Tuesday, November 10, 2009

Sexual Violence and Mental Health

Last Friday, Nov. 6, I attended the quarterly meeting of MN's SVPN (Sexual Violence Prevention Network) in St. Paul.

We got a quick reminder about The first Minnesota Summit to Prevent Sexual Violence scheduled for Dec. 3 - 4.


The Minnesota Summit will engage Minnesota leaders in identifying actions to prevent the losses caused by sexual violence.
This is an important event and I am looking forward to finding out what actions will come out of this summit.

Before the main presentation began, Lindsay Gullingsrud, the Sexual Violence Prevention Coordinator at MNCASA, gave a brief overview of the spectrum of prevention. The spectrum levels are:

influencing policy and legislation
changing organizational practices
fostering coalitions and networks
educating providers
promoting community education
strengthening individual knowledge and skills
I won't go into more detail here other than to say that this spectrum is very useful for ensuring that a plan of action is truly comprehensive.

Our main presenter was Phyllis Brashler Ph.D., MDH Suicide Prevention Coordinator, who gave a presentation entitled: Promoting Health and Healing: Addressing the mental health impacts of sexual assault from an advocacy perspective.

Brashler highlighted that this effort takes a public health approach and that everything starts with advocacy and movement. We need to keep in mind that our ultimate goal is helping sexual violence survivors.

Brashler highlighted definitions of mental health.

Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. -- World Health Organization

Our goal is to foster environments where everyone has an opportunity to live, learn, work, and fully participate in communities where they experience joy, health, love and hope

Brashler then went on to discuss the mental health continuum and the understanding that mental illness is mediated by the brain. To illustrate this point she showed P.E.T. brains scans of a mentally healthy person and one of a person suffering from depression which were significantly different from each other. She talked about the limitations of the medical model and how a diagnosis can create or alleviate sigma.

The data on the intersection of sexual assault and mental illness is limited and most of the data available gives researchers a snapshot of a small sample. This data is an important addition to what experts learn through their work either in the mental health field or the sexual assault advocacy field. Without data needed funding may not be offered.

Individuals who live with serious mental illness are at higher risk of experiencing sexual violence and sexual violence can contribute to mental illness.

Studies of mental health consumers found between 28% and 71% were sexual abuse survivors. A research review done by Mary Koss in 2003 found the lifetime prevalence of Major Depressive Disorder to be 2-3 times higher for women who have experienced sexual assault than for women who have not. The age of first victimization and the number of assaults impacted the depression rate.

When people talk about PTSD they may overlook that many who suffer these symptoms are not in fact beyond the source of their trauma. These people are described as experiencing complex trauma.

PTSD affects the ability to seek help, make decisions and access resources. Women who experience sexual assault in the context of physical and/or psychological abuse experience a greater number of PTSD symptoms.

Dissociative Identity Disorder (DID) is a mental process which separates out an individual's emotions, physical feelings, responses, actions, or sense of identity and while it is viewed as negative this disorder provides victims a way to survive violence they cannot escape.

A history of sexual assault is closely linked to suicide attempts. In Minnesota the number of people who died by suicide was nearly 5 times higher than the number of homicide victims.

Brashler talked about the study of 9th grade students: Youth Risk Behaviors and Social Factors Associated with Suicidal Thoughts and Attempts, 2007 (pdf) which found that 34.6% of those who reported attempting suicide also reported experiencing unwanted or forced sexual touching. 30.2% who reported suicide attempts also reported being forced to have sex or do something sexual against their will by a dating partner.

Sexual assault in the context of domestic violence increases the mental health risk. In addition to this combination, domestic violence victims can also suffer from traumatic brain injury.

Common experiences of sexual trauma survivors can include, self-loathing, hypervigilance, impulsiveness, anger, sleep disturbances, feeling disengaged and low stamina. The difficulty with thinking and processing can involve screening out stimuli, processing information, disturbing thoughts, a sense of restricted options and low tolerance for stress. Survivors can have difficulties in interactions, a strong response to negative feedback and a sense of urgency.

These issues related to sexual violence and mental health are personal and they are political. The goal of those who are committed to prevention and appropriate responses is to work together towards healing and recovery from trauma.

Brashler gave information about general suicide risk and protective factors, warning signs and suggestions about what we can do. Rather than summarizing this general information I'll link to MN's suicide prevention resources.

Those interacting with sexual assault survivors need to understand the difference between self-injurious behavior and suicidal behaviors. The main difference is that those who are self-injuring are seeking ways to relieve their pain while those who are suicidal want the pain to end and see no hope for other methods of relief.

Programs that serve survivors need to be trauma sensitive. This includes the importance of letting survivors know that the impact of trauma they are experiencing is normal and not a sign of personal weakness. I can speak to how much of a difference this would have made to me after my first boyfriend raped me. I didn't learn this until 2 decades later when other survivors related experiences and reactions which mirrored my own.

When programs are evaluated this needs to include the perspective of those who have experienced trauma. This goes beyond what people say to survivors. The physical environment can make a huge difference.

When those wanting to help survivors see survivors not reaching out for help, reframe the response from "Why won't this survivor do __?" to "What is preventing this survivor from ___?"

Ask survivors about what makes them feel less safe and offer alternatives when possible.

By understanding the link between sexual violence and mental health issues a primary prevention approach can help prevent the development of serious mental illness and can help survivors have a reduction of symptoms. This can also help prevent revictimization.

Victims of domestic violence are already encouraged to create safety plans but mental health issues are often not included in these safety plans.

This presentation was a strong reminder about why those who tell sexual violence survivors to "get over it" are not only wrong but contribute to survivors not being able to get over sexual violence.

Here are some trauma and mental health resources Brashler provided in a handout:

ACE (Adverse Childhood Experiences) Study: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults

American Association of Suicidology

Growing Beyond Survival: A self-help toolkit for managing traumatic stress by Elizabeth Vermilyea (Sidran Press)

Helping Sexual Assault Survivors with Multiple Victimizations and Needs: A guide for agencies serving sexual assault survivors by Jill Davies (2007)

National Center on Domestic Violence, Trauma & Mental Health
Curricula: Access to Advocacy: Responding to trauma & domestic violence in lives of women with psychiatric disabilities, and risking connection -- DV: A curriculum for working with survivors of domestic violence and lifetime trauma (incomplete)
See also: Mental Health and Domestic Violence: Collaborative initiatives, service models, and curricula.

Living with Dissociative Identity Disorder: One woman's experience by Olga Trujillo.
Video: A Survivors Story

Peer Support Resources:
Mary Ellen Copeland http://mentalhealthrecovery.com/
Shery Mead: http://www.mentalhealthpeers.com/
Minnesota Consumer Survivor Network

Suicide Awareness Voices of Education (SAVE) based in Minnesota.

Suicide Prevention Resource Center

Using Trauma Theory to Design Service Systems edited by Maxine Harris and R. Fallot. (2001) Jossey-Bass Publishers. (Maxine has written a lot on trauma and trauma-informed care and I'd recommend any of her books/articles.)

Brashler also included a research bibliography (doc).

Not included in the references but related to this topic is a World Health Organization report that calls for improved health care for women and girls.
"The biggest shortcomings relate to mental health problems and sexual violence, which women suffer more than men, and which many societies prefer to brush aside than confront head-on."

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