A University of Missouri researcher says a significant number of women who are in or have been in abusive relationships are not getting mental health care.

Assistant processor of social work in the University of Missouri's College of Human Environmental Services Mansoo Yu (photo courtesy; MU News Bureau)

Assistant processor of social work in the University of Missouri’s College of Human Environmental Services Mansoo Yu (photo courtesy; MU News Bureau)

The study involved 50 women who had been the victims of violence brought by intimate partners. It found that more than 70 percent of them did not receive mental health care, even though they regularly see a primary care physician. 54 percent of them were suffering from post-traumatic stress disorder (PTSD), clinical depression or both.

Assistant Professor Mansoo Yu says that could be due to factors including social stigma, shame, concerns about privacy, healthcare costs or a lack of information. He says many of the women in the study also said they do not utilize housing, legal services or crisis lines.

Yu says screenings for domestic violence by primary care providers could help turn up more cases that go unreported, and get more help to victims.

“Though most of the survivors did not use services they reported using regularly their family doctors. So, based on our study, medical primary care doctors are uniquely positioned to screen for mental health problems and then they can refer these survivors to other services.”

Colleen Coble, CEO of the Missouri Coalition Against Domestic and Sexual Violence, says the study affirms how battered women often respond to the trauma of domestic violence.

“I think it reflects the experiences of women throughout Missouri and certainly coincides with the reports from all of the service providers in the state, primarily those who are running domestic violence shelters … that they are really facing a crisis in being able to get adequate services for women in terms of mental health treatment and substance abuse treatment for those that they’re serving.”

As for reasons why women might not utilize services, Coble says there is a host of reasons that could be responsible.

“Those services not being available, not knowing what it entails, some of the services may be provided on a residential basis and do not make provisions for your children, it may be that the services are distanced from your home community and that will pose problems with maintaining your employment.”

Insurance coverage as a barrier to mental health care

Another reason could involve insurance coverage. Coble says many victims of domestic violence are among the many Missourians who do not have private health care coverage and make just enough income to not qualify for Medicaid coverage, leaving mental health care unaffordable.

“If you’ve gotten employment, which is the goal … you are separating from an abusive partner, you wish to sustain your family without the violence and support yourself and your children, very often with a job that is just a little bit over minimum wage you’re no longer eligible for the types of public assistance services that would perhaps get you quicker access to mental health treatment.

Yu says the women in the study were also skeptical of law enforcement. Coble says that is often for good reason.

“You can’t deny someone’s experience. If they’ve called for assistance and were told there was nothing that could be done by law enforcement or they went to court and found that it was not a responsive system to their needs in terms of ongoing protection, or things worked at one point but yet nobody enforces, say, an order of protection … it’s a very reasonable opinion to be skeptical that the system is not going to work for you.”

Screenings as a first step toward help

Coble thinks the recommendation that questions related to domestic violence be included in medical screenings is a good one, and adds, that is a requirement included in the federal healthcare reform law. She says the best way to do such a screening is to talk about an individual’s experiences.

She says that includes questions like, “Who makes the financial decisions in your home, what level of interference to you experience in how you are a parent, are you allowed to work, are there constraints on who you can spend time with … your family or friends, are you ever afraid?” Coble adds, “You can’t run down a list of checkboxes and expect someone who is a stranger to you to pour out very personal and traumatic information.”

Yu says his study did not explore any connection between mental health issues resulting from domestic violence in relation to gun violence, but says that is an area that deserves study.

“Some existing studies already found that there are significant relationships between mental health problems including PTSD and depression, and gun violence. In this study we didn’t see that correlation but I think that’s really some important topic that we have to study further.”

Coble says there is no one or easy answer to these issues.

“It’s layers upon layers of complexity.” She adds, “One of the simple solutions is having access to mental health care around the state that is offered clearly as, ‘This is a normal response to trauma of being victimized by your intimate partner repeatedly through violence.'”

The study was co-authored by researchers at Washington University in St. Louis and the University of Louisville.