Recently an Indian teenager became the victim of dishonor killing by the members of her extended family for wearing jeans and this made global headlines. Indian women and girls face patriarchy and sexism in a thousand different ways within their homes and birth families and later marital homes.

Violence against women (VAW) within the family that they live with is categorized under the common term- domestic violence. This includes all forms of violence in the domestic space like spousal abuse, dowry-related violence, marital rape, emotional abuse, and denial of basic rights such as contraceptive use.

According to United Nations Development Fund data, more than a third of women globally have experienced physical or sexual violence in their lifetime, which has a dramatic impact on health. The mental health impacts are extremely devastating. There is a steep rise in mental illness including depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation as well for women and girls who have experienced violence and abuse. The reverse is also true: women living with severe mental illness are also six times more likely to fall victims to violence.

Girls, women, and gender diverse people experience a wide range of explicit and implicit, nuanced, subtle instances of harassing behaviors; all of which invade and violate their physical and psychological integrity.

Violence and Mental Health crisis for women

The connection between violence and mental health issues is much higher for women. Several studies have concluded that women with a previous history of surviving physical violence have significantly higher incidences of major depression. Almost 50% of women who have experienced violence often also have had a mental health diagnosis.

Any kind of gender-based violence (GBV) has complex short- and long-term consequences on women’s physical, sexual and reproductive and mental health as well as on their overall well-being. Mental health impacts for survivors of gender-based violence include Post Traumatic Stress Disorder (PTSD), depression, anxiety, substance use disorder, self-harm and suicidal ideation, and sleep related issues. In addition, a survivor of GBV may also face stigma and rejection from her immediate family and community forcing them either to keep quiet and suffer alone or reach out and be shamed publicly, both having devastating consequences on their mental health.

Patriarchy, in the name of “family values” and “tradition,” normalizes a lot of domestic violence. A 2009 study published in the Journal of Adolescent Health, ‘Impact of Sexual Harassment Victimization by Peers on Subsequent Adolescent Victimization and Adjustment’ found that sexual harassment against girls in grade 9 (ages 13,14) was “associated with elevated risk of self-harm, suicidal thoughts, maladaptive dieting, early dating, substance use and feeling unsafe at school.”

Not only do women and girls learn to suppress and neglect their sense of self as a result of sexual harassment and abuse from a young age, they quickly learn that who they are, who they want to be is not ‘theirs’ but is a commodity or object. This results in them always living in fear and self-doubt having serious consequences for their emotional wellbeing.

What are the social challenges here?

The stigma associated both with gender-based violence and mental health concerns can stop women from sharing their experiences, from reporting the incidents, and from accessing support. Many women say the fear of not being believed by their friends, family, or law enforcement keeps them from ever sharing their experiences. Some fear losing custody of their children and that prevents many women from disclosing their experiences. Women who experience mental health concerns are even less likely to report that they have experienced violence, as their mental health is often used to discredit their experiences or to blame them for what happened. Intersectional factors like living in poverty, caste, and discrimination due to age, and sexual orientation, are also other barriers to accessing supports.

 

Pandemic, Domestic Violence and Mental Health

In humanitarian crises, levels of these and other forms of violence based on gender inequality (GBV for gender-based violence) grows more acute. Since March 2020 almost the entire world has been in the grip of the ongoing COVID19 pandemic which did put a halt to almost all human activity outdoors but did not stop domestic violence against women. The statistics showed a steep surge and one must remember that these are only the reported cases. The numbers of cases covered up, cases never reaching law enforcement or any social support organization are far more. This was a scenario in non-pandemic days too due to the stigma and shame and the victim-blaming women face if they report violence in homes. In the pandemic women had even less access to phones, internet or other support resources and hence the fear of violence and the mental health burden after such incidents was witnessed to grow to unprecedented proportions.

Through financial instability, being forced to stay with abusive partners, difficulty in accessing help, this past year, women and girls globally have been pushed to the sharpest end of inequality. While the mental health impact of this unprecedented and prolonged crisis on all cannot be denied, it has severely affected women due to their pre-existing vulnerabilities in a system that is hugely sexist and misogynist.

The pandemic and its sociopsychological and economic consequences have highlighted the inequalities and women girls experience in a way never seen before. There has been an increased rate of domestic abuse worldwide and in addition the disproportionate pressure put on women and girls in families to care for children, elderly or disabled family members and loved ones surviving the pandemic. Girls since childhood and a very tender age undergo almost inescapable emotional as well as physical harassment here, this can be extremely damaging to their healthy sense of identity; which is an essential baseline to good mental health.

 

Lack of accessible mental healthcare services

The overall health of women and girls including mental health is never a priority in families. Cultural cliches like that of all-sacrificing great mothers and women have unlimited patience further propagate this and normalize women suffering in silence.

More often than not, mental health services are not available for survivors of domestic violence. Whatever and wherever some services are available, they are not integrated into the primary health care system. Hence most women almost never receive any comprehensive and gender-sensitive mental health services that can allow them to regain autonomy and control of their bodies, sexuality, and lives.

The connection between mental health and violence is never properly addressed which means that women are often misdiagnosed or unable to access the support they need and want to recover. Often women who have experienced violence and have been given diagnoses related to their mental health can be labelled as “difficult”, “bad” and “non-homely” and refused services. Some of them who are prescribed medications for their mental health needs, can face side effects that can sometimes compound their trauma – for example, anti-anxiety medications may impair some women’s ability to assess their safety.

Australia started a women-only mental healthcare facility recently to tackle the issues of abuse even there for women coming from abuse and having nowhere else to go. The rate of domestic violence related incidents has been all-time high in almost all countries.

However, the response of most governments to the pandemic and the resulting mental health crisis has been largely reactive and gender-neutral. The society urgently needs to build a social recovery that works for women, girls, their families and communities specifically taking into account their specific and typical struggles at all levels.

 

What needs to be done?

Providing an empathetic listening ear, inquiring about their needs, validating what the survivor is saying, enhancing her safety and support, creating safe spaces for women are the components of first-line psychosocial support that any health care provider should know how to do.

There is a need for institutional support to be strengthened for women experiencing mental health concerns, both for prevention of violence before the occurrence and addressing the violence and its impacts later. This requires free or affordable access to long-term counselling, affordable and/or free safe shelters and childcare supports, better legal assistance, and work opportunities.

Individually, people, communities and families have to inform themselves of the ways that both violence and mental health concerns affect women and girls. They need to be trained and made aware as to how to offer non-judgmental support, active listening, and offer logistical help to find resources. This shall go a long way in breaking the stigma and the isolation that women experiencing violence often undergo. We also need to support organizations that are addressing gender-based violence and mental health in our community.

The State Disaster Response Force (SDRF) has recently inaugurated the 'Sukoon', the union territory's first 24x7 counselling helpline number to provide mental health counselling. Hope they look into women-specific issues as well.

 

If you or someone you know is experiencing violence, please call the recently launched helpline by

National Commission for women Helpline for emergency response to women facing gender-based violence (24x7) - 7827 170 170

KIRAN psychosocial Helpline (24x7) – 1800 599 0019

SUKOON (24x7) - 1800-1807159