Asian Women, Domestic Violence and Mental Health

1 Asian women , Domestic Violence and Mental HealthA Toolkitfor Health Professionals EACHC ontentsAcknowledgements ..1 Foreword Ann Keen, MP Parliamentary Under Secretary for Health Services, Department of Health ..2 Background EACH and Pukaar ..3 Section one Introduction .. 4 Section two Asian women s experiences of Domestic Violence ..5 Section three Barriers to accessing Health four The consequences of Domestic Violence for Health ..14 Section five The consequences of Domestic Violence for Mental Health ..19 Section six Asian women s experiences of Health care ..29 Section seven Good practice guidelines for Health professionals ..31 Section eight Outlines ..40 Section nine Agencies offering specialist support ..43 Section ten References ..46 If I am laughing and alive today, it is because of my counsellor and Pukaar.

2 Pukaar service userAsian women Domestic Violence and Mental Health Toolkit 1 AcknowledgementsEACH would like to thank the following people for their time and the valuable contributions they have made to the production of this special thanks to Dr Roxane Agnew-Davies, Chartered Clinical Psychologist and specialist advisor to the Department of Health Victims of Violence and Abuse Prevention Programme (VVAPP), for compiling this toolkit and for bringing a wealth of knowledge and expertise in the Domestic Violence and Mental Health field. Particular thanks to Pukaar Service Users for participating in focus groups and sharing their experiences and for their invaluable to the team of Pukaar counsellors who provided valuable information relating to their work with Asian women experiencing Domestic Violence and abuse and contributed throughout the process:Gayatri Shah, Foziha Raja, Balbir Kang and Jyoti Mashru.

3 Also, thanks to Lakhvir Randhawa, Deputy Director, EACH for editing and reviewing the is grateful to Government Office for London for providing the funding to undertake the specialist Domestic Violence training across the Health sector in the London Boroughs of Ealing and Hounslow and enabling the production and dissemination of this would also like to thank our partner agencies Hounslow Safer Community Partnership and Ealing Safer Communities Unit for their support and guidance in the development and delivery of the Domestic Violence and Mental Health training and to members of the Steering Group who took forward the implementation of the project: Permjit Chadha, Senior Community Safety Officer, Hounslow Joyce Parker, Domestic Violence Co-ordinator, EalingSandra Machado, Director, EACH We are grateful to a number of people who contributed to the promotion and delivery of the training to Health professionals in Hounslow and Ealing.

4 Dr Roxane Agnew-Davies, Director of Domestic Violence Training LtdFoziha Raja, Domestic Violence Trainer, EACH Sarah Khalil, Domestic Violence Consultant Hazel Daniel, Senior Project Manager, Hounslow Primary Care TrustHanna Gottschling, Head of Training for West London Mental Health TrustJane Darraoch, Health Promotion Team Leader, London Borough of EalingJohnny Nota, Mental Health Older People and Alcohol, London Borough of EalingIan Davies, Commissioner Mental Health Bridget Ledbury, Head of Adult Mental Health Integrated Services, London Borough of Ealing2 EACHF orewordIn my professional capacity as both a nurse for 25 years and currently as a Parliamentary Under Secretary for Health Service at the Department of Health , issues around women s Health have always been of importance to me.

5 Domestic Violence , we know, has a significant impact on women and their children s Mental Health and well-being as highlighted by The Department of Health s report Into the Mainstream , which shows that women s experiences of Violence and abuse frequently leads to Mental Department of Health has undertaken significant work to promote awareness, understanding and to develop best practice on Domestic Violence for Health professionals, recognising the key role that Health services play in providing opportunities for women to disclose in a safe environment and to address these dual Asian women , we know that their particular experiences of Domestic Violence and abuse are greatly influenced and exacerbated by cultural dynamics, pressures and issues around honour, which not only impacts on their Mental Health but also on the way they disclose and seek toolkit, Asian women , Domestic Violence and Mental Health is an invaluable resource which will assist Health practitioners to recognise the links between Asian women presenting with Mental Health issues and their experiences of Domestic Violence , and thus be able to respond more ve known the work of EACH and Pukaar, a specialist resource which has been a life-line to Asian women experiencing Domestic Violence and abuse.

