COVID-19: Wake-Up Call to Reduce Barriers to MH Care for Intimate Partner Violence, Other Traumas

Under pre-COVID-19 circumstances, intimate partner violence (IPV) was already a public health crisis, with the World Health Organization naming IPV a global health problem of epidemic proportions. In a 2015 national survey, a staggering 12 million men and women, 24 people per minute, were victims of rape, physical violence, or stalking by an intimate partner within the United States.

During a pandemic, we can expect gender-based violence to intensify due to increased tension and economic distress in the household, compounded by limited in-person resources to seek help and an inability to escape abusive partners. In fact, preliminary reports suggest that there has indeed been an exponential rise in IPV-related cases.

In addition to increased rates of IPV, mental health experts are warning of a mental health crisis to follow this initial COVID-19 outbreak that will impact a large segment of the population. Vulnerable populations will be especially affected as socioeconomic and racial inequities underlie multiple mental health conditions. The presence of these inequities prior to COVID-19 now serve as catalysts for heightened mental health–related stress during this pandemic: Members of marginalized groups are less likely to work in jobs that can be performed remotely, less likely to have benefits such as paid sick leave and health insurance, less likely to have a financial safety net, and more likely to live in dense neighborhoods and crowded homes, limiting the ability to maintain social distancing safety measures, but also limiting the ability for accessing social support during times of need. IPV and mental health have a bidirectional relationship: IPV increases the risk of mental illness (for example, posttraumatic stress disorder, depression, anxiety, substance use disorders, suicide attempts), which themselves increase the vulnerability to IPV. The added risks during COVID-19 require interventions that are agile for identifying and addressing both IPV and mental illness.

Prior to COVID-19, significant structural and systemic barriers prevented IPV survivors from accessing high-quality mental health care. Importantly, these obstacles were especially pronounced for minority women, who in the United States are less likely than white women to seek help from various formal and informal sources. In New York City, some of us began addressing this issue in 2014, initiating a tripartite partnership with private, public, and academic collaboration that imbeds skilled mental health clinicians within the Family Justice Center (FJC), a resource center for survivors of IPV and sex trafficking. Since 2017, this new collaboration has been funded by ThriveNYC and provides free, evidence-based treatment, including psychotherapy, skills-based learning, and psychopharmacology in a trauma- and culturally informed capacity by the country’s largest public hospital system, NYC Health + Hospitals. This is the nation’s first such integrated mental health model. New York City now boasts the largest network of FJCs in the country, operated by the Mayor’s Office to End Domestic and Gender-Based Violence.

By bringing experienced mental health clinicians to the community, the program is meeting the survivors where they are and where they feel safest. In a citywide program evaluation I led, our data demonstrated that not only do the survivors continue to report feeling safe physically, but they also report feeling safe emotionally and improvements in sleep, mood/anxiety, psychological distress, interpersonal relationships, and parenting skills. Aditional bonuses of the program are reduced wait times and improved staff morale.

At this time, the continuing challenge is to create and maintain a system that can meet the ever-growing mental health needs of IPV survivors during COVID-19. Although our program has shifted to remote work, technology has allowed for greater cross-collaboration across institutions and immediate access to clients. Increased brief sessions serve as anchors for augmented support during social distancing measures. Privacy, confidentiality, and assessing safety present ongoing challenges that require creative solutions. Furthermore, formal psychological support systems are have been created for frontline mental health workers, who are partaking in a shared collective trauma response.

IPV and mental health concerns were here prior to COVID-19, but as with any disaster, cracks in the system have been revealed that should not be overlooked. This is a wake-up call and an opportunity to reduce systemic barriers to ensure families affected by trauma are not only safe physically, but also emotionally. ■