Projects 

Towards Better Practice: Enhancing collaboration between domestic violence and mental health services

PROJECT UP-DATE MARCH 2008

This project is a three year study funded by the Australian Research Council which is being conducted by The University of Sydney in partnership with; Joan Harrison Support Services for Women, Fairfield and Liverpool Mental Health Services, The Education Centre Against Violence and the Transcultural Mental Health Centre.

Background:The connection between domestic violence and mental health problems has been firmly established by numerous studies (e.g. Krug et al., 2002).  However the very different histories, philosophies and organisational cultures of these two service sectors present formidable challenges to the development of effective working relationships and the sharing of different expertise (Gondolf, 1998). While coordinated or “joined up” approaches to domestic violence service delivery are commonly advocated, efforts to promote interagency collaboration have typically focussed on the criminal justice system (Shepard & Pence, 1999). Less attention has been paid to the role of mental health services in responding to domestic violence.  Yet failure by mental health services to recognise these connections and to respond appropriately to domestic violence can place women at risk of ongoing and escalating violence and compromised mental health (Humphreys & Thiara, 2003).  Likewise, women’s domestic violence services also have difficulty in responding to the needs of women with complex mental health concerns.  This can be exacerbated by lack of access to services and other supports, placing such women at greater risk of homelessness and poverty, and the development of entrenched mental health problems (Astbury & Cabral, 2000).

The Research:The project aims to explore how collaboration between the two service sectors, domestic violence and mental health, can be achieved.

The project comprises of four interrelated and independent studies. These include: a practitioner survey, interviews with women who have experience using both mental health and domestic violence services, practitioner focus groups, and an action evaluation study.

The project began in January 2006 and it is anticipated that it will be complete in December 2008.

Study 1 - Self-completion Survey: Practitioners’ responses to the co-existence of domestic violence and mental health concerns:
This study explored how service providers in the mental health and domestic violence service sectors respond when both domestic violence and mental health concerns co-exist with their clients. The survey asked practitioners to respond in the context of: agency function, statutory responsibilities, disciplinary knowledge, policy mandate and interdisciplinary and interagency collaboration. 

107 surveys were received from across the state:

1. 56% of these responses were from mental health workers while 44% were from domestic violence workers
2. 85% of those that returned the survey were providing direct client service
3. 3.2% of the responses were from remote areas of NSW; 42.6% from rural NSW; 9.6% from city centre; 35.1% from urban areas; and 9.6% from urban fringe

The results from the survey have been presented at conferences and forums across the state and have been used to inform studies three and four of the research.

Study 2: In-depth interviews: Women’s stories of domestic violence and mental health provision:
Interviews were undertaken with 33 women across NSW including 5 women from Indigenous communities, and 8 women from Culturally and Linguistically Diverse (CALD) backgrounds. The age range of the women was 19 to 65 years. The women came from rural, urban, and city locations and were contacted through local women’s services.

This study explored women’s experiences of responses they receive(d) from mental health and domestic violence services. These accounts have been core to the research. The information gained from women’s experience of using domestic violence and mental health services, has been invaluable in directing the research and reinforced the importance of collaborative practice between organisations.

Study 3: Focus groups: Barriers and opportunities in collaboration:
A series of focus group interviews were undertaken in key locations across NSW. The focus groups occurred in two phases. Initial focus group interviews were held with practitioners from each of the two service sectors - domestic violence and mental health. Participants were asked about current practice in cases where there are both domestic violence and mental health issues, factors that contributed to successful outcomes in those cases, difficulties encountered, barriers to collaboration, what they saw as necessary to best respond to women when there is an overlap of domestic violence and mental health issues, and their vision of future collaboration between domestic violence and mental health services.

The ideas generated from these first groups fed into the second series of focus groups, where participants from both service sectors were included. The focus of the second series of focus groups was on identifying approaches that enhanced collaboration and which could be trailed and evaluated in the fourth stage of the project. These identified collaborative approaches have been used as a basis for study four: action evaluation.

In total, 18 practitioner focus groups were held in six geographical areas across NSW. This included 6 focus groups with domestic violence specialists, 6 groups with mental health clinicians, and 6 groups with workers from both the sectors.

Study 4: Action evaluation: Working together:
Four of the geographical areas in which the focus groups were held are now participating in the fourth study: action evaluation. Collaborative initiatives developed in each area by mental health and domestic violence workers are currently being trialed and evaluated over a 12 month period. The nature and type of initiatives are shaped by the different service contexts in the various study sites. Examples of the collaborative initiatives include: cross training initiatives, the development of formal service agreements, the development of consultation lines, and the development of new referral pathways and joint assessment between the mental health and domestic violence sectors for women who experience both domestic violence and mental illness/health concerns.

These initiatives will continue to run and be evaluated in their specific location until July 2008.

Outcomes:The anticipated outcomes of the project include increased expertise in both mental health and women's domestic violence services in responding to diverse women with complex needs, increased collaboration between the sectors (inter and intra-agency), development of referral pathways between the sectors, and increased knowledge and confidence of workers in these sectors.

Further Information: If you would like further information about this project, initial findings or publications, please contact: Cherie Toivonen, Senior Research Assistant, Faculty of Education and Social Work, on 02 9351 6434, or via email at  c.toivonen@edfac.usyd.edu.au

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