Skip to main content

Advertisement

Log in

On the Margins: the Challenges of Identifying Domestic Violence in Mental Health Services. Findings of a Qualitative Irish Study

  • Original Article
  • Published:
Journal of Family Violence Aims and scope Submit manuscript

Abstract

Although the relationship between mental ill health and the experience of domestic violence (DV) is well established, service users frequently report an absence of appropriate professional responses to disclosures. This study explored how professionals in an Irish mental health (MH) setting understand, identify and respond to DV in a multidisciplinary practice context. An exploratory qualitative approach using semi structured focus group interviews was employed. The data consisted of six focus group interviews with occupational therapists, nurses, consultant psychiatrists, junior doctors, social workers and psychologists working in acute MH care (n-27) in Ireland in 2018. Data was analyzed using Braun and Clarke’s Qualitative research in psychology, 3(2), 77-101, Braun and Clarke (2006) six stages of thematic analysis. Study findings suggest that a prevailing medical model along with an exclusive focus on physical forms of violence shaped the [in]visibility of the DV in this practice setting. DV issues were marginalized from MH care due to its construction as a social problem, with resultant patient needs related to DV not considered within the remit of MH services. This disconnected construction was influenced by several factors including training and education, fear, professional roles and team working in a dominant medical model. This study supports the need for conceptual frameworks that do not marginalize issues of DV in the discourse of MH care delivery but provide a foundation for service user centered collaboration across professional disciplines. The potential benefits of trauma informed care models in increasing recognition and response to DV in MH services are indicated by the present study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. For the purposes of clarity, the term ‘professional’ refers to mental health professionals unless otherwise specified.

References

  • Alhabib, S., Nur, U., & Jones, R. (2010). Domestic violence against women: Systematic review of prevalence studies. Journal of Family Violence, 25(4), 369–382.

    Google Scholar 

  • Bradbury-Jones, C., Taylor, J., Kroll, T., & Duncan, F. (2014). Domestic abuse awareness and recognition among primary healthcare professionals and abused women: A qualitative investigation. Journal of Clinical Nursing, 23(21–22), 3057–3068.

    PubMed  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Google Scholar 

  • Cases, J. G., Usaola, C. P., Aguado, F. G., Gironés, M. L., Trincado, M. R., & Liria, A. F. (2014). Prevalence and characteristics of intimate partner violence against women with severe mental illness: A prevalence study in Spain. Community Mental Health Journal, 50(7), 841–847.

    Google Scholar 

  • Chang, J. C., Cluss, P. A., Burke, J. G., Hawker, L., Dado, D., Goldstrohm, S., & Scholle, S. H. (2011). Partner violence screening in mental health. General Hospital Psychiatry, 33(1), 58–65.

    PubMed  Google Scholar 

  • Cleary, M., Escott, P., Horsfall, J., Walter, G., & Jackson, D. (2014). Qualitative research: The optimal scholarly means of understanding the patient experience. Issues in Mental Health Nursing, 35(11), 902–904.

    PubMed  Google Scholar 

  • Cobo, J., Muñoz, R., Martos, A., Carmona, M., Pérez, M., Cirici, R., & García-Parés, G. (2010). Violence against women in mental health departments: Is it relevant for mental health professionals? Revista de Psiquiatría y Salud Mental (English Edition), 3(2), 61–67.

    Google Scholar 

  • COSC. (2011). Domestic and sexual violence Services in Ireland: Service provision and co- ordination. Dublin: Stationary Office.

    Google Scholar 

  • Creswell, J. W., & Plano Clark, V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks: Sage.

    Google Scholar 

  • Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., Astbury, J., & Watts, C. H. (2013). Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies. PLoS Medicine, 10(5), e1001439.

    PubMed  PubMed Central  Google Scholar 

  • Dwyer, S. C., & Buckle, J. L. (2009). The space between: On being an insider-outsider in qualitative research. International Journal of Qualitative Methods, 8(1), 54–63.

    Google Scholar 

  • Ehrensaft, M. K., Moffitt, T. E., & Caspi, A. (2006). Is domestic violence followed by an increased risk of psychiatric disorders among women but not among men? A longitudinal cohort study. American Journal of Psychiatry, 163(5), 885–892.

    Google Scholar 

  • Evans, M. A., & Feder, G. S. (2014). Help-seeking amongst women survivors of domestic violence: A qualitative study of pathways towards formal and informal support. Health Expectations, 19(1), 62–73.

    Google Scholar 

  • Ferrari, G., Agnew-Davies, R., Bailey, J., Howard, L., Howarth, E., Peters, T. J., Sardinha, L., & Feder, G. (2014). Domestic violence and mental health: A cross-sectional survey of women seeking help from domestic violence support services. Global Health Action, 7(1), 25519.

    PubMed  Google Scholar 

  • García-Moreno, C., Pallitto, C., Devries, K., Stöckl, H., Watts, C., & Abrahams, N. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.

  • Gergen, K. J. (1985). Social constructionist inquiry: Context and implications. In K. J. Gergen & K. E. Davis (Eds.), The social construction of the person (pp. 3–18). New York: Springer Science & Business Media.

