Mental health therapists’ perceived barriers to addressing intimate partner violence and suicide.

Abstract

Introduction: Intimate partner violence (IPV) and suicide are pressing public health issues, yet their intersection in mental health care settings is understudied. We conducted a qualitative study to characterize mental health therapists' personal and system barriers in preparation for an upcoming training curriculum seeking to help patients address these interconnected issues. Method: We partnered with an urban community mental health center in New York to facilitate focus groups grounded in communitybased participatory research principles. Twenty-three therapists formed 3 focus groups. Participant responses were audio-recorded, transcribed, and coded using Bronfenbrenner's socioecological model. We performed a primary qualitative framework analysis, coding for therapist barriers in addressing the intersection of IPV-suicide at individual, relational, community, and societal levels. Results: Therapists perceived numerous barriers in all 4 domains. Individually, some struggled with feelings of helplessness and a lack of appropriate training. At the relational level, therapists expressed apprehension about harming the therapeutic relationship by discussing IPV and suicide at length. From a community perspective, therapists voiced concerns for clients' limited local access to support systems and financial resources. Societal barriers included policy-related limitations such as length of appointment times. Discussion: Community mental health center therapists face considerable barriers working with patients affected by IPV and suicide. The socioecological model is a fitting framework for understanding multisystem barriers at individual, relational, community, and societal levels. A better understanding of these challenges is critical for advancing therapist education, enhancing patient outcomes, and improving health systems. Public Significance StatementIntimate partner violence and suicide are prevalent conditions globally with considerable effects on physical and mental health. Greater recognition and study of the intersectional nature of these conditions may improve patient outcomes, as well as have significant impacts upon therapist training initiatives and public health policy.

A Complex Relationship: Intimate Partner Violence, Identification With the Aggressor, and Guilt

“…The WHO found that IPV affects approximately 641 million women globally, making it the most prevalent form of violence against women (WHO, 2021). IPV has a range of effects on the victimized partner, including but not limited to physical injury, suicidality, depression, anxiety, substance use, posttraumatic stress disorder (PTSD), selfharm, sexually transmitted diseases, and injury to reproductive health (Beck et al, 2016;Kubany & Watson, 2002;Lahav, Renshaw, & Solomon, 2019;Lahav et al, 2018;Willie et al, 2018;Wilson et al, 2021).…”

Barriers to routine screening for intimate partner violence during pregnancy in Nigeria

“…The referral centres should be all inclusive centres that can provide holistic care to women who have experienced IPV. Miller et al [ 13 ], and Wilson et al [ 10 ], confirmed that lack of referral centres makes it futile to screen for IPV. They advised that referral centres facilitate pregnant women's access to social services, support, and safety.…”

“…Despite these benefits, barriers to routine screening have been reported in many midwifery settings globally. These include lack of time due to huge workload, lack of privacy due to the presence of pregnant women's partners, lack of resources, and absence of implementable policies, protocols and guidelines [ [10] , [11] , [12] ].…”

Mitigating the impact of intimate partner violence in pregnancy and early childhood: A dyadic approach to psychotherapy

“…While several disciplines including gynecology, pediatrics, psychology, and emergency medicine have been encouraged by national organizations to screen for IPV, professionals across these disciplines also routinely report barriers to screening. Healthcare professionals note hesitations based on (a) a lack of training and confidence in asking about IPV sensitively, (b) fear of causing offense, (c) feeling ill‐equipped to follow‐up with a positive screen, and (d) insufficient time to screen (Aregger Lundh et al, 2023; Schilling et al, 2012; Thackeray et al, 2010; Wilson et al, 2021). While many proposals have attempted to address these barriers by increasing system wide training and harnessing technology to assist with screening (Mancheno et al, 2020; Schilling et al, 2012), these changes are slow and screening for IPV remains significantly less frequent than screening for other psychosocial factors like depression or anxiety (Perone et al, 2022).…”