An Exploration of Knowledge and Attitudes about Victims or Survivors of Domestic Violence with Mental Health Disability: Perspectives from Domestic Violence Service Providers

Background: Domestic violence (DV) has significant negative implications on women's mental health. In order to effectively alleviate the debilitating impact of poor mental health and to increase safety, survivors need access to appropriate service provisions. Domestic violence service providers often serve as critical entry points for survivors who are seeking services and are experiencing mental health challenges. These service providers are therefore well positioned to provide and assure quality and accessible mental health services for victims/survivors with mental health disability. However, we know little about DV service providers’ knowledge and attitudes about working with victims/survivors with mental health disabilities. The current study aims to contribute to this research gap by exploring the perspectives of DV service providers’ knowledge and attitudes about working with survivors with mental health disability.

Methods: The current study employed a qualitative research design to conduct needs assessments with service providers of DV services. Eleven focus group discussions with 8-10 participants in each group were conducted with staff and administrators in five different DV advocacy agencies and shelters in a Midwest region of the US. Staff and administrators were provided with an opportunity to share their own personal experiences when working with survivors who present mental health disability. Focus group discussions were audio-recorded and transcribed. Five researchers analyzed the data separately using structural coding and thematic development. Next, researchers convened and compared analyses to validate codes and themes and to resolve discrepancies.

Results: Key themes regarding knowledge and attitudes when working with victims/survivors with mental health disability were revealed for staff and administrators. Differences in the themes was noted for staff and administrators. Both staff and administrators reported some level of knowledge surrounding mental health and the connection to DV. However, administrators perceived that staff members lacked necessary knowledge and were fearful in regard to working with survivors with severe mental health disability. Staff members were uncomfortable addressing substance use related issues, suicide and self-harm with clients and expressed confusion and concern about their role in responding to these issues. Administrators perceived a discrepancy between the trauma-informed care and its application to their current service deliveries. On the other hand, staff members’ had varying attitudes related to the helpfulness of the trauma-informed model of care. When substance-using clients posed a risk of harm to themselves or others, staff felt there was not one way to intervene that was safe and that would meet the needs of all clients. Staff members also expressed that they found it challenging to support clients that struggle with substance abuse.

 Implications: Findings point to the need for providing training and technical assistance to build the capacity of staff and administrators to better respond to complex mental health needs of survivors. There is also a need for more clarity and training in responding to substance use, suicidality and self-harm. Findings also call for the need to incorporate integrated trauma-informed care models when working with DV survivors who have mental health disability.