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Building Bridges: Exploring the Links Between Woman Abuse, Substance Use and Mental Ill Health BC Women’s Hospital and Health Centre Woman Abuse Response Program: Jill Cory email@example.com AlexxaAbi-Jaoude firstname.lastname@example.org Louise Godard email@example.com Amber Hay firstname.lastname@example.org Academic Partners: Dr. Amy Salmon email@example.com Dr. Marina Morrow firstname.lastname@example.org We Started Through Dialogue • Invited anti-violence partners for 2 days to talk about what they were observing on the frontlines related to woman abuse, substance use and mental ill health • Lead to a report of recommendations, development of a provincial Building Bridges Steering Committee and a successful proposal funded by Vancouver Foundation for $45,00.00 Project Methodology • BC Province-wide workshop/consultation with N=460 service providers representing mental health, substance use and anti-violence sectors from 82 communities • 15 Focus groups with N=100 women affected by woman abuse, substance use and mental ill health • 9 interviews with policy leaders INCLUSION CRITERIA • Self-identify as a women • Be 19 years old or greater • Have past or current experience(s) of abuse • Have past or current experience(s) of either substance use or mental health issues or both • Have received support, currently or in the past, for their experience(s) of abuse DATA COLLECTION • Focus groups were facilitated using a semi- structured interview schedule • How they experienced the links between abuse, substance use and mental health issues? • How they experienced accessing anti-violence, addictions and mental health services? • What kinds of improvements would they recommend to better support women? DATA ANALYSIS • Located all data related to service experiences, needs, gaps, outcomes • Identified repeated observations • Collated those observations into themes and subthemes • Made comparisons and connections between themes and subthemes • Applied coding labels • Selected quotations to illustrate key points Understanding Women’s Experiences of Abuse Woman abuse is most commonly defined as: • Any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women, including threats of acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life (United Nations, 1993, p. 3). What women say… “There has been several times especially in [ ]. My hip was broken. My partner had broken my hip and I chose not to go until I was out of the situation. He had refused to take me. He had basically stopped me from going. I heard people say that you make your own choices you can do whatever you want. And to an extent I agree but when you make that choice, you and your children could be killed if you do it, so you choose not to. To an extent that choice is made for you.” - Natalie CYCLE OF VIOLENCE EXPLOSION HONEYMOON TENSION What women say… “A lot of it was just verbal, but I wished he would have hit me instead of said what he said. The words were just as bad as, they hurt more than probably any being could have. And they did more damage for the long term.” – DJ Connecting health issues "When I did finally get out of the relationship, I didn’t feel good about anything. I was a failure as a mother, I was a drug addict. I was in horrible shape. I’d lost so much weight. I was old and haggard looking. I’d lost all my friends. I was nothing. I didn’t think I was going to make it. It’s pretty tormenting. And to think that somebody can brainwash you to that extreme, or beat the hell out of you to that extreme. If it wasn’t for my son constantly saying ‘I love you Mommy. I need you, Mommy’ I would have given up and just died." - Dot Health Impacts of Abuse • Exhaustion, trouble • Bruises, lacerations, burns, sleeping, insomnia, sprains, back pain, fractured nightmares or repetitive bones, broken teeth, dreams choking, head or abdominal • Stomach pain, anorexia, injuries bulimia, GI pain • Hearing loss, visual • Fainting, seizures, chest impairment, disfigurement, pain, hypertension, brain damage, or paralysis headaches, back pain, • Substance use, mental palpitations, dizziness and health issues hyperventilation • STIs, HIV/AIDS, forced • Eberhard-Gran et.al, J Gen Intern Med, 10.2007 pregnancies, menstrual pain Health Impacts of Abuse • Women impacted by physical and/or sexual abuse reported 6.0 somatic symptoms and 1.5 diseases (mean) • Compared to women not experiencing abuse, who reported 1.8 and 0.5 • Eberhard-Gran et.al, J Gen Intern Med, 10.2007 Not taking women’s (health) concerns seriously • “I agree, my abuse was 18 years ago and no one believed me and [I thought] it was my fault. The things that happened were my fault and it didn’t happen the way I said they did. And my ex was good ‘cause he knew how to beat me so that I didn’t have any visible bruises. And they didn’t believe me. And I would go to the hospital, and I wasn’t even doing drugs at the time, and they would say ‘you are just trying to get drugs for a pain that was non-existent’. Meanwhile he had beaten me and raped me… And I didn’t get any help. And it was my fault. And maybe if you were