By Mariel Ferragamo
Domestic violence takes a severe toll on its survivors, and its effects are all-encompassing. While most of the attention is rightly focused on addressing the physical, social and financial damage that domestic abuse has on survivors, there is still little work being done to address the lasting mental health impacts. As the world concludes 16 Days of Activism against Gender-Based Violence, activists and mental health workers are drawing attention to this harmful gap.
Domestic violence, also called intimate partner violence, is the most common form of violence against women. The WHO estimates that a quarter of women aged 15-49 years who have been in a relationship have been subjected to physical and/or sexual violence by their intimate partner at least once in their lifetime. It is a global problem, with WHO data showing only a small difference in prevalence rates between high-income and low- and middle-income regions.
Research shows that rates of mental health issues such as depression and anxiety are higher in women who experience domestic abuse, and that the effects last long after the violence itself has ended. But getting help to deal with the psychological scarring is difficult for many survivors. Lack of local, dedicated services, cost, and stigma are all obstacles to getting counseling.
Women’s Advocates, a shelter for domestic violence survivors in Saint Paul, Minnesota, is dismantling some of those obstacles with a deceptively simple solution: instead of asking women to come to the shelter for support, they bring the support to women. Counselors like Anna Perrotta visit women in their homes to provide counseling that is no-cost, private, and personal.
“They’re not coming into my office and sitting in a cushy chair for an hour every week,” said Perrotta, who uses they/them pronouns. “Many of them don’t have the resources they would need to do that – for example, access to transportation or childcare. So, being able to go out and meet them where they are is really important. I’m able to provide very low-barrier mental health support to these women.”
How to meet survivors where they are
Another critical aspect of the Women’s Advocates counseling program is how long Perrotta works with survivors, which can be up to two years. Spending a significant amount of time with each client makes it easier to transition them to long-term therapy, Perrotta said. “In all of the cases I’ve worked on, clients have wanted to continue paying attention to their mental health,” they said. “In our time together, they are able to deepen their awareness and appreciation for how the trauma that they’ve survived is impacting their day-to-day lives and they recognize that it helps to get therapy.”
This nontraditional approach to counseling helps hundreds of women a year cope with the psychological legacy of abuse, with 168 survivors coming through Women’s Advocates in 2023 and more than 500 using its hotline.
But, this all comes at a cost: the shelter’s expenses last year were more than $4 million, most of which was covered by philanthropic donors.
Lack of funding is just one of the many obstacles to getting mental health support to all domestic violence survivors who need it. A report co-published last year by the Equality Institute and the Accelerator for GBV Prevention shows that in 2022, countries around the world spent $204 billion in overseas development assistance and only 0.2% of that went toward preventing gender-based violence. Which means even less than that was allocated to studying and addressing the mental health impacts of domestic abuse. “We need to better understand the multiple and intersecting factors that influence domestic violence and the different ways it can affect mental health,” Mental Health Europe told the WHO Foundation in a statement.
Reframing support and recovery
The consequences of domestic violence on the mental health of survivors can be profound and life-long. An estimated 50-80% of survivors develop severe psychological conditions like post-traumatic stress disorder (PTSD) and depression, according to the international not-for-profit organization ActionAid. Abuse can lead to increased rates of substance abuse, higher risks of long-term mental health disorders, reduced capacity for healthy relationships, and potential vulnerability to re-victimization.
The effects also reach far into the future, as children in families with unaddressed trauma are significantly more likely to carry with them intergenerational patterns of violence, perpetuating cycles of psychological and physical abuse.
Tackling this “hidden crisis” demands that governments and healthcare providers recognize mental health as a core component of survivor recovery, “not just as a peripheral service,” said Penelope Neves, Senior Women’s Rights and Gender-Based Violence Specialist at ActionAid UK.
“Mental health services must evolve to become more intersectional, recognizing that survivors’ experiences are shaped by multiple, interconnected identities including race, class, gender, age, disability, sexual orientation, and cultural background,” she said. “This includes a true understanding of how cultural norms around mental health differ, how interpretations can create barriers to survivors accessing the support they often need.”
This is especially true in conflict areas, where ActionAid does a lot of work supporting survivors of sexual violence, which is often used as a weapon of war. The combination of continual, all-encompassing trauma and broader societal instability make mental health support all the more crucial, but also more difficult to address, Neves said.
“The collapse of legal protections, judicial systems, and community support networks creates an environment where survivors are systematically exposed to multiple layers of violence,” she added. “Structural breakdown means women lose critical safety mechanisms – any previous economic independence they may have had is taken away, family and community structures disintegrate, and the very institutions designed to protect them cease to function. Complex PTSD becomes not the exception, but almost an expected outcome.”
One solution that ActionAid has found to be effective is creating safe spaces for women domestic violence survivors to support each other as they access mental health services, along with other essential services such as financial advice. These include women-led community-based counselling networks and culturally relevant trauma support systems, Neves explained. “Women-led, community-led dialogue has proven to be a powerful tool to dismantle stigma,” she said. “By creating open dialogues about domestic violence, mental health, and survivor experiences, societies can begin to normalize support-seeking behaviors and challenge harmful cultural narratives that silence survivors.”
At the Women’s Advocates shelter, Perrotta also sees the benefits of rethinking the traditional model of mental health support, saying it helps make support more affordable and accessible and, at the same time, reframes how survivors approach their recovery. Counseling women where they feel safe and comfortable, instead of forcing them to come to an office or a shelter, can make the process feel less clinical and daunting – and that increases the chances of success, they said.
“Increasing domestic violence survivors’ access to trauma-responsive mental health care [means] being as resourceful and creative in our strategies to meeting their needs as they have to be in surviving violence and rebuilding their lives,” Perrotta said.
WHO Foundation