Report explores women's experiences of abuse, violence and suicidality

The National Collective of Independent Women’s Refuges has published a report exploring women's experiences of abuse, violence and suicidality.

The report, “There was no other way out”: Exploring the relationship between women’s experiences of intimate partner violence and their self-harm, suicidal thoughts, and suicide events, summarises findings from an online survey completed by more than 1200 people.

The study explored women and gender minorities' experiences with intimate partner violence (IPV), other forms of abuse and suicide. The aims were to increase knowledge of women’s experiences of being both suicidal and a victim of intimate partner violence, and to identify opportunities for development in practitioners’ responses to victims of intimate partner violence who have been or are suicidal.

All respondents had experienced IPV and had considered or attempted suicide. Respondents were predominately Pākehā, but almost 20% identified as Māori and approximately 6% as other ethnicities. The majority had children, and were aged 16-65. Nearly 25% identified with sexual orientations other than heterosexual. Most were women, but some identified as non-binary.

The report examines:

• Experiences of IPV
• Abuse and adversity other than IPV
• The relationship between partner abuse and different types of abuse perpetrated by someone other than a partner
• Experiences of self-harm and suicide, including experiences that preceded suicide attempts, and help seeking 
• The relationship between IPV and suicidal thoughts or attempts
• Differences between Māori and Tauiwi respondents' experiences
• Differences in experience by sexuality and gender identity.

More than 90% of respondents reported they had experienced at least one form of abuse by someone other than an intimate partner prior to entering a relationship where they experienced IPV. (Categories were: witnessing family violence, child sexual abuse, child physical abuse, child  psychological abuse, neglect, rape or sexual assault as an adult, psychological abuse as an adult, physical assault as an adult, bullying, sexual harassment, and homophobia/biphobia/transphobia.) Most respondents had experienced multiple forms of abuse in childhood, and outlined the ways in which these experiences collided, in addition to detailing aggravating factors accompanying this abuse. The report summarises:

"Many outlined the contexts driving them to consider or attempt suicide, including feeling worthless, certain acts of (escalated) violence, the impacts of prior abuse, overwhelming emotion, unrelenting emotion, the hopelessness of their  situations, relationship breakdowns, additional stressors, and unresponsive systems."

The dynamics of the IPV often prevented seeking help for suicidality. As well as reduced self-esteem as a result of abuse discouraging help-seeking,

"... many faced additional barriers such as abusers becoming angry when respondents attempted to speak about their feelings, being suspicious about who they spoke to, preventing them from seeing support people, and encouraging them to end their lives. Respondents often spoke about how the vulnerability they experienced was capitalised on by their abusive partners to perpetuate further abuse."

Respondents reported that they disclosed considering suicide to a range of informal sources and professional groups. Overall:

"Experiences of disclosure were pervaded by a sense of shame, by feelings of being unheard, and by the perception that recipients of disclosures were not genuinely interested. On the other hand, having people listen, take accounts seriously, offer belief, and provide practical and emotional support was invaluable to respondents."

Respondents' found the responses they received highly variable. The researchers note that variance of perceived helpfulness or harmfulness even within specific groups of practitioners or informal support sources suggests that responsiveness is heavily dependent on the individual responder rather than being easily generalisable by group. However they note that no single group received a consistently high rating for helpfulness. Child protection workers and family members were rated as the least helpful overall and sexual violence agency workers, counsellors and domestic violence agency workers rated as the most helpful (although showing significant room for improvement).

There were some differences between Māori and Tauiwi respondents' experiences. Māori respondents were more likely to report having attempted suicide (63%) than Tauiwi (48%). There were some differences in help seeking as well. Māori respondents were more likely to disclose to religious leaders/Kaumātua and also reported less helpful responses from disclosures to child protection workers.

Transgender respondents were more likely to report attempting suicide (83%) compared to cisgender respondents (48%). LGB+ respondents were more likely to report attempting suicide (60%) compared to heterosexual respondents (44%). Both transgender and LGB+ respondents discussed negative experiences when help-seeking, related to discrimination, judgment and services lacking the knowledge to meet the victim's needs.

The conclusion of the report includes 10 main findings:

