Violence against women services generally are seeing more and more women with co-occurring issues. There are a number of reasons for this:
- As other community services become underfunded and over-extended, they are referring clients to VAW services
- Women who have experienced abuse and are also dealing with mental health or substance use issues prefer the non-judgmental, harm reduction approach offered by VAW services
- These women can be very hard to serve so they are often passed around from service to service, wearing out their welcome at each one as they go
Few of those working in mental and health and substance use have an adequate understanding of violence against women and the inter-relationships between those issues and VAW and few of those working in VAW organizations have adequate training in supporting women with serious mental health and/or substance use issues.
Those of us assisting women in family court know all too well that the mere allegation of substance use or a mental health issue can jeopardize a woman’s custody claim while also throwing her evidence about abuse into question.
In this posting, I use the term substance use to refer to a woman’s use of alcohol, prescriptions drugs, over the counter medication and/or street drugs. Many of the issues she deals with are similar to issues for women who have other dependent behaviours such as eating, gambling, shopping, internet use and so on.
The term mental health issues, refers to depression, anxiety disorders, panic attacks, PTSD and trauma.
These issues are explored not from a diagnostic perspective because that is not the expertise that you bring or are expected to bring to your work, but rather from a behaviour-based perspective.
Understand the connections
Women who have experienced abuse have higher rates of mental health and substance use issues than women who have not. Sometimes, these issues arise as a result of or a response to the abuse; other times the mental health issue or substance use existed prior to the abusive relationship and made the woman more vulnerable to being abused. The relationship among abuse, substance use and mental health is a cyclical one, with any one of the three increasing vulnerability to either of the other two, and with both mental health and substance use being responses to violence.
More than 50% of women in shelters experience major depression and more than 33% of them experience PTSD. 67% of women with substance use issues have a concurrent mental health issue.
Women who experience abuse are 4 times more likely to develop PTSD than women who have not. More than one-quarter of women who have a history of PTSD report having problems with alcohol and there is a high correlation between PTSD and other substance use.
In some cases, the substance use, including alcohol, precedes the PTSD and in others it follows – women use substances to try to manage their PTSD symptoms.
We all bring our personal lived experiences and values into our work. While we are all committed to bringing a non-judgmental approach, it can be difficult sometimes to separate our own values and beliefs from our approach to the women we support. Like everyone else, we are affected by social values and norms. Often those norms are highly judgmental about women (mothers) who engage in behaviour that is seen as “bad,” including the use of substances. Many social norms also assume that women with mental health issues are not capable of appropriate parenting.
When you are working with women who are confronting these issues, it is critical not to buy into those social norms. If you have a particular life experience that makes it difficult for you to bring a non-judgmental approach to a woman with mental health or substance use issues, you should speak to your supervisor about having someone else support this woman.
You also need to put supports in place for yourself, as you may be deeply affected or triggered by the experiences of women in these situations. Make this part of your regular supervision.
Encourage her to be honest
Understandably, given negative social attitudes, many women are reluctant to admit to having mental health or substance use issues. You need to let women know it is very important that they disclose this information in any court proceedings. In all likelihood, her partner is aware of any mental health or substance use issues and, if he is, there is little doubt that he will exaggerate the seriousness of them in his court documents. The woman needs to be upfront about her issues, the causes of them and what she is doing to address them.
For instance, if she has a long-term issue with depression, she can tell the court how she is managing it (e.g. regular medical care, medication, therapy, diet, etc.) and can point out that she has been parenting the children for years with no difficulties. She can, if it is the case, let the court know that her partner has never before noted any concerns related to her parenting even though he has known about her depression throughout their relationship.
Mitigate the negatives with positives
When you are supporting a woman living with a mental health or substance use issue, you can assist her to gather evidence to support her custody case. If she is in active treatment for substance use, encourage her to share this information with the court. If her abuser’s description of her substance use is exaggerated or false, help her frame a response. If she is seeing a therapist or psychiatrist for help with a mental health issue, encourage her to get a letter or affidavit from that professional that outlines the work the woman is doing.
Perhaps the children’s daycare worker or teacher can provide evidence of her positive parenting. If she is involved in her children’s activities – maybe she coaches her daughter’s soccer team – she can produce evidence about this for the court.
She should be frank with the court about the connection between the abuse she has experienced and her substance use or mental health issues.
She may want to consider introducing expert evidence about her situation and its connection (or lack of connection) to her ability to parent safely and well.
Her goals should be to:
- Keep the judge focused on the abuse issues and why those should carry weight in the custody decision
- Help the judge understand the connections between her mental health and/or substance use issues and the abuse
- Provide strong evidence of her parenting strengths and capacity
- Provide a plan for the future – for parenting but also for addressing mental health/substance use
- Demystify her situation by helping the judge understand her use of substances and/or her mental health issues
Connect her to other services
As with any woman you support, helping her find other services that can assist her is a key part of your job. Make sure you are knowledgeable about mental health and substance use services in your community.
Does any of them operate from a harm-reduction perspective? Will they bring a case management approach to working with this client?
Work towards increased collaboration
Finding ways to work with other services in your community is critical to supporting women who are dealing with co-occurring issues. Increased collaboration will mean you can:
- Pool resources
- Increase trust
- Increase skills and knowledge through cross training
- Make seamless referrals for women
- Bring a holistic, feminist, harm reduction approach to supporting women