A question of commitment – improving practitioner responses to domestic and sexual violence, problematic substance use and mental ill‐health

Abstract

PurposeAVA (Against Violence & Abuse) is funded by the Department of Health to deliver the Stella Project Mental Health Initiative. This project aims to develop and implement models of good practice for responding to survivors and perpetrators of abuse who also have a dual diagnosis. Marking the project's halfway point, this article aims to review what is already understood to be best practice in this area, to present the initial learning from the project evaluation, and to consider the most effective ways of promoting and enabling behaviour change among practitioners.Design/methodology/approachThe research design for the evaluation is a mixed methods evaluation, drawing on both prospective and retrospective research techniques. The design was developed within an action research framework.FindingsIn line with other research, levels of routine enquiry or enquiry about experiences of violence were low amongst staff from all organisations participating in the project. In comparison staff seem somewhat more likely to enquire about substance misuse and mental health issues. Wide variation in attendance at training was found with a complex relationship between training and confidence emerging.Originality/valueThis paper adds to the growing evidence base to suggest that a lot more training, organisational support and research is needed to ensure that professionals who have contact with women who have experienced abuse, have mental health or substance use problems are asking their clients about all three issues, making appropriate referrals and ensuring victims with complex needs having access to protection and support.

Underserved survivors of sexual assault: a systematic scoping review

“…According to Brooker and Durmaz ( 2015 ), clients with pre-existing mental health conditions need to receive a thorough assessment and often require specialized follow up care. Unfortunately, mental health screening is not routinely conducted and referring clients on to mainstream mental health services for needed follow-up appears unnecessarily complex (Brooker & Durmaz, 2015 ; Holly & Horvath, 2012 ). Similar issues were reported in the US.…”

“…Indeed, women with substance misuse and histories of sexual victimization expressed feeling marginalized by the health care system and incapable of attaining the services desired (Kalmakis, 2011 ). A lack of refuges willing to accept survivors with active substance misuse was also identified in the UK (Holly & Horvath, 2012 ). When services are accessed, survivors with problematic substance use may not receive adequate and holistic support (Zweig et al, 2002 ).…”

“…Given the diverse needs and histories of survivors illustrated by the findings of the present review, formal sources of support should not only assess for sexual violence but also provide holistic and integrated services that adequately address co-occurring oppressions and psychosocial needs (Macy, Giattina, Montijo et al, 2010 ). However, few services seem to tailor interventions to survivors and many of the included studies suggested that referring clients on for needed follow-up was difficult (Brooker & Durmaz, 2015 ; Holly & Horvath, 2012 ; Zweig et al, 2002 ). This finding is in line with other recent reviews of the literature, which identified wide variations in the provision of mental health and substance abuse services at SA centres (Stefanidou et al, 2020 ), and found that pathways from SA services to mental health services are often difficult (Brooker, Hughes, Lloyd-Evans, & Stefanidou, 2019 ).…”

“… 60 professionals caring for SA survivors 2 Qualitative (interview/survey) Only a minority of clinics ( n = 3) tune their protocols based on the survivor’s gender identity and sexual orientation. 4 Holly & Horvath, 2012 . UK.…”

Beyond co‐occurrence: Addressing the intersections of domestic violence, mental health and substance misuse

“…The co‐occurrence of domestic violence (DV) with other adult problems of substance misuse and mental health difficulties is well recognized (Gilchrist et al, 2010; Mason & O'Rinn, 2014; Trevillion et al, 2012). However, while a lack of routine inquiry across sectors into these co‐occurring issues for clients has been identified (Holly & Horvath, 2012), the ways in which these problems intersect, the barriers, and the implications for more integrated practice have received far less attention. This paper explores the ways in which practitioners attempted to re‐orientate their practice with families experiencing the complex, intersecting issues of domestic violence, mental health difficulties and substance misuse.…”