a good little girl and sat back and be quiet that wouldn’t happen to you.” Violence against women and mental health Linking Woman Abuse and Mental Ill Health • There is evidence that many mental health problems post-date experiences of abuse “Mental health issues should be treated as effects of abuse and not as mental disorders per se.” - Flitcraft Women, Violence and Mental ill Health “I don’t call it mental health, I call it symptoms of abuse, because to me that is what it is.” - Gail, woman abuse survivor Cathy Humphreys, Mental Health and Domestic Violence: a research overview. Conference Presentation for Making Research Count, Coventry, 2003 Women, Violence and Mental ill Health • 70% of women in psychiatric in-patients and 80% of those in secure settings have histories of physical or sexual abuse (Phillips, 2000) • More than 70% of those with post-traumatic stress disorder (PTSD) are women (Kessler, ‘95). • “It’s just taken a toll on me. I don’t know where to turn. I thought I was going mentally insane.” Women, Violence and Mental ill Health • Between 35 – 73% of abused women experience depression or anxiety, which is at least 3x as great as for the general female population. (Golding, 1999, Fikree & Bhatti, 1999) “In the end, I ended up doing self harm to my wrists. It was superficial…It was a way to get out of that relationship after two years of physical and mental abuse.” - Kathy Women, Violence and Mental ill Health • Generally rates were 2 x greater than in the control group in different sectors across the study. eg. In-patients - prevalence of depression was 32% in exposed and 17% in unexposed women (Cascardi et.al., 1999) • Primary care - prevalence of depression was 69.9% in ‘exposed’ and 31.9% in ‘unexposed’ women (McCauley et.al., 1995) • Domestic Violence intervention services - prevalence of depression was 83% (Campbell et.al, 1995) Women, Violence and Mental ill Health • Demonstrated that rates of depression in women leaving a refuge fell from 83% to 41% in 6 months if no recurrence of abuse occurred but only fell to 71% if women were re-abused in the 6 month follow-up. (Campbell et.al, 1995) Women, Violence and Mental ill Health • Rates of female suicide attempts are as high as 44% for women who have lived in refuges (Golding, 1999) • 30% of female suicide attempts presenting at accident and emergency were the subject of woman abuse (Stark and Flitcraft, 1995) • Risk ratio for suicide was 20.9 in women diagnosed with personality disorders, one of the highest risks of any category studied (Baxter and Appleby, 1999) Women, Violence and Mental ill Health • Psychological impact of woman abuse not determined by the severity or frequency of physical assault, but by exposure to dominance • “Whether it was verbal abuse or physical abuse. The physical abuse actually was a little better because the bruises go away. But the mental and verbal abuse really sticks with a person for a long time.” - Cheryl Women, Violence and Mental ill Health “What appears to be a constellation of symptoms or disorders may reflect a normal response to abuse and trauma and the social realities of continued isolation and danger.” - Warshaw, 1997 What women say… Perpetrators Grooming Others “I used to get, “Oh, your crazy?!” He always presented himself in a good way. Most of them do and you’d never know…People don’t know what goes on behind closed doors.” – Maggie “And that’s what he was going out and tell everyone, ‘well the reason I’m like this [abusive] to her is because [she drinks]’” - Janet Abusers may exploit a woman’s vulnerability • Keep medications from her, give her too much medication, demand she takes medication • Take advantage of changes in her symptoms and moods (eg. encouraging suicidal feelings) • Threaten to take her children away and tell child protection authorities or the court of her illness • Minimize her credibility What women say… “Because he always participated. This is another barrier. He always participated in my sessions with my mental health worker. He had them believe, for the little while, that he was Mr. Support. Hugely. He couldn’t do that with the Stopping the Violence Program. He insisted. And they agreed, “OK”. My partner insisted and allowed him to. So I could never speak completely freely or anywhere freely about the relationship. All that was being dealt with was the mental health issue. But the mental health issue had so much to do with the relationship issues.” - Vivian What women say… “Mine was happy that I was getting mental health care. Because I was in an extremely low depressive state. But I had to sneak around to get the type of help that I really need in order to be able to climb out of that hole. He wanted mental health and addictions to fix me so that I would be his mould. And that I could go back to living in the bedroom of the RV and not coming out and bugging him and just doing what he told me to do when he told me to do it. That would be his idea of fixing me.” - Emma What women say… “Whereas my first encounter with the social worker was after I attempted suicide and so he put himself out there like he could help. So he was