BOOK REVIEW

Louise M. Edward, Gene Feder, and Roxane Agnew-Davies:Domestic Violence and Mental HealthRCPsych Publications, London, 2013 ISBN 978 1 9088020 56 7

Joanna Jarecki

# Springer-Verlag Wien 2014

Individuals with mental health issues experience a higherincidence of domestic violence than does the general popula-tion. Research shows men and women with severe mentalillness face 12 times the risk of violent victimization (Teplinet al. 2005). The impact of domestic violence on mental healthis significant and affects the onset, severity, and course ofpsychiatric illness. As such, it is a significant public healthconcern and of great relevance to mental health professionals.The compounding effects of mental illness and domesticviolence present individuals with unique challenges and com-plex needs. This can be overwhelming for mental healthprofessionals who often feel ill-equipped to properly identifyand respond to this important issue that so intimately affectsthe treatment of their patients.

“Domestic Violence and Mental Health” provides the men-tal health professional with both knowledge and practical toolsto utilize in providing sensitive and effective interventions inorder to reduce domestic violence and improve mental healthcare. It specifically addresses the complexities inherent in theoverlap between mental health and domestic violence. Theeditors have organized the book into independent chapterswritten by different authors. These chapters present relevantinternational studies in combination with clinical experienceto synthesize guidelines for health care providers. The bookestablishes the prevalence of domestic violence and the com-plex relationship with mental health. It highlights the issue ofdomestic violence as both a causal factor in mental healthproblems and a disruption of the individual’s journey towardwell-being. The book also emphasizes the fact that addressingthe issue requires a multidisciplinary team (and often a mullti-agency) approach.

In Chapter 1, “Prevalence and physical health impact ofdomestic violence,” the authors begin by clarifying the focusof domestic violence in this book as more specifically refer-ring to intimate partner violence. This is the focus of mostresearch to date. The definition used throughout the book isstated as “multi-dimensional and encompassing non-physicalforms of abuse that impact health and well being”. Thisdefinition is inclusive and recognizes all forms of abuse(physical, sexual, and psychological). The chapter importantlyintroduces the concept of coercive control as being the under-lying factor in all forms of chronic abuse. In citing interna-tional prevalence studies, the authors highlight the fact thatwomen are overwhelmingly more likely to be the victims ofintimate partner violence. Intimate partner violence leads tosignificant physical health effects ranging from acute injuriesto chronic illnesses and effects on gynecological and repro-ductive health. The result is that victims require more medicalattention, hospital admissions, and often fear for their lives.Importantly, the authors also highlight the significant impacton children who witness domestic violence which includeseffects on emotional and behavioural development. A discus-sion of causation, included in this chapter, identifies compet-ing theories based on explanatory frameworks which attemptto explain intimate partner violence. This includes psycholog-ical, biological, sociological, and feminist frameworks. Theeditors astutely point out that no single theory explains theproblem and state that an integrative and multi-dimensionalapproach is required to effectively intervene.

Chapter 2 focuses on the association between domesticviolence and mental health problems. Studies conductedworldwide highlight the association of domestic violence witha multitude of psychiatric disorders including depression,anxiety disorders, eating disorders, bipolar disorder, psychoticdisorders, antenatal and postnatal mental disorders, and alco-hol and substance abuse (Golding 1999; Campbell 2007;Golinelli et al. 2009; Trevillion et al. 2012). It is clear from

J. Jarecki (*)McMaster University, Hamilton, ON, Canadae-mail: joanna.jarecki@medportal.ca

Arch Womens Ment HealthDOI 10.1007/s00737-014-0430-y

these studies conducted across a wide range of communityand clinical settings that there is a higher prevalence of womenwith mental health issues who are victims of domestic vio-lence, again highlighting the gender issue that exists. Whenavailable, the authors are sensitive to include data on men andpoint out that men with psychotic disorders are at particularlyincreased risk. An important concept illuminated in this chap-ter is the bidirectional causality between domestic violenceand mental health disorders. Numerous international studiesillustrate that domestic violence is a causal factor in thedevelopment of psychiatric disorder and that the severity andduration of intimate partner violence is associated with theseverity and duration of psychiatric symptoms. As such, re-ducing prevalence of domestic violence could contribute to asubstantial reduction in the burden of mental disorder andlower health care costs. The converse relationship is alsodemonstrated in that psychiatric disorder increases the vulner-ability to experiencing domestic violence. In addition, theauthors present potential pathways explaining the bidirection-al relationship including common factors such as impairmentsin social functioning, poor living conditions, substance abuse,and previous history of trauma. Given the strong relationshipbetween mental health and domestic violence, it is importantthat mental health professionals be able to identify do-mestic violence and act effectively to improve safety andmental health.

Chapters 3 and 4 of the book provide the best practiceguidelines for mental health providers for identifying domes-tic violence and responding appropriately to disclosure.Chapter 3 outlines barriers to disclosure including intimida-tion, pressure to remain in the relationship, and the fear ofsuffering consequent abuse related to the disclosure. Thebarrier to disclosure that is of particular note is the victimnot being asked to disclose by the professional. Only 10–30%of recent violence is asked about and identified in clinicalpractice (Howard et al. 2010). This, according to the editors, ismost often the result of lack of training, lack of confidence,and fear of the consequence of asking. In response, the editorshave provided a series of visual organizers which succinctlypresent information about indicators, barriers to professionalenquiry, questions specific to the form of abuse, questionsspecific to minority groups, and guidelines for difficult assess-ment situations and documentation. Chapter 4 focuses on theprofessional response to disclosure. As the victim’s first oronly contact with a professional, the initial response is crucial.The first response must confirm the right to safety and theaccess of appropriate support for recovery, in the context ofnon-judgment and assurance that the victim is not at fault.Guides for risk assessment, safety planning, safeguarding ofchildren, and long-term strategies are provided.

