About our service
For several years our organisation had noticed an increase in the amount of service users and their children who were either reporting or demonstrating severe and enduring poor mental health and signs/symptoms of trauma. We also noticed how difficult it was for our service users to engage with treatment and recovery; there was often months of waiting to see someone and then either nothing could be offered due to lack of services/resources or there would be a further wait (ten months average) for support. We recognised that we needed to offer a service to support those living with domestic abuse, poor mental health and trauma and this led to creation of the Mental Health Idva, funded for four years through the Big Lottery.
Multi-agency working
We established contact with statutory and voluntary mental health services and organisations in our area, to understand the services currently being offered, the referral processes and thresholds. This enabled us to see the gaps in services; we believed it was important to contribute to creating a multi-agency culture of engaging victims of domestic abuse with poor mental health. We also wanted to coordinate a joined up approach that is able to manage risk and to support each person and their family, and which builds on their resources and resilience. Another aim of the project was to support and educate mental health professionals around domestic abuse and the impact this can have on mental health. This not only offered a proactive response for service users but also increased opportunities for engagement.
Referral pathways
One of the priorities was to create clear referral pathways between the Mental Health Idva and the statutory services who would offer emergency care, assessment, and access to therapeutic treatment and medication. Training was delivered to these teams to support them in asking about domestic abuse (routine enquiry) and supporting them with referrals to our service. This created a lot of new multi-agency working.
Engagement
We wanted to offer people a way to engage that suited them; we recognised that our current approach wouldn’t always be right. We needed to be creative and flexible, work at the service user’s pace and in their preferred way. We needed to identify their needs and wishes and jointly create a personalised support plan that worked towards short and longer-term goals, and improved their safety and well-being. We wanted to use a trauma-informed approach; understanding the prevalence and impact of trauma and the complex paths to healing and recovery.
We also recognised that engagement styles differ; many were uncomfortable being in a room in an interview style appointment, so I would often meet with them for walks on the beach or the park. This helped reduced the pressure of direct eye contact and we could use the environment as a distraction when talking became too much. It also supported positive mental health techniques such as mindfulness and grounding; being outside and connecting with nature. Exercise is also a great tool to keep mentally healthy.
We had to accept that we wouldn’t just be providing a domestic abuse intervention; we would continue to identify and refer to other agencies, but we acknowledged that our advocacy role would also need to extend to helping resolve other issues faced by service users. We couldn’t expect mental health to improve unless and until we addressed wider problems such as potential homelessness.
It is an essential part of the role to be able to assess and understand symptoms of mental health problems and to offer tailored support. This may include support with medication, emergency support at home or assistance with admission into hospital. Due to the complexities of this work, it is vital that the Mental Health Idva holds a reduced caseload. I would often spend several hours at a time with one person and would see them several times a week, especially when they were in crisis.
Psycho-education and trauma work – the impact of trauma
Our initial information gathering showed gaps in service, much of this due to limited resources in our area which meant extended waiting times for service users. Often by the time the service was available to them, their mental health had deteriorated to the extent that they were no longer eligible for the service or they were too unwell to engage.
For many there has been limited opportunity to learn about their own mental health, and so we use psycho-education as much as possible. We talk to service users about trauma; the short and long term impacts and the way adverse childhood experiences (ACEs) can feed into trauma. Once they have this understanding, they are then in a better position to process their own experiences.
Many people that have experienced trauma have been misdiagnosed with conditions such as personality disorders. Knowing their past and/or current diagnosis helps us understand which medications or therapeutic interventions have been tried. It’s also important for us to know what the service users experience of previous interventions has been.
Interventions
Building resilience and working on recovery can include offering medication and therapies. The Mental Health Idva is qualified to offer trauma informed cognitive behavioural therapy (CBT), an approach which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems. It combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do).
Dialectical Behaviour Therapy (DBT) is a Cognitive Behavioural treatment designed for people who experience difficulties in managing their emotions and who may have developed ways of coping such as self-harm and attempted suicide. It focuses on mindfulness, interpersonal effectiveness,emotion regulation and distress tolerance. We also offer eye movement desensitization and reprocessing (EMDR), which can help with the symptoms of post-traumatic stress.
About Amber
Amber Canham is a qualified social worker with experience of working in a Community Mental Health Team. She has also worked for NDADA in North Devon as a Marac Idva, and as a Health Idva. Her most recent role involved creating the Mental Health Idva post. Amber has trained as an EMDR (eye movement desensitisation and reprocessing) therapist and continues to work with adults experiencing post-traumatic stress disorder/trauma symptoms alongside delivering domestic abuse training.