welcome.” - Sam Violence against women and substance use Violence against women and substance use • Partner may be the primary or sole supplier of drugs, increasing her dependence on him by exploiting her dependence on drugs • “He wouldn’t let me not drink, he would bring alcohol over, or you had to drink just to be near him. He would put a glass under my face, he knew I didn’t want to drink.” Violence against women and substance use • Substance use may begin or escalate as a response to victimization/ woman abuse “My addiction was the solution- my problem is abusive relationships and molestation when I was 6 or 7 years old” - Stella “It went from mental abuse to physical to emotional. The way I dealt with it was by drinking all the time. That’s the only way I could cope.” – Naomi What women say… • Between 60-80% of women in treatment have experienced sexual or physical abuse at some point in their lives. • Alcohol dependency is 15 times more prevalent among women impacted by abuse than the general public. Violence against women and substance use • Between 55 and 99% of women who have substance abuse issues have been victimized at some point in their lives (Moses et.al, 2003) • Between 67 and 80% of women in substance abuse treatment are IPV victims (Cohen et;al, 2003;Downs, 2001). • Between a quarter and a half of the women receiving victim services for IPV have SA problems (Bennett and Lawson, 1994; Downs, 2001; Ogle and Baer, 2003) Violence against women and substance use • 60% of substance abusing females were victims of domestic violence and 42% of women who were victims of violence and receiving domestic violence treatment were substance abusers. (Bennett and Lawson, 2004). • The prevalence of domestic abuse within the substance treatment population is reported to be between 60-80% range but rises to between 90- 100% when psychological abuse is accounted for (Downs 1999, Stringer, 1998) Violence against women and substance use • Efforts to stop using substances may precipitate abusive partners' use of increased violence or other control tactics. • “I went from a mentally abusive household to a husband who physically abused me and did drugs. And my home was so full of drugs, I had no control over what he was selling in the house, what he was doing in the house or doing to me.” - Amy Violence against women and substance use • Some women drink alcohol or use other substances to numb or escape the emotional and physical trauma of violence/abuse “One starts with one- the abuse and then you have the abuse and then you start with alcohol and then a bit of coke and carry on from there and keep going. Just trying to be numb...” – Alice What women say… • “With drugs it’s not really a means of addiction, it’s more a means of survival. You do them to sell them and to get away from the guy you’re with you go to a house and do drugs instead of sit at home and be abused. “ And that’s been my life history. My brothers, my father, my forefather.” - Willie What women say… • Substance use can placate her abusive partner and create temporary safety for her “We use the drugs to try and mask the abuse. And once you stop using them flashbacks come. It’s just a constant. We just self- medicate. Trying to push those memories out.” - Christine Medicating Impacts of Abuse • Women in abusive relationships may be addicted to medications prescribed by health care providers for health concerns related to abuse. For example: • Chronic pain • Chronic headaches • abdominal pain • joint and muscle pain • anxiety and depression • sleep disorders Medicating Impacts of Abuse • “I don’t understand. Oh, ‘we’ll help you, we’ll help you’. Whatcha going to do, give me a teddy bear? Basically, that’s what it was. Doctors, they give me medication I’ve never had before. So I’m walking around like gumbie. So I can suppress it.” Medicating Impacts of Abuse • I was thrown down by my partner a couple of years ago… went to the DTES clinic for T3s. And they never asked me what happened. Never asked me what I wanted to do about it. I told them what happened.” Medicating Impacts of Abuse • “A person might think ‘how did you all of a sudden start get involved in drugs when you were married and never done them before?’ How it started for me was I started with prescriptions. Sleeping pills, and anti-depressants and valiums. That was the way my doctor tried to help me deal with my loss. From there you need more pills and you go find people who you think can get you something and that leads to other things. So that’s how it happened to me.” Linking Woman Abuse, Substance Use and Mental Ill Health What women say… “The abuse part… I think sometimes times the abuse comes first, for some of us, and then I think the abuse continues because of the drugs and alcohol. It changes your personality… especially if you have mental health. Mental health, get some crack in there and some meth in there… you’re a different person.” - Kathy Linking Woman Abuse, Substance Use and Mental Ill Health • Not an equal triad • Links to woman abuse are often missed in services • Language of co-occuring, concurrent disorders conceal root causes • Conflating