Building Bridges: Exploring Women’s Experiences of Violence , Mental Health, and Substance Use

1. Building Bridges: Exploring Women’s Experiences of Violence, Mental Health, and Substance Use

2. BC Women’s Hospital andHealth Centre Woman Abuse Response Program: Alexxa Abi-Jaoude Louise Godard aajaoude@cw.bc.calgodard@cw.bc.ca 604-875-3717

3. What we do • Focus on the health impacts of violence • Program activities include: • training and support; • research; • consultation;  • development of resource materials related to practices, policy, and guidelines • Have led a number of community and province wide projects/consultations including Building Bridges, Making Connections and currently Girls Speak Out

4. Addressing the links between violence, substance use and mental health concerns is important because….

5. The Issue • Research shows that woman abuse often precedes the development of mental health concerns and substance use • This emerging evidence is not yet reflected in practice and policy • In response, the Woman Abuse Response Program at BC Women’s initiated a research and practice programme – Building Bridges and Making Connections

6. Project Methodology • BC Province-wide workshop/consultation with N=460 service providers representing mental health, substance use and anti-violence sectors from 82 communities • 15 Focus groups with N=102 women affected by woman abuse, substance use and mental health concerns

7. Hearing from women • Through consultations and focus groups we have heard from women and providers about: • The impact abuse has on women’s health and wellness, and on their ability to access services and support, • How services unintentionally create barriers to access • How women’s interactions with services can echo their experiences of abuse, and • Recommendations for how to improve access and support to this population of women

8. Building Bridges Framework

9. Doubly Victimized • “Many women who access the health care system experience their contact with the “helping” professions and systems as another form of abuse. These women are doubly victimized, first by violent partners and then by practices and procedures that are insensitive to their needs” (Health Canada)

10. Violence Against Women

11. What is Woman Abuse? • Violence against women in relationships is defined as: “a pattern of intentionally coercive and violent behaviour with whom there is or has been a relationship. These behaviours can be used to establish control of an individual and can include physical and sexual abuse; psychological abuse with verbal intimidation, progressive social isolation, or deprivation; and economic control” • “the abusive use of power by which an individual in a position of force aims to control another person by using different strategies to keep this person in a position of inferiority or to compel this person to adopt behaviors in compliance with the individual’s own desires. Because violence can be exerted in larger systems, this definition is not limited to individual conduct but also includes violence imposed by social and structural systems.”

12. Violence against women • 50% of Canadian Women have experienced sexual or physical violence. • 1 in 3 women experience abuse in their relationship at some point in their lives • Women constitute 87% of the victims of violence in relationships • 80% of the accused perpetrators are men1 • From 1999 to 2004, 4 out of 10 women reported that their children witnessed the abuse.

13. What is Violence against Women “A lot of it was just verbal, but I wished he would have hit me instead of said what he said. The words were just as bad as, they hurt more than probably any beating could have. And they did more damage for the long term.”– DJ

14. Who is Most Vulnerable to Abuse? • Aboriginal Women are almost 3.5 times more likely to report violent victimization, and more than 8 times more likely to be killed by their spouses than non-Aboriginal women. • More than half of children taken into custody in BC are Aboriginal, with Aboriginal children being apprehended more than 6 times as often as non-Aboriginal children • Abuse for racialized women can be compounded when disclosure triggers assumptions that ‘certain cultures’ are inherently violent or results in culturally inappropriate responses

15. Who is Most Vulnerable to Abuse? • Young women aged 25-34 years old were 3 times more likely than those aged 45 or older to state they had been physically or sexually assaulted by a male intimate partner. • Girls between the ages of 13-15 are at the highest risk of being sexually assaulted. More than half of all women who are sexually assaulted are under 18. • Women working in the sex trade are at enormous risk of sexual and physical assault, ongoing abuse, and murder. Often when they do report abuse (from partners or johns), their stories are discredited or minimized

16. Who is Most Vulnerable to Abuse? • Women with disabilities are 40% more likely than non-disabled women to be abused by their male partner. • Senior women are vulnerable to abuse from their spouse as well as their adult children and care givers • Pregnant women are more likely to experience violence. • Low-income women may be more often trapped in abusive relationships because of a lack of financial resources for housing and income support.

17. Who is Most Vulnerable to Abuse? • Immigrant & refugee women may face barriers to escaping due to isolation (language or culture), dependent status on their partners (immigration legislation), or their marginalized place in the workforce . • Women in rural and remote communities can face barriers to escaping abuse due to isolation and confidentiality concerns • Lesbian, bisexual, queer, transsexual and transgendered women can face barriers in obtaining support in the social context of homophobia and heterosexism

18. Intersectional Lens • Women have a number of different roles and identities, and experience various forms of oppression that can intersect • Geography - rural, urban, reserve • Ethnicity • Race • Class • Sexual orientation • Disability • Mothering • Financial insecurity and Poverty • Homelessness

19. Violence and Homelessness • Women’s incomes from employment and social assistance are often too low to afford safe, stable housing • exposes women to the risk of further abuse and sexual exploitation • Single mothers entering the shelter system at twice the rate of couples with children • Women will often do everything they can to avoid losing housing for themselves and/or their children. • We see all “choices” as survival strategies – choices made between crappy options i.e. trading sex for shelter, couch surfing, entering into an unsafe relationship for shelter or continuing to stay in an abusive relationship because they have nowhere else to go.