    Google Scholar 

  • Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14(2), 99–132.

    Google Scholar 

  • Green, J., & Thorogood, N. (2018). Qualitative methods for health research. Sage.

  • Gutmanis, I., Beynon, C., Tutty, L., Wathen, C. N., & MacMillan, H. L. (2007). Factors influencing identification of and response to intimate partner violence: A survey of physicians and nurses. BMC Public Health, 7(1), 12.

    PubMed  PubMed Central  Google Scholar 

  • Hague, G., & Mullender, A. (2006). Who listens? The voices of domestic violence survivors in service provision in the United Kingdom. Violence Against Women, 12(6), 568–587.

    PubMed  Google Scholar 

  • Holt, S., & Devaney, J. (2015). Understanding domestic abuse and sexual violence in the Republic of Ireland and Northern Ireland: Prevalence, policy and practice. In D. Healy, C. Hamilton, Y. Daly, & M. Butler (Eds.), The Routledge Handbook of Irish Criminology (pp. 70–88). London: Routledge.

    Google Scholar 

  • Howard, L. M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R., & Feder, G. (2010). Domestic violence and severe psychiatric disorders: Prevalence and interventions. Psychological Medicine, 40(6), 881–893.

    CAS  PubMed  Google Scholar 

  • Humphreys, C. (1999). Avoidance and confrontation: Social work practice in relation to domestic violence and child abuse. Child and family social work, 4, 77–87.

    Google Scholar 

  • Humphreys, C., & Thiara, R. (2003). Mental health and domestic violence: ‘I call it symptoms of abuse’. British Journal of Social Work, 33(2), 209–226.

    Google Scholar 

  • Husso, M., Virkki, T., Notko, M., Holma, J., Laitila, A., & Mäntysaari, M. (2012). Making sense of domestic violence intervention in professional health care. Health & Social Care in the Community, 20(4), 347–355.

    Google Scholar 

  • James-Hanman, D. (2018). Whose movement is it anyway? Reflections for the field. In S. Holt, C. Overlien, & J. Devaney (Eds.), Responding to domestic violence: Emerging challenges for policy, practice and research in Europe (pp. 292–308). London: Jessica Kingsley Publications.

    Google Scholar 

  • Kearns, N., Coen, L., Canavan, J. (2008). Domestic violence in Ireland: An overview of national strategic policy and relevant international literature on prevention and intervention initiatives in service provision.

  • Khalifeh, H., Oram, S., Osborn, D., Howard, L. M., & Johnson, S. (2016). Recent physical and sexual violence against adults with severe mental illness: a systematic review and meta-analysis. International Review of Psychiatry, 28(5), 433–451.

    PubMed  Google Scholar 

  • Khalifeh, H., Moran, P., Borschmann, R., Dean, K., Hart, C., Hogg, J., Osborn, D., Johnson, S., & Howard, L. M. (2015). Domestic and sexual violence against patients with severe mental illness. Psychological Medicine, 45(4), 875–886.

    CAS  PubMed  Google Scholar 

  • Koziol-McLain, J., Coates, C. J., & Lowenstein, S. R. (2001). Predictive validity of a screen for partner violence against women. American Journal of Preventive Medicine, 21(2), 93–100.

    CAS  PubMed  Google Scholar 

  • Lagdon, S., Armour, C., & Stringer, M. (2014). Adult experience of mental health outcomes as a result of intimate partner violence victimisation: A systematic review. European Journal of Psychotraumatology, 5(1), 24794.

    Google Scholar 

  • Lavelle, E. (2011). Mental health rehabilitation and recovery services in Ireland: A multicentre study of current service provision, characteristics of service users and outcomes for those with and without access to these services. Mental Health Commission.

  • Loseke, D. R. (2003). Thinking about social problems. New Brunswick. NJ: Transaction.

    Google Scholar 

  • McCormack, P. (2018). Development, coordination and implementation of National Strategies for the prevention of domestic, sexual and gender-based violence in Ireland: Lessons and unlearned. In S. Holt, C. Overlien, & J. Devaney (Eds.), Responding to domestic violence: Emerging challenges for policy, practice and research in Europe (pp. 292–308). London: Jessica Kingsley Publications.

    Google Scholar 

  • Michailakis, D., & Schirmer, W. (2014). Social work and social problems: A contribution from systems theory and constructionism. International Journal of Social Welfare, 23(4), 431–442.

    Google Scholar 

  • Morgan, D. L. (1996). Focus groups as qualitative research (Vol. 16). Sage publications.

  • Muehlenhard, C. L., & Kimes, L. A. (1999). The social construction of violence: The case of sexual and domestic violence. Personality and Social Psychology Review, 3(3), 234–245.

    CAS  PubMed  Google Scholar 

  • Mullender, A. (2002). Rethinking domestic violence: The social work and probation response. Routledge.

  • Nevala, S. (2014). Violence against women: An EU-wide survey. European Union Agency For Fundamental Rights.