trauma and woman abuse leads to inappropriate and sometimes unsafe practices Linking Woman Abuse, Substance Use and Mental Ill Health • The largest contributions to the burden of disease associated with woman abuse are mental health and substance use issues, accounting for 73% and 22% of the total disease burden, respectively (Vos et al., 2006). Linking Woman Abuse, Substance Use and Mental Ill Health • When services address only one problem- either abuse or substance use or mental health issues- at anytime, one or the other issue(s) becomes secondary and the opportunity to address all three issues together is lost (Humpreys, Regan et al., 2005; Humphreys, Thiara, et al., 2005). Linking Woman Abuse, Substance Use and Mental Ill Health • Women who remain in services are often forced to enter settings that focus on narrowly defined problems, rather than being able to address themselves as a whole (Stenius & Veysey, 2005). What women say… “It’s totally inter-related. Because abuse in relationships, depression, guilt, and then anxiety reducers, whether it’s ups or downs in your emotional state or whether it’s drugs or whatever it is I need today so I can forget about my pain or feel pretty or whatever. So, it’s all connected.” - Carrie More Complexity Systems and Social Conditions Conditions of Women’s Lives • Housing • “Understanding the context in which • Mothering women live also • Poverty means understanding • Geography the impact these issues have in many • Racism areas of women’s • Isolation lives.” “You have to be broken and down and out” • “You have to be broken and down and out before you get anything. At the bottom. I had to go to the extreme of living in poverty to get any help. It’s devastating. I mean I used to support my family and my kids had everything they needed. I mean my 11 year old had been living with her dad for the last year and she was living in a $500,000 house and has everything she needs and now I have to take her and move into second stage living, which is not bad, but I mean it’s a big huge drop in what she had to take her away from that and it’s almost like I don’t want to. .. “You have to be broken and down and out“(con’t) • …I mean she’s my daughter and I’ve raised her for ten years and her dad for one, but I want my baby back and she wants to come back, but then we’re stuck in the place… and it’s hard. And for food-wise, it’s not just the home, it’s food and clothes and her baseball, and having the things she already had. And the necessities too, going to the food bank, I mean thank God for those kinds of places, but to have to do that and to have to be in that position to get help… I mean it’s hard. And yea if I wasn’t pregnant I’d be out there and get a job, but having him (her infant baby) just brings you back. The worst I feel is for my daughter… trying to give her things that she used to have and I don’t have. We tell each other “okay we’re going to make it, we’re going to move forward.” Service Encounters Can Increase/Cause Harm Service Encounters Can Increase/Cause Harm • Services can retraumatize women by replicating the events or dynamics of women's primary trauma (Markoff et al., 2005; Elliot et al., 2005; Warshaw, 1997). • Retraumatization occurs when services are unable to recognize and validate the trauma/ abuse in women's lives, thus making services emotionally unsafe, disempowering and often devastating (Markoff et al., 2005; Elliot et al., 2005; Warshaw, 1997). Service Encounters Can Increase/Cause Harm • “Drugs. I mean after all you said, who wouldn’t turn to drugs or alcohol with all that? Every time you turn around another obstacle, another mountain to climb. Who wouldn’t give up? That’s so much work. And on your own. Nobody telling you ‘you’re doing the right thing and here’s another resource.’ Yeah, with no support. None.” Service Encounters Can Increase/Cause Harm • “When women present with all 3, it prevents them from getting services because no one wants to touch these women.” – service provider • “It doesn’t seem like systems want to make the extra effort to assist the most vulnerable women.” – service provider Service Encounters Can Increase/Cause Harm • Retraumatization can occur in numerous ways - use of seclusion, restraints or involuntary medication (Markoff et al., 2005). • Can also occur in more subtle ways - confrontational or aggressive techniques that may be used to break down a women's denial of her substance use can be retraumatizing in that such an approach parallels the interpersonal dynamics of a women's abusive relationship (Markoff et al., 2005; Warshaw, 1997; Swan et al., 2001). Service Encounters Can Increase/Cause Harm • “Denial and minimization of experiences of abuse are used as tactics of psychological control in abusive relationships and these can be inadvertently repeated in clinical encounters if the clinician is unable to apply an approach that is framed by the need for safety, whether we are aware of the context of abuse or not.” – Dr. Carole Warshaw ‘97 Minimizing Women’s Safety • “A lot of doctors don’t want to talk about it or deal with it [violence/abuse]. So they just give you what you