Abuse is the main cause of mental illness in women, survey finds

Abuse and violence are the main reasons women and girls are much more likely than men and boys to develop mental health problems, a survey conducted by the Royal College of Psychiatrists has found.

The experience of being abused or attacked can trigger serious problems such as suicidal thoughts and psychosis, the college said. It added that difficult relationships, especially those involving coercive behaviour, and dealing with home and family pressures, are also major drivers of poor mental health in women.

The findings come from a UK-wide survey of 515 psychiatrists, 82% of whom were female, which asked about their experience of treating patients.  When respondents were asked to name the top three issues that contributed to poor mental health in women and girls, almost three in five (59%) identified violence and abuse – more than cited money worries, loneliness, hormonal health or work or exam pressures.

Almost half (49%) said that relationship issues, often involving coercive behaviour, were another important underlying factor, while 48% cited home and family pressures.

Victims’ problems go unidentified

Dr Catherine Durkin, the college’s joint presidential lead for women and mental health, told the Guardian: “Tragically, it is not uncommon for female patients to experience long-term abuse that causes serious symptoms, including suicidal ideation or symptoms of psychosis. I regularly see patients who are dependent on an abusive partner or family member due to emotional, family or financial reasons.”

She added: “Victims often feel unable to speak openly about such issues, meaning their problems go unnoticed, sometimes for years. Not all abuse is physical. Psychological abuse also causes extreme harm and casts a long shadow over victims.”

Isolation was also listed as a common challenge facing female patients (24%). Although people with mental illness often feel isolated, it can be made significantly worse if they are experiencing abuse.

One in four respondents to the survey cited funding as the most significant barrier to providing services tailored to the needs of women and girls.

The college is calling for a robust cross-sector strategy to draw together the response to domestic abuse.

It also wants ring-fenced funding for independent domestic violence advocates to be placed in every mental health trust, in line with best practice. There should also be an expansion of the Identification and Referral to Improve Safety (IRIS) programme, to support the primary care response to domestic violence and abuse, the college said.

Access to independent domestic violence advocates is essential

Dr Philippa Greenfield, the college’s joint presidential lead for women and mental health, said: “Clinicians often do not realise that violence, abuse and coercive behaviour can have serious mental health implications. This lack of awareness can leave victims undetected and their mental health needs not appropriately addressed.

“Poor access to practical and psychological support also means that most victims are not receiving the specialist care they deserve and fundamentally, we are missing opportunities to keep them safe.

“As soon as the need arises, victims of domestic abuse should be offered the right support. Access to independent domestic violence advocates is an essential part of this.

“We need to shift our response to domestic abuse. This requires partnership working between third-sector organisations at a local level, general practices, community health services, in addition to acute and mental health trusts and the wider system. It also needs to include recruiting and training the required healthcare workforce.

“If we carry on waiting until victims reach crisis point, we won’t improve outcomes for women and girls’ mental health. Every victim should know that the NHS is there for them when they need to escape the harm of an abuser.”