In Chapter 5, the editors highlight the fact that currentevidence on interventions to support mental health serviceusers who experience domestic violence is limited. Studies

suggest that CBT for women who have suffered domesticviolence with PTSD leads to improvements in symptoms ofdepression, PTSD, and self-esteem (Feder et al. 2009). Theauthors emphasize that psychological interventions are unlike-ly to improve outcomes unless they directly address the abuseexperienced. Research on mental health users’ perspectivesdemonstrate that women identify interventions as helpfulwhen they are encouraged to identify domestic violence, aredirectly asked about their experiences of abuse, and helpedwith safety planning or parenting and offered support torecover from their experiences (Humphreys and Thiara2003). Given the complex and multi-dimensional needs ofvictims with mental health issues, the authors argue the needfor joint working practices between the mental health anddomestic violence sectors. This chapter discusses domesticviolence advocacy interventions that are being implementedin the community and primary health care settings in the UK.These interventions consist of collaboration between healthcare professionals and specialized domestic violence advo-cates that include referral pathways to a designated advocatewhen abuse is identified. The authors present evidence of theeffectiveness of these interventions and argue for similarinterventions in the mental health care setting. The chapterprovides extensive information regarding the effectiveness ofother models of collaboration used in Britain. Although do-mestic violence advocacy roles do not exist in Canada, it isinteresting to learn from the universal principles of this modelwhich highlight collaboration with specialized domestic vio-lence services. The authors are of the opinion that goodclinical practice includes professional training, clear referralpathways to provide practical and emotional support, and theestablishment of inter-agency collaboration to provide inte-grated services for women with complex needs.

The concluding chapter reminds the mental health pro-fessional of her responsibilities with regard to medico-legal issues given the overlap between mental health andlaw in the area of domestic violence. The mental healthprofessional has an obligation to act in the interest ofvulnerable adults and vulnerable children. Relevant prin-ciples and practical procedures are outlined to guide themental health professional in this process. This includes adiscussion of capacity and consent and the balance be-tween the responsibili ty of ensuring safety andempowering capable individuals to make their own in-formed decisions. The editors provide a summary of rel-evant legislation including the Mental Health Act andprovide the mental health professional with practical sug-gestions for civil and criminal court proceedings. Al-though this is discussed in the British context, the discus-sion refers to an adversarial system which has similaritiesto the Canadian legal system.

The strength of “Domestic Violence and Mental Health” isin its simplicity. The information presented within each self-

J. Jarecki

contained chapter is simple, concise, and easy to follow. Goodpractice guidelines are presented in bulleted format with visualorganizers in order to allow the reader quick access to a greatdeal of information. References to numerous resources areincluded for professionals that wish to obtain more informa-tion and further training. The simplicity of this book does notcome at the expense of depth of the issues explored. Together,the chapters synthesize and weave together the multitude ofcomplex issues relevant to the interface between domesticviolence and mental health. The reader comes away with botha deeper understanding of the complexities of these issues aswell as practical tools on how to identify, respond, and inter-vene. Although some of the content is specific to the UK, theconcepts are universal and can be applied to any setting. Alsostated simply and poignantly throughout the book is theunderstanding that mental health service users want recogni-tion of their trauma and need to tell their story. This is avaluable resource for any mental health professional seekingto expand their knowledge and skills in detecting andresponding to domestic violence and promoting optimal men-tal health and safety.

References

Campbell JC (2007) Assessing dangerousness: violence by batterers andchild abusers. Springer, New York

Feder G, Ramsay J, DunneD et al (2009) How far does screeningwomen fordomestic (partner) violence in different health-care settings meet criteriafor a screening programme? Systematic reviews of nine UK NationalScreening Comittee Criteria. Health Technol Assess 13:iii–113

Golding MJ (1999) Intimate partner violence as a risk factor for mentaldisorders: a meta-analysis. J Fam Violence 14:99–132

Golinelli D, Longshore D, Wenzel SL (2009) Substance use and intimatepartner violence: clarifying the relevance of women’s use and part-ners’ use. J Behav Health Serv Res 36:199–211

Howard LM, Trevillion K, Khalifeh H et al (2010) Domestic violence andsevere psychiatric disorders: prevalence and interventions. PsycholMed 40:881–893

Humphreys C, Thiara R (2003) Mental health and domestic violence: ‘Icall it symptoms of abuse’. Br J Soc Work 33:209–226

Teplin LA, McLelland GM, Abram KM et al (2005) Crime victim-ization in adults with severe mental illness—comparison withthe national crime victimization survey. Arch Gen Psychiatry62:911–921

Trevillion K, Oram S, Feder G et al (2012) Experiences of domesticviolence and mental disorders: a systematic review and meta-analysis. PLoS ONE 7:e51740

Louise M. Edward, Gene Feder, and Roxane Agnew-Davies: Domestic Violence and Mental Health