need or what they think you need and they push you out of the way…They just want to keep you medicated.” Services can increase harm: substance use approaches • “The focus on the woman sends the message that the responsibility is on women to correct situation, no accountability for the abuser.” (service provider) • Focus on single issues, often without recognizing social conditions Minimizing Women’s Safety Concerns • Treatment length and lack of options for non- residential support • Mandates that don’t support women staying in treatment: mixed gender, male dominated and male oriented services • Services without childcare • Lack of focus on safety after Rx completion • MI, Stages of Change,12 Step, Trauma/PTSD Abstinence Abstinence • “There’s still only around 7 detox beds. Can’t smoke in there now. But it’s pretty harsh because a lot of people are leaving because of the cigarette thing. My partner got kicked out last week for smoking a cigarette. Having to quit smoking while you’re detoxing. I think it’s too much…. They can’t take everything away at the same time.” Abstinence • “They say ‘well we give you the patch’ and I was like ‘you can’t smoke the patch’!” • “What works for one doesn’t work for others... there’s so many people leaving because of cigarettes. It’s a big thing going on now.” Services can increase harm: substance use approaches “I watched a lot of women get kicked out of the recovery house for getting loaded. And I think it’s ridiculous. I can understand those women are dangerous. But give them somewhere else to go. Give them a detox bed.” - Manny Services can increase harm: mental health treatment models • Mental health practices can retraumatize. • Confinement or isolation, • Removing autonomy • Intensive therapy • CBT • Enforcing medication Get to Know Me • “CBT is good in some ways but it doesn’t really help you tap into your feelings. So she recommended me to someone else and right away she wanted me to jump in and I’m going like…excuse me shouldn’t you know better…rapport building or something. This is my first day with you so I didn’t go back.” - Harjeet Unmet treatment needs • Among women receiving substance use treatment, only 25% state that their experiences of abuse were adequately addressed (Swan et al., 2001). • Providers may be reluctant to acknowledge women's experiences of abuse, either viewing it as a distinct issue in itself or may diminish its significance due to fear or misperceptions, concerns that addressing abuse is counter-therapeutic, lack of appropriate and specialized programs, or insufficient knowledge or training (Morrow, 2002). Trauma Interventions Can Cause Harm • Self Regulation • Self Soothing • Self Esteem • Self Trust • Limit Setting and Assertiveness • Clear Express of Needs and Desires • Clear Communication • Accurate Perception of Others and Honest labeling • Appreciating Mutuality and Reciprocity Service Encounters Can Increase/Cause Harm • For those who do successfully enter services, research has shown that in comparison to women with either condition alone, women who have experiences of abuse, substance use and mental health issues have worse treatment outcomes (Swan et al., 2001; Thompson & Kingree, 1998; Comfort & Kaltenbach, 2000). Service Encounters Can Increase/Cause Harm • Women living within an abusive relationship were significantly less likely to complete substance use treatment; only 41% of women who were currently in an abusive relationship completed treatment, compared to 77% of women who were not in an abusive relationship. (Swan et al.2001) Service Encounters Can Increase/Cause Harm • “And when I left they said, ‘take these. They are anti-depressants. But don’t drink. Don’t drink more than 6 drinks per week.’ I thought, I’m not taking them because I drink more than 6 drinks per day. So, I just didn’t take them.” Services Can Increase Harm • Most transition houses won’t accept women who are substance using • Must be clean 7 to 10 days • Have medications controlled by staff • Have belongings searched • “Our mandate can set women up to think that ‘clean’ is right or that they must fit our mandate. Limits service availability.” –provider Abstinence • “When you’re talking about women getting kicked out. It depends on the situation.  house is OK because it’s low barrier and you can come in there. But at the women’s shelter, where there are kids there, I do believe you have to be clean and sober.” • “My doctor is my drug dealer… I tell her that I have someone else that deals with my health… you’re just my drug dealer.” • My own doctor even… I can’t believe he wanted to write me a prescription for morphine, and that was I wanted to get on methadone because I wanted to get off the morphine… He said well I don’t know what you’re asking for and I said well I want something for the pain but not Tylenol not something that’s just going to just dull the pain. I said “quite frankly I’m surprised you offered morphine because you know I’m an ex- morphine addict- or user I should say, because I’m still addicted, up here (pointing to her head). Now I’m just on straight codeine. Services Can Increase Harm • “Well, I