Interventions
• Limited evidence but CBT effective in improving symptoms
and self esteem in women who have left abusive relationships
• Standard psychological interventions that are not adapted for
this population likely to be ineffective
• One small RCT of trauma (not specifically domestic violence)
focussed CBT for patients with severe mental illness
• Intensive (>12 hrs) advocacy for women at a refuge
quality of life, safety behaviours and abuse at 12-
24mths
• Brief advocacy intervention (<12 hrs) improves safety
behaviours
• Telephone intervention for women at a family violence unit
safety behaviours
Ramsay et al, 2009; Howard et al, 2009; McFarlane et al, 2002; Meuser et al, 2008; Sullivan & Bybee 1999
16. Figure 2
IRIS outcomes - Box plot of identification and referrals to advocacy
agencies of women experiencing domestic violence
(Vertical lines denote interquartile range)
Source: The Lancet 2011; 378:1788-1795 (DOI:10.1016/S0140-6736(11)61179-3)
Terms and Conditions
17. LARA pilot study: Intervention
Linking
• Domestic violence training of CMHT staff Abuse and
Recovery through
– 2 didactic/interactive workshops with on-going training
Advocacy
• LARA Advisors trained by mental health
professionals and domestic violence sector
• Clear referral pathways to LARA Advisors
• LARA Advisors integrated within teams
• Control CMHTs
18. LARA pilot study: measures Linking
Abuse and
• Professional knowledge and attitudes: Recovery through
Advocacy
PREMIS (Professional Readiness to Manage Domestic Violence)
• Service user outcomes
– Composite Abuse Scale
– MANSA Quality of Life
– Adult Service Use Schedule
– Safety Behaviour Checklist
– Camberwell Assessment of Need/CAN-M
– Social inclusion
• Process measures
– Referrals and number of sessions (LARA advisors)
– Nature of support provided by advisors
– Experience of the intervention for service users
22. MARACs (Multi-Agency Risk
Assessment Conferences)
•Often police-led - primary focus is to safeguard the adult victim
•Information shared on very high-risk domestic abuse cases
patients
•Attendance incls representatives of local police, probation, health,
child protection, housing practitioners, independent domestic
violence advisors
•Representatives discuss options for increasing the safety of the
victim
•Create a coordinated action plan.
• Victim does not attend the meeting but is represented by an IDVA
• Evaluations have found that their use reduces recidivism, even for
the highest risk patients, and improves professionals’ practice and
the safety of victims and their children
23. What Works for Service Users?
Qualitative data
Linking
Abuse and
Recovery through
Advocacy
Improved health professional response to disclosures:
“This way I’m actually getting help it’s not just been pen to paper;
cause in the past that’s what it was”.
Documentation of abuse:
“It’s a bit of a relief….that if anything did happen to me, you know,
things did go too far at least it was all on record”
Securing safety:
“Yeah speaking to her [Advisor] and asking her to help me do the
door, was a best plus….the door’s safe, so I know that no one can
bust it” .
24. What Works for Service Users?
Qualitative data
Linking
Abuse and
Recovery through
Advocacy
Integrated support:
“I just feel so much better knowing that…I’ve got a support network
around me that I can….talk too or talk about my issues…
beforehand I just felt like a bit isolated, I didn’t have no one”
“I could speak to any of them [referring to Advisors and mental
health professionals]…so I had like two sets of people that I could
contact, which was fantastic”
25. What Doesn’t work for Service Users?
Linking
Abuse and
Recovery through
Advocacy
Professional focus on separation from partner:
“He [referring to professional] wanted me to leave [partner] straight
away and because I didn’t have the strength to do it he said, sort
of, he can’t work with me anymore….I didn’t find that bit helpful at
all, because I thought that he should have supported me
regardless”.
Limited discussion of DV by health professionals:
“I could have done with a bit more support actually. I could have
done with a few phone calls or some letters or some more
information…. the CPN, the team haven’t asked me anything else
about it”
26. + Improvements in quality of life and social
inclusion
Reduction in number of unmet needs
27. LARA Conclusions Linking
Abuse and
• Increased prevalence of domestic violence Recovery through
experienced by mental health service users Advocacy
• Mental health service users experience significant
barriers to disclosure of domestic violence
• Barriers to enquiry are similar to those reported in
other settings; knowledge and practice not optimal
• Training on safe assessment and treatment needed
for mental health professionals
• Integration of multi-faceted intervention (training with
domestic violence advocacy) into mental health
services may be helpful
This presentation presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit
Programme (PB-PG-0906-11026). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the
Department of Health.
