Women who have experienced domestic violence often don't get the mental health services they need, according to a new study.
Elena Fernandez, the director of behavioral health at St. John's Well Child and Family Center in South Los Angeles, can name at least one reason why.
"You have to remember that it's very stigmatizing," she said. "There's a lot of shame that comes with disclosing that 'I am a victim of domestic violence.'"
That's what researchers found in their study, which was published in the journal Social Work in Mental Health. In a statement, lead researcher Mansoo Yu said stigma, shame, concerns about privacy, health care costs and a lack of information were all found to play a role in preventing survivors from getting needed mental health services – even if they had access to them.
Fernandez says in South L.A., access to those services aren't a given.
"Domestic violence is very prevalent in many communities, but I would argue it's more prevalent in impoverished communities," she said. "And the reason for that is there are a lot of psychosocial stressors that play a role in this."
That could mean a lack of affordable health care, housing or food. It could also mean working several low-paying jobs or having no job at all.
She explained that although domestic violence is often thought of in physical terms, it can be emotional, sexual or financial – an abusive partner's limiting a person's income, for example. That creates an "impoverished sense of self," said Fernandez.
"They don't have the ability to talk about it," she said. "There aren't enough resources in the community, and often they're told by some of our churches or even their parents that they have to stay in this relationship for their kids."
Remaining in an abusive relationship, though, can lead to further corrosion of someone's ego and self-esteem – and that usually makes it more difficult to muster up the strength and resources to leave an unhealthy relationship, said Fernandez. She added that it's best for people experiencing domestic violence to have a plan in terms of where they'll go and how they'll get by before they leave the relationship.
Without follow-up mental health services after leaving an abusive relationship, the "majority of individuals who are victims of domestic violence tend to return back to their abuser," explained Fernandez.
"They feel they can't make it without them," she said. "Again, this goes back to the level of codependency that's established. It goes back to what's happened to this individual, which is a very poor sense of self, feeling they can't survive [without their abuser]."
Researchers on the Social Work in Mental Health study found that overall usage of mental health services by domestic violence survivors was low, but that once those survivors had used some sort of service, they found it helpful.