20. Violence and Homelessness “And the bottom line is if women don’t have safe housing, how are they supposed to be productive members of society. Really? When we are sitting in a transition home for 30 days, moving from one into another. Going to a hostel. Sleeping on our parents couch or our sister’s couch. How are we supposed to be productive if we don’t have consistency in our lives? We’re not. We’re going to stay stuck” - Dawn

21. Dominant Discourse of Violence Against Women • Commonly held societal beliefs, perceptions and commonly used language can be just as damaging as formal practices and laws. • 40% of men (n=1000) in recent Alberta study believe that if a woman wears provocative clothing, she’s putting herself at risk for rape “How many times do women get told… oh you shouldn’t have been wearing that short skirt, it’s been going on for generations. It’s always thrown back at you." - Kris

22. Dominant Discourse of Violence Against Women • Many do not see it as a systemic issue, but instead issue of violence against women is becoming “privatized” • Instead, stories of abuse are told as individual stories, disconnected from each other, and rooted in personal characteristics and behaviours.

23. Dominant Discourse of Violence Against Women • Language is relevant in all of our work. We use it every day to talk to colleagues about the clients that we serve . • The language and words we use to write up a woman’s files and how that gets documented impacts how the woman may see and understand her own experiences. • The kinds of questions we ask, when we ask the questions and in what tone may impact a woman’s ability to share her experiences of violence with us.

24. The Language of Violence and Abuse • WE USE: woman abuse, violence against women and girls, gender-based violence, women with experiences of abuse • Instead of: intimate partner violence (IPV), domestic violence, family violence

25. The myth of mutual battering • Research tells us that 88% to 95% of victims of abuse are women • Women rarely initiate violence against men • Women's aggression is mostly retaliatory or self-defensive • Violence experienced by women, as well as its impacts, is far more severe than that experienced by men

26. What about men? • Any kind of violence is wrong, be it against men, women or children. • The idea is not to paint men as villains, or group ALL men with the group of men who choose to perpetrate violence. We recognize that this is a small subsection of males. • We need to look at the clear gender relationship in violence, and what it tells us about the issue and potential solutions, so we can avoid perpetuating the problem for generations to come. • Need for relevant and effective ways to support men who are abusive as well ways to engage boys and men to work towards ending VAW

27. CYCLE OF VIOLENCE

28. Cycles of Violence and Abuse “I was in a very abusive violent relationship for too long. I was so worn down because his moods would change just like that. One minute he would be telling me how much he loves me and the next minute he’d be hitting me or screaming at me. And I never knew when he would switch.” - Jennifer

29. Cycles of Violence and Abuse • Abusive men target vulnerable women, portraying themselves as someone who can protect her and care for her, making false promises to attract her to him. • Girls fleeing abusive families often become involved in abusive relationships - He tells her he can protect her or meet some of her needs. • The process of leaving is hard. For some women, they leave immediately and never look back. But most return hoping for a different outcome, that promises will be kept.

30. Leaving = dominant normative ideal of services and supports designed to help women with experiences of violence • based upon the basic unexamined assumption of 'leaving' as the most rational choice, much like abstinence-based approaches to substance use. • also based on the notion that if a relationship is abusive, a woman will exercise agency and choose to leave • tension between discourses of free will and control. “I heard people say that you make your own choice; you can do whatever you want. And to an extent I agree, but when you make that choice, you and your children could be killed if you do it, so you choose not to. To an extent that choice is made for you.” - Nicola

31. Cycles of Violence and Abuse – Why doesn’t she leave? • Increased lethality/Fear of retaliation • Wants to keep her family intact/ avoid a custody battle/fear of losing kids • Fear of disapproval by her cultural community • Negative consequences of such actions on her immigration status • Economic and language barriers • Fear of dealing with unfamiliar legal systems • Lack of long-term stable, affordable housing • If women fail to successfully leave and cease contact with the abuser, the ‘truth’ surrounding their experiences of violence and their mental capacity is questioned • reducing questions of complex social and structural inequities to issues of self-esteem and co-dependence

32. It is important that you do not see women’s return to abusive relationships as a failure on your part. • Women leave and return to their abusers several times before finally leaving (current average: 8 times). • Important that she feels like she can come back and that you will do the same for her the next time she walks into your organization.