stayed at some shelters. I had a really bad experience at a shelter. The first night I was there, the woman in the next bed to me OD’ed. And I felt really unsafe in shelters. That’s why I stayed in my car the majority of the time.” Help Can be Retraumatizing • “Same with storage. Everything I do have. You can take a box of things that you love and treasure to a transition house. You can bring clothes. What happens to your stuff?” • “Hard to live in a transition house with my kids—it was traumatic for all of us.” Homeless Shelters • “He lived there, he said, ‘it’s great, you get breakfast’. I’m thinking you get bacon and eggs! A little different. I was hungry. It was overwhelming. You drive up, there’s about a gazillion people waiting for their beds. I thought, ‘What am I doing here?’ … they said, ‘You need to rest, we’d like you to stay here [drop-in centre] for a couple of days.’ I only stayed there for one night and that was enough. But it was an experience. I thought I was suffering! You sleep in a dorm with 150 women, and they’re all so very tired. They know, they’ve been there before. … They’re just so tired. Then you see one woman in a wheelchair going around and stealing other people’s purses in the middle of the night…So I stayed up and I cried all night. It was sad. This is a whole different world for me. I’ve never experienced something like that. You go into the washroom and there’s a great big jar of condoms. This was all so new. They come in with this great big hose and they hose down the bathroom.” Jumping through hoops to stay in services • “I’m out of the shelter for stuff that I did so I’ve been asked to leave. ..And it is was difficult for me to understand, for me to come here and not be able to leave at four o’clock in the afternoon and I can’t go anywhere. I can’t phone somebody. Like I don’t have a person after me. And if I can’t leave, can I phone? Not that I have anyone that I need to phone or want to phone, I just want to know I can phone. It’s very difficult.” - Jose Barriers And there are many!! Gaps and Barriers • Compartmentalizing Issues • “Mental health issues are construed as separate from abuse – now that’s crazy!” – service provider Gaps and Barriers • Gaps between Services – “Substance use counselling is sometimes in conflict with mental health counselling, and neither support women’s safety and other impacts of abuse.” – service provider Gaps and Barriers • Lack of Integration –”These three things are impacting women’s lives at the same time and makes it difficult to access services because of ‘silos’ and turf issues.” – service provider Attitudes of Professionals Reduce Access • “I don’t feel comfortable if it’s a certain person. There’s somebody there that makes you feel like you’re a burden. And I’ve been a burden all my life. I don’t need to feel that. You need people to love you when you can’t love yourself.. Not feel like they are just there for a pay cheque.” - Wendy Attitudes of Professionals Reduce Access • Some service providers are ill-informed and stigmatize/punish women. • “Not all service providers see women survivors as survivors.” – service provider • “The ‘oh. it’s you again’ mindset in ALL services. Women’s history follows them, but shouldn’t.”- Meg • “Attitude of ‘what will you do differently this time?’ instead of ‘what do you need from us this time that we didn’t provide you last time?’” – service provider Attitudes of Professionals Reduce Access • “I’m always seeing judging eyes. Judging ears. It feels like they don’t want to hear your story. Or maybe, you’re fabricating some of your story? This is how it was. This is how I present it, because it’s the only way I know how to. It’s judging eyes. That’s the barrier I face every day when I leave the door. Which people are going to have those judging eyes?” - Hanna Labelling Women Reduces Access • “It’s the labels too. Once they label you… either you use coke, or you’re in an abusive relationship, or alcohol or whatever. It’s there. It’s like a red flag. ‘Hey! You’re an addict’.” - Del Rules, Hoops, Doors, Circles… Jumping through Hoops • I just got so overwhelmed at the beginning. Ok, start at the transition house. Then welfare, then family resources, then mental health. I went through mental health, they couldn’t help me out. The family resource centre, no, they don’t do it here. I went to the health unit. No, they can’t help you here. So I did a big circle and ended back with [original counsellor]. By then, you don’t want it anymore. I’ll do it on my own. I’ll do it on my own with the one counsellor I connect with…”. - Isabelle Closed Doors: Bouncing from service to service • “When you make that first step and walk into a transition house. You tell your story. They start a file on you. Then they send you to the next place. You have to tell your story again. By the time you get to the 6th place of the day you say ‘f… this man’.” - Suki Service Saturation • “From my point of view, I had been with a marriage counselor and I had already been in Mental Health and I was going through NA AA, whatever. From my point of view, I was already saturated with, ‘You’ve got to do