  • Nyame, S., Howard, L. M., Feder, G., & Trevillion, K. (2013). A survey of mental health professionals' knowledge, attitudes and preparedness to respond to domestic violence. Journal of Mental Health, 22(6), 536–543.

    PubMed  Google Scholar 

  • O’Doherty, L. J., Taft, A., Hegarty, K., Ramsay, J., Davidson, L. L., & Feder, G. (2014). Screening women for intimate partner violence in healthcare settings: Abridged Cochrane systematic review and meta-analysis. Bmj, 348, g2913.

    PubMed  PubMed Central  Google Scholar 

  • O’Dwyer, C., Tarzia, L., Fernbacher, S., & Hegarty, K. (2019). Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units. BMC Health Services Research, 19(1), 1–9.

    Google Scholar 

  • Oram, S., Trevillion, K., Feder, G., & Howard, L. M. (2013). Prevalence of experiences of domestic violence among psychiatric patients: Systematic review. The British Journal of Psychiatry, 202(2), 94–99.

    CAS  PubMed  Google Scholar 

  • Överlien, C., Aronsson, K., & Hydén, M. (2005). The focus group interview as an in-depth method? Young women talking about sexuality. International Journal of Social Research Methodology, 8(4), 331–344.

    Google Scholar 

  • Pearson, D., & Vossler, A. (2016). Methodological issues in focus group research: The example of investigating counsellors’ experiences of working with same-sex couples. Counselling Psychology Review, 31(1).

  • Rogers, A., & Pilgrim, D. (2014). A sociology of mental health and illness. UK: McGraw-Hill Education.

    Google Scholar 

  • Rose, D., Trevillion, K., Woodall, A., Morgan, C., Feder, G., & Howard, L. (2011). Barriers and facilitators of disclosures of domestic violence by mental health service users: Qualitative study. The British Journal of Psychiatry, 198(3), 189–194.

    PubMed  Google Scholar 

  • Sawyer, S., Coles, J., Williams, A., & Williams, B. (2016). A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners. Medical Education, 50(11), 1107–1121.

    PubMed  Google Scholar 

  • Simmons, C. A., Lindsey, L., Delaney, M. J., Whalley, A., & Beck, J. G. (2015). Real-world barriers to assessing and treating mental health problems with IPV survivors: A qualitative study. Journal of Interpersonal Violence, 30(12), 2067–2086.

    PubMed  Google Scholar 

  • Sprague, S., Madden, K., Simunovic, N., Godin, K., Pham, N. K., Bhandari, M., & Goslings, J. C. (2012). Barriers to screening for intimate partner violence. Women & Health, 52(6), 587–605.

    Google Scholar 

  • Stark, E. (2007). Interpersonal violence.Coercive control: How men entrap women in personal life. Oxford University Press.

  • Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Rockville: Substance Abuse and Mental Health Services Administration.

    Google Scholar 

  • Taylor, J., Bradbury-Jones, C., Kroll, T., & Duncan, F. (2013). Health professionals’ beliefs about domestic abuse and the issue of disclosure: A critical incident technique study. Health & Social Care in the Community, 21(5), 489–499.

    Google Scholar 

  • Tower, L. E. (2006). Barriers in screening women for domestic violence: A survey of social workers, family practitioners, and obstetricians–gynecologists. Journal of Family Violence, 21(4), 245–257.

    Google Scholar 

  • Tower, M. (2007). Intimate partner violence and the health care response: A postmodern critique. Health Care for Women International, 28(5), 438–452.

    PubMed  Google Scholar 

  • Trevillion, K., Oram, S., Feder, G., & Howard, L. M. (2012). Experiences of domestic violence and mental disorders: A systematic review and meta-analysis. PLoS One, 7(12), e51740.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Trevillion, K., Hughes, B., Feder, G., Borschmann, R., Oram, S., & Howard, L. M. (2014). Disclosure of domestic violence in mental health settings: A qualitative meta-synthesis. International Review of Psychiatry, 26(4), 430–444.

    PubMed  Google Scholar 

  • Trevillion, K., Corker, E., Capron, L. E., & Oram, S. (2016). Improving mental health service responses to domestic violence and abuse. International Review of Psychiatry, 28(5), 423–432.

    PubMed  Google Scholar 

  • Van Deinse, T. B., Macy, R. J., Cuddeback, G. S., & Allman, A. J. (2019). Intimate partner violence and sexual assault among women with serious mental illness: A review of prevalence and risk factors. Journal of Social Work, 19(6), 789–828.

    Google Scholar 

  • Warshaw, C., Sullivan, C.M. and Rivera, E.A., 2013. A systematic review of trauma-focused interventions for domestic violence survivors. National Center on Domestic Violence, Trauma & Mental Health.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elaine Donnelly.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Donnelly, E., Holt, S. On the Margins: the Challenges of Identifying Domestic Violence in Mental Health Services. Findings of a Qualitative Irish Study. J Fam Viol 36, 481–492 (2021). https://doi.org/10.1007/s10896-020-00205-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10896-020-00205-w

Keywords

Navigation