28. Acknowledgements Linking
Abuse and
ALSPAC Team:
LARA Team: Recovery
through
Roxane Agnew- Jonathan Evans Advocacy
Davies Clare Flach PROVIDE
Sarah Byford Team:
Gene Feder
Gene Feder Gene Feder
Jonathan Heron
Diana Rose Sian Oram
Kylee Trevillion Morven Leese
Kylee Trevillion
Anna Woodall Debbie Sharp
This presentation reports independent research commissioned by the
National Institute for Health Research (NIHR). The views expressed
are those of the author(s) and not necessarily those of the NHS, the
29. References
Trevillion K, Oram S, Feder G, Howard LM. Experiences of
Domestic Violence and Mental Disorders: A Systematic Review
and Meta-Analysis. PLoS ONE 7(12): e51740.
doi:10.1371/journal.pone.0051740
Howard LM, Trevillion K, Khalifeh H, Woodall A, Agnew-Davies R,
Feder G. Domestic violence and severe psychiatric disorders:
prevalence and interventions. Psychological Medicine 2010 40,
881–893.
Howard LM, Trevillion K, Agnew-Davies R. Domestic violence and
mental health. International Review of Psychiatry October 2010;
22(5): 525–534
Rose D, Trevillion K, Woodall A, Morgan C, Feder G, Howard LM.
Barriers and Facilitators of Disclosures of Domestic Violence by
mental health service users: a qualitative study. British Journal of
Psychiatry. March 2011 198:189-94.
Flach C, Leese M, Heron J, Evans J, Feder G, Sharp D, Howard
LM and the ALSPAC team. Antenatal Domestic Violence and
Subsequent Child Behaviour. BJOG 2011; 118 (11), 1383–1391
Editor's Notes
0·9% [0·7—1·2] DALY for sexual violence intimate partner violence, which accounted for 1·5% (1·0—2·1) of DALYs
Service users’ barriers to disclosure of domestic violence.
Professionals’ barriers to enquiry of domestic violence.
A wide range of individual psychological interventions have been demonstrated to show improvements for women with depression and post-traumatic stress disorder including for levels of depressive symptoms, post-traumatic stress symptoms and self-esteem (comprehensively reviewed by Feder et al (Feder et al. 2009). In particular, two trials of cognitive behavioural therapy for women with post traumatic stress disorder who were no longer experiencing violence suggest that cognitive behavioural approaches are helpful (Kubany ES et al. 2003; Kubany ES et al. 2004). There are also studies of group psychological interventions which show improvement in psychological outcomes though these have major methodological limitations (Feder et al, 2009). However, these findings cannot be extrapolated to women still in abusive relationships, nor for women with more severe psychiatric illnesses in contact with mental health services. Domestic violence advocacy
Box plot of identification and referrals to advocacy agencies of women experiencing domestic violence Vertical lines denote interquartile range.
Training manual;
Post Traumatic Stress Disorder Scale (PDS), which has been used to identify PTSD in domestic violence survivors (Foa et al, 1993) and psychiatric outpatients (Foa et al, 1997); Composite Abuse Scale (Hegarty et al, 2005), a validated scale measuring physical and sexual abuse, emotional abuse, severe combined abuse and harassment; Adult Service Use Schedule (AD-SUS), an interview measure of hospital and community health and social services, criminal justice sector resources, accommodation and productivity losses for use in the assessment of costs and cost-effectiveness (Barratt et al, 2006); EQ-5D measure of health related quality of life capable of generating a generic cardinal index of health-related well being to calculate quality adjusted life years (The Euroqol Group, 1990);
Commented on the improved response of MH prof to disclosures of abuse, which in past experiences hasn’t always been positive Process of staff documenting abuse Support from Advisors to improve safety
Integrated support of Advisors and MH prof greatly valued: Spoke of double support for MH and DV problems Ability to speak to both professionals about experiences Advisors able to provide clients with access to Freedom programme – looking at challenging abusers behaviour and meeting with other survivors to talk through experiences
Identified concerns: MH focus on separation from partner Some identified a limited discussion of abuse experiences by prof – Felt because prof felt Advisors responding to DV so they did not bring it up
Our findings suggest that mental health service users experience significant barriers to disclosure of domestic violence. This is concerning as people with severe mental illness are at increased risk of victimisation compared with the general population. Therefore these findings suggest the needs of people with experiences of domestic violence and mental illness are currently being unmet. Our findings regarding barriers to disclosure are similar to those of a recent systematic review of other healthcare settings. Research indicates that women in the perinatal period and people with a mental illness are at an increased risk of domestic violence victimisation. Taking in to account these findings the DoH now recommend Clinicians ask about violence and abuse in both obstetric and psychiatric settings