1. "The phenomenon of women being abused and then considering suicide or attempting to take their own lives is far from rare;
2. The role of childhood trauma in shaping women’s experiencing of subsequent violence and feelings of suicidality cannot be overstated, given the extremely high associations between types of adversity, categories of victimisation through intimate partner violence, and suicidal thoughts and attempts;
3. Given the manipulation of children and parenting by abusers and the proportion of respondents who had one or more children, intervention design should recognise the protective capacity of the non-violent parent and prioritise child safety;
4. Feelings of worthlessness, perceiving no way out of situations where there is violence, and a sense of hopelessness about the future are all significant risk factors for suicidal thoughts and attempts amongst women who have been subjected to violence by a partner;
5. Specific instances of abuse and adversity are associated with different methods of self-harm;
6. Current understandings of self-harm need to be expanded to capture the ways in which victims harm themselves that may not involve physical injury and may reflect methods of harm they have previously experienced during abuse;
7. The risk of suicide is still elevated after the end of a relationship with an abuser; consequently, mechanisms for support need to be long-term, ongoing, or able to be reactivated when necessary;
8. Many women who are considering suicide or who have attempted suicide receive unsatisfying responses from the people they choose to tell, highlighting the need for a robust understanding of the intersections between suicide and IPV by every professional group likely to encounter women who have been victims;
9. Social stressors, including inadequate access to housing, financial insecurity, blaming responses from family or peers, and punitive or non-protective responses from agencies and statutory systems exacerbate distress after abuse by a partner and can act as direct precipitants to suicide attempts; and 
10. Māori women, LGB women, and trans women who have been abused by an intimate partner are all disproportionately at risk of suicide attempts."

The researchers provided eight recommendations focused on improving service responses. These are:

1. All practitioners become familiar with the impacts of adverse childhood experiences (ACEs) and the ways in which these are believed to influence subsequent vulnerability to abuse, social situations and support mechanisms, and capacity to cope with later adversity;
2. Extensive training be delivered to all counselling, mental health, domestic violence, and sexual violence practitioners in order to progress the quality of screening to jointly address the often co-occurring issues of IPV and suicidality;
3. The forms and periods of time in which suicidality is believed to present be challenged by practitioners, so that victims do not experience an expectation of coping or the anticipation of a shaming or blaming response to suicidality;
4. Relationships between possible recipients of disclosures are strengthened, with joint training and clear referral pathways facilitating effective collaborative work so that all aspects of victims’ experiences are addressed effectively and expeditiously;
5. Family violence practitioners develop processes for working with the risk of suicide across time, and use the analysis of informal lines of questioning relating to specific emotional experiences across time to inform their understanding of risk;
6. Responses that incorporate the safety of children be prioritised, with emphasis on building parenting capacity of the non-abusing parent to care for the child;
7. Services that may have contact with victims ensure a wide range of methods and times for engagement are available to them and explore potential IPV-specific barriers with clients ahead of time; and
8. Mental health and domestic violence providers grow their awareness of constraints to service access that may result from suicidality or from abusers’ control tactics, and target service design initiatives to engage with all victims.

Dr Ang Jury, CEO of Women's Refuge, discusses ways to improve responses to IPV victims and suicidality in article by media outlet Stuff. She said women were reaching out for help then being faced with the potential losing their children as a result and that barrier needed to be addressed. She planned to send the report to Oranga Tamariki. Ang Jury also said:

"There's a stark need for much closer linkages between the family and sexual violence agencies and mental health services. Traditionally we have worked on a referral basis but there's not been enough co-ordination on this. We have been working in silos too much."

She discussed the importance of more in depth training:

"GPs, lawyers, police – they all get some training but it's time compressed. It's a matter of people knowing how to respond. They need to know what's going to hurt and what's likely to help.”

She also noted that because victims are often traumatised and struggling to articulate what they are experiencing and feeling, they may not come across to agencies as well as the person abusing them. It was important to understand this and not judge the women or dismiss what they said.

Related information

The Government is currently conducting an Inquiry into Mental Health and Addiction - Oranga Tāngata Oranga Whānau. The Inquiry Panel is now preparing for delivery of their report to Government in late October.

The Clearinghouse published a reading list on the links between abuse/violence, trauma, mental health issues and addictions.

Previous New Zealand research on suicidality and violence includes:

Exploring risk factors for suicidal ideation in a population-based sample of New Zealand women who have experienced intimate partner violence (Gulliver & Fanslow, 2013)

Finding safety: provision of specialised domestic violence and refuge services for women who currently find it difficult to access mainstream services: disabled women, older women, sex workers and women with mental illness and/or drug and alcohol problems as a result of domestic violence
(Hager, 2011)

He drove me mad (DVD)
(Hager and Mental Health Foundation, 2011)

He drove me mad: an investigation into the relationship between domestic violence and mental illness
(Hager, 2001)

See also The Backbone Collective Submission to the Inquiry into Mental Health and Addiction (2018)

In 2017, Le Va launched a new suicide prevention training programme called LifeKeepers. This programme is now available online.

A number of our previous stories have highlighted research and coroner's reports linking family violence with suicide:

VAWnet resources: economic abuse; forced marriage; adults exposed to childhood violence (see the guide Responding to the Long-term Needs of Adult Children Exposed to Domestic Violence: Exploring the connection to suicide risk)

Inquest into youth suicides finds exposure to family violence

Coroner finds exposure to domestic violence major stressor in teen's suicide

Suicide mortality review committee gains ongoing funding

Related media

Study reveals link between domestic violence and suicide attempts, Radio NZ, 10.09.2018

Victims of partner violence see death as an escape: report, Stuff, 10.09.2018

Time to Acknowledge Family Violence as a Health Issue, Press Release: Aviva, Scoop, 10.09.2018