6 I am proud to endorse this tool-kit which will provide a practical resource for Health professionals and hope that it will be widely used and Keen Parliamentary Under Secretary of State for Health Department of Health February 2009 Asian women Domestic Violence and Mental Health Toolkit 3 BackgroundOver the duration of the project Pukaar has supported 1100 Asian women and girls who have presented with a range of issues such as anxiety and depression, Post Traumatic Stress Disorder (PTSD), self harm, substance misuse, suicidal ideation and suicidal attempts along with experiences of Domestic Violence and abuse. The success of Pukaar can be measured by the number of women and girls (85%) who have reported an improvement in their emotional and Mental heath as one of the outcomes from receiving support from Pukaar.

7 Pukaar offers:One-to-one sessions with qualified Asian female counsellors in Gujerati, Hindi, Punjabi, Urdu and work and referrals to other agencies Information to help women to make informed choicesWomen-only support groups which included group therapy, confidence building and empowermentOutreach work in schools Home visits For further information about EACH, please contact:EACH 729 London Road Hounslow TW3 1SE Tel: 020 8577 6059 EACHEACH is a specialist counselling and support organisation providing a range of community-based services to individuals and families affected by alcohol and drug misuse and Mental Health and Domestic Violence concerns. Established in 1991 in the London Borough of Hounslow as one of the foremost Asian specific alcohol counselling services in the UK, EACH today works with all communities and operates across West Pukaar Pukaar, a project of EACH and funded by London Councils (formerly Association of London Government) was set up in 2003 to provide counselling and support to Asian women and girls affected by Domestic Violence and abuse.

8 The project operates in the boroughs of Barnet, Brent, Ealing, Richmond upon Thames, Harrow, Hillingdon, and Hounslow. The counsellor told me it s not my fault and I don t deserve to be hit, that they didn t have the right to hit me, and that I was good. Hearing this the first time made me feel special. Pukaar service user4 EACHS ection one Target audienceThe toolkit is designed mainly for use by primary care Health professionals including GPs, practice nurses, Health visitors, midwives and Mental Health staff such as psychiatrists, psychologists, counsellors and CPNs. It provides background information to Asian women s experiences of Domestic Violence , its impact on their Health and how Health professionals can respond to these issues within their professional TerminologyIn this toolkit Asian women are defined as women who themselves or their families originated from South Asia, a region comprising India, Pakistan Bangladesh and Sri Lanka.

9 The main South Asian languages include Bengali, Gujerati, Hindi, Punjabi, Tamil and Urdu. We have also used the term Domestic Violence to cover the whole range of abuse that Asian women experience; its definition is included in section EACH S training to Health professionalsIn 2007, EACH was funded by the Government Office for London (GOL) to deliver, in partnership with Ealing Safer Communities Unit and Hounslow Safer Community Partnership, training on Domestic Violence awareness across the Health sector, with a particular emphasis on the experiences of Asian women . 206 Health professionals (GPs and Practice Nurses), social workers and professionals working within the Mental Health sector received training across the boroughs of Ealing and Hounslow. The toolkitAs part of this initiative, this toolkit was developed to disseminate culturally appropriate best practice for professionals working with Asian women experiencing Domestic Violence and abuse.

10 As local communities become more diverse, this toolkit can enable better care of Asian women presenting with physical and Mental Health consequences of living with Domestic Violence and this section: EACH s training to Health professionals on Domestic Violence .. The Toolkit .. Target audience .. Terminology ..4 Asian women Domestic Violence and Mental Health Toolkit 5 Section two Asian women s experiences of Domestic violenceAmongst Asians, the family (extended over numerous households) is a fundamental and influential foundation, providing financial support and emotional The accomplishments of an Asian family are judged in terms of the family as a whole, so privacy or independence is seen as undesirable. Gender stereotypes are highly conventional5 and since women are held responsible for maintaining family honour, known as izzat, and avoiding sharam (shame)6 the family may justify women being guarded and considered not as individuals but as At worst, the result is an honour killing in which a woman is murdered to preserve the honour of her family in the eyes of the obligation to maintain izzat can keep Asian women trapped in violent relationships8.