33. Power and Control • Power and control is central to dynamics of abuse • Perpetrators are 100% responsible for their use of abusive strategies • Perpetrators use abusive strategies intentionally – they are not out-of-control • Abuse is not equivalent to mismanaging anger

34. Power and Control Wheel

35. Intersectional Power and Control Wheel

36. What are some of theImpacts of Abuse?

38. Linking Violence against Women and Mental Health Impacts

39. Linking Woman Abuse and Mental Ill Health “like the first counseling…was totally uncomfortable because she’s like right off the bat, not even five minutes [into the session], and she’s like “oh, so you’re depressed.” No, I’m just tired of being hit all the time.” - Kate (GSO) • There is evidence that many mental health problems post-date experiences of abuse • 70% of women in psychiatric in-patients and 80% in secure settings have histories of physical or sexual abuse (Phillips, 2000) • Between 35 – 73% of abused women experience depression or anxiety (Golding, 1999, Fikree & Bhatti, 1999) • More than 70% of those diagnosed with post-traumatic stress disorder (PTSD) are women (Kessler, ‘95).

40. Mistaken Assessments • Research identified women being pejoratively characterized and labeled as neurotic, hysterical, hypochondriacal, having personality disorders, or as a “well-known patient with multiple vague complaints” • These outcomes may be effects of abuse or signs of coping “Going to my doctor, I used to break down and cry in his office and he’d say, “You’re depressed”. “No I’m just sad. I’m just going through a really sad time”. He said, “There’s a name for that. It’s depression”. Finally he convinced me I should go on an anti-depressant. Like that was going to stop me from being beat up.”- Gillian

41. ‘Symptoms’ of Abuse • What is interpreted in a woman’s presentation as non-compliance, aggression, an inability to make a decision or follow through with a decision, dependency, dysfunction, poor mothering, etc. may be the demeanour of a woman impacted by abuse “I don’t call it mental health, I call it symptoms of abuse, because to me that is what it is.” - Gail

42. Abusers may exploit a woman’s vulnerability • Keep medications from her, give her too much medication, demand she takes medication • Take advantage of changes in her symptoms and moods (eg. encouraging suicidal feelings) • Threaten to take her children away and tell child protection authorities or the court of her illness • Claim that she is an unfit mother because of her mental health problem • Minimize her credibility

43. Abusers may exploit a woman’s vulnerability “Mine was happy that I was getting mental health care. Because I was in an extremely low depressive state. But I had to sneak around to get the type of help that I really need in order to be able to climb out of that hole. He wanted mental health and addictions to fix me so that I would be his mold. And that I could go back to living in the bedroom of the RV and not coming out and bugging him and just doing what he told me to do when he told me to do it. That would be his idea of fixing me.” - Emma

44. Linking Violence Against Women and Substance Use

45. Connections Between Substance Use and Violence • Alcohol dependency is 15 times more prevalent among women impacted by abuse than the general public • Between 60-80% of women in treatment have experienced sexual or physical abuse at some point in their lives. This increases to 90 – 100% when emotional/verbal abuse is included. “I went from a mentally abusive household to a husband who physically abused me and did drugs. And my home was so full of drugs, I had no control over what he was selling in the house, what he was doing in the house or doing to me.” - Amy

46. Connections Between Substance Use and Violence • In a BC study of 512 young Aboriginal people who smoke or inject drugs, a large majority (68%) of the 262 participating girls and young women had experienced early childhood sexual abuse, with a mean age of 7 years old “…growing up in foster homes and group homes. And, the neglect and the abuse that goes on in there, like I don’t wanna remember that or participate in what’s really going on, so I check out from life, and I bang heroine all day – so I can numb myself, right? – Jessica (GSO)

48. Medicating Impacts of Abuse:“My doctor was my drug dealer” “My addiction was the solution, my problem is abusive relationships”- Stella • Women in abusive relationships may be addicted to medications prescribed by health care providers for health concerns related to abuse. For example: • chronic headaches • abdominal pain • joint and muscle pain • anxiety and depression • sleep disorders

49. Connections Between Substance Use and Violence • Substance use may begin or escalate as a response to victimization/ woman abuse • Some women drink alcohol or use other substances to numb or escape the emotional and physical trauma of violence/abuse • Substance use can placate her abusive partner and create temporary safety for her. “One starts with one- the abuse and then you have the abuse and then you start with alcohol and then a bit of coke and carry on from there and keep going. Just trying to be numb...” – Alice

50. Connections Between Substance Use and Violence • An abuser may introduce his partner to alcohol or drug use to increase her dependence on him and to control her behaviour • Efforts to stop using substances may precipitate abusive partners' use of increased violence or other control tactics. “It went from mental abuse to physical to emotional. The way I dealt with it was by drinking all the time. That’s the only way I could cope.” – Naomi