Domestic Violence, Trauma and Mental Health Conference Overview

On June 24, 2010 in Nashua, NH and June 25, 2010 in Meredith, NH, close to 250 members of the mental health professions and advocates from New Hampshire domestic violence and sexual assault programs met for the Mental Health, Trauma & Domestic Conference. Sponsored as a part of the Open Doors to Safety project of the NH Coalition Against Domestic and Sexual Violence, the goals of the conference included enhancing services of both mental health and DV/SA agencies to survivors with mental health issues, build a bridge between the two disciplines by using trauma theory as a common language, and start a collaborative process between existing services.

 Terri Pease, Linda Douglas, Carole Warshaw and Grace Mattern

Carole Warshaw M.D. and Terri Pease Ph.D. of the Domestic Violence and Mental Health Policy Initiative and the National Center on Domestic Violence, Trauma and Mental Health were the primary speakers for the conference and were sponsored by the National Network to End Domestic Violence (see links to the left). The following is my attempt to outline some of the topics that were discussed.

Why Address the Issues of Domestic Violence, Trauma and Mental Health?

• Domestic violence can have serious mental health consequences and abuse and violence play a significant role in the development and exacerbation of existing mental health disorders. 
• Through the Adverse Childhood Experiences Study (Felitti et. al. 1998) it has been found that the great number of risks (physical, sexual, psychological abuse; witnessing violence toward parent, household members with substance abuse, suicide attempts or incarceration) encountered in childhood, the greater the likelihood of experiencing poor health, alcohol or drug abuse, or mental illness as an adult.  
• Batterer’s use MH issues to control their partners by control meds and/or treatment and undermining sanity. Often, since symptoms of trauma are misdiagnosed as mental illness, the batterer is able to use the symptoms against the victim by way of stigma, poverty, discrimination and institutionalization.

Issues of Collaboration: Concerns of DV Programs and Survivors

• Availability and Accessibility –  
• Linguistic and cultural appropriateness 
• Priorities, time and Cost 
• Transportation and Childcare 
• Abuser Control of Insurance 
• Service Quality 
• Choice of provider 
• Providers knowledge of DV 
• Trauma informed vs. trauma competent 
• Need for gender specific services 

Trauma Theory

Trauma theory normalizes the responses that humans experience when exposed to traumatic events. It reframes many symptoms of PTSD and borderline personality disorder as adaptations and survival strategies necessary for survival in a life of complex (ongoing) trauma. Trauma theory also integrates developmental, biological, emotional, cognitive, spiritual and relational domains and challenges both DV and MH providers to expand their skill base and build a broader response to survivors of trauma.

Carole Warshaw M.D. also presented information based on research in the field of neuroscience to explain how the brain and body reacts when experiencing trauma or reminders of the trauma. Similar information is presented in previous blog postings so I will not cover it here.

In order to increase the mental health clinicians’ knowledge of what domestic violence and sexual assault advocates do, I, Linda Douglas, gave a short presentation outlining the aspects of empowerment, advocacy and privilege. As advocacy and empowerment are discussed in other blog postings I will not review here. The issue of privilege and how it pertains to the survivors confidentiality will be covered at another time.

Carole and Terri provided a forum to discuss clinical implications for mental health clinicians. Issues regarding documentation, safety planning and the dynamics of power and control were discussed along with the counter transference, transference and the parallel process that occurs in the therapeutic relationship.

On both days a case was presented and participants were asked to work together to determine what services would be needed for a survivor who is experiencing domestic violence currently and has adaptive behaviors due to complex childhood trauma. It was during this time that domestic violence advocates and mental health clinicians were able to discuss what they can do in the context of their programs and also began to identify gaps in services in their area. Hopefully, steps were taken to continue to discuss collaboration within their communities, with mental health clinicians recognizing that DV/SA advocates are doing trauma informed work with survivors and that mental health services would be valuable in providing assistance to survivors who are dealing with the affects of complex trauma.

This post can in no way cover all the important aspects of this conference. If you desire any more information, please feel free to email me with your questions or make comments below. In addition, I have provided the following bibliography for your use.

•  Warshaw, C. Domestic Violence, Trauma and Mental Health. Encyclopedia on Interpersonal Violence. (C. Renzetti and J. Edleson (eds.). Sage. Thousand Oaks, CA. 2008
•  Warshaw, C., Brashler, P., and Gill, J. Mental health consequences of intimate partner violence. In C. Mitchell and D. Anglin (Eds.), Intimate partner violence: A health based perspective. New York:
• Oxford University Press (2009)
•  Warshaw, C., Brashler P. Mental Health Treatment for Survivors of Domestic Violence. In C. Mitchell and D. Anglin (Eds.), Intimate partner violence: A health based perspective. New York: Oxford University Press (2009)
•  Herman, JL. Trauma and recovery: The aftermath of violence: domestic abuse to political terror. New York: Basic Books; 1992.
•  Davies J, Lyon E, Monti-Catania D. Safety planning with battered women: Complex lives/Difficult choices. Thousand Oaks: Sage; 1998.
•  Markham DW. Mental illness and domestic violence: Implications for family law litigation. Journal of Poverty Law and Policy. 2003;May-June:23-35.
•   Clark C, Young MS, Jackson E, et al. Consumer perceptions of integrated trauma-informed services among women with co-occurring disorders. J Behav Health Serv Res. Jan 2008;35(1):71-90.