this, you’ve got to do this’. I don’t need another one.” Mandates that Exclude • “But I ended up phoning one, and it was in [community], and they had decided not to take anymore bipolar patients. So, yah, just that afternoon. They said, ‘we’ve had some problems with bipolar people and we had a team meeting and we decided that were not going to take anymore’. So are there shelters out there for people that are bipolar specifically? No. There’s not out there. Because there’s a lot of women that I have run into. Lots.” Access to Care • “Next to impossible to get a psychiatrist here—and once they find out you’re an addict they assume they know exactly what to do: here are your pills, take methadone and I’ll see you in 3 weeks. Yeah, they label you.” Limited Services • “I don’t agree with the 30 days at the T house. You’re only allowed to stay 30 days and I don’t agree. For some women, 30 days is not enough. Then you boot them out the door and they go back.” Limited Services Obstacles to Mothering • “I’ve seen this tons living in [treatment centre], a women is not allowed to have her children for a certain amount of time. She has to have so many days clean. She has to prove herself. So what happens is she either has to stay in transition or she has to bunk up with a roommate.” Obstacles to Mothering • “My barrier is having [my daughter] taken care of when I go somewhere, or being able to take her with me.” • “The reality is you can’t really trust someone with your child. You know you can trust yourself. You always have a little doubt.” Obstacles to Mothering • “If I was to be sexually abused today and needed to go to a safe house, there isn’t one. My son is 16 years old and they would not take my son in.” • “When that all happened I went into rehab. They didn’t want the kids there. But then I went into a house for women and children. And that helped me out. It’s recovery. It was where I could live until I could get a job and afford to move out.“ Obstacles to Mothering • “But you shouldn’t have to go through those obstacles. I don’t know what you have to do to help women today so they don’t have to go through all those obstacles and be able to get the resources. I took my kids to mental health 3 times a week for 3 years… How do you go to work when you have to go to counseling 3 days a week? How do you go to work when your kids are screaming at 3 am with bad, bad dreams and you can’t get the answers because they’re 3 and 5 years old. You know, where do you reach out? I mean I was lucky enough because I guess I had a career behind me and I knew how to dig up the resources on my own, but what about the women who don’t have that? Where do they go?” Women without Children: Another Barrier • “Can I also say that I think, that as much as a lot of us have children, those who don’t have children still need the same help…Just because you don’t have kids doesn’t mean you haven’t been abused. Doesn’t mean that you don’t need help too. And there’s resources for women who have kids but I don’t see a lot of resources for women without kids.” Women without Children: Another Barrier • “Like [ ], you can only come here if you have a kid 2 years and under.” • “What about a women who don’t have kids? They can’t come here and they’re just as traumatized as we are. They still have to go through the same stuff as we do and do the doors open for them? Probably even slower because they don’t have children that depend on them, but they still have to go through the same thing.” Women, pets and obstacles • “This may not apply to the majority, but when I was on the streets of Vancouver, I had a dog. That was my connection to staying sane. And I had her till she was 15. But I had no where to go. I was in [ ] when they did a women’s shelter and I fought for them to put kennels in because a lot of women had dogs, cats, whatever. I think there needs to be. I’ll stay outside. I won’t leave my animal.” Lack of Compassion/ Relationship Building • “There are too many people that are there for their paycheck and not with their heart. When you work in mental health, you need to be a kind, caring and giving person to be in that area. There should be some kind of test for that. You don’t got the guts for this.” Lack of Compassion/ Relationship Building • “My violence worker, that’s who I went through [for counselling]...It was just very cognitive. I mean, I would share information and then she would give me more and I would walk out of there, you know, my head this big, ….I felt even more overwhelmed. …and it just keep going like that…” Not taking women’s (health) concerns seriously • “A couple of years ago I was at [ ] hospital (Psychiatric Emergency Service), I told them I was going to kill myself and they sent me home... They just switched a couple of meds and sent me home.” Not taking women’s (health) concerns seriously • “That’s the same when I was beat up… I couldn’t walk. They wouldn’t take x rays or anything. I went back 5 times and there was a crack in my spine. I couldn’t walk. They made me wait in the waiting room for 18 hours. They take forever.” Questions?
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