Intimate Partner Violence and Homicide

 

street fightI am thankful everyday when I think back to my very personal experience as a survivor of Intimate Partner Violence[IPV]. I was neither poor nor uneducated, but I lived within this reality of fear and uncertainty on a daily basis. There were many occasions in which I thought that I was certain to be killed, and leave my children without their mother. Actually, you can’t get more intimate than when your partner is also your legal spouse. Logically, you ask the question of why women[men, also] stay in these relationships, as from the outside, it seems to be illogical. After all, that violence is violent and extremely unfair to use a ‘loved’ one as an emotional outlet. Mainly, it is unwarranted, as it has more to do with the abusive partner than the subject of that abuse.

Is it for the children, or do we believe that we can change the other person, or has the abuse become so intertwined and compounded by psychological abuses that we feel that it is our own fault? Who knows the answer, because certainly, it is a complex one at best. We tell the victims who are subject to violent partner’s abusive behaviors that, “You should leave!” “There are places you can go to be safe.” “You don’t have to take this kind of treatment.” Worst than that, we say that these couples should seek counseling. As if….

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Survivors are lucky to get out alive, if they in fact do seize any opportunity to leave the situation or sever the relationship. Fortunately, I happen to be one of the lucky ones. I was able to leave- not unscathed, but gone. Moving forward, here are some statistics regarding those who never left willingly, but their escape was death…. at the hands of their partner-their abuser.

Homicide is one of the leading causes of death for women aged ≤44 years. In 2015, homicide caused the death of 3,519 girls and women in the United States. Rates of female homicide vary by race/ethnicity  and nearly half of victims are killed by a current or former male intimate partner. Non-Hispanic black and American Indian/Alaska Native women experienced the highest rates of homicide (4.4 and 4.3 per 100,000 population, respectively). Over half of all homicides (55.3%) were IPV-related.

Approximately 15% of female homicide victims  of reproductive age, 18-44 years, were pregnant or postpartum.

Homicide is the most severe health outcome of violence against women, and young women, racial/ethnic minority women, were disproportionately affected. A cross all groups of women, over 1/2 of female homicides, IPV-related, over 90% of these women were killed by their current or former intimate partner.

Strategies to prevent related homicides range from protecting women from immediate harm and intervening in current situations, to developing and implementing programs and policies to prevent IPV from occurring. First responders who assess risk for lethality can identify victims at risk for future violence. These assessments should inform and facilitate immediate safety planning and connect women with other services, such as crisis intervention, counseling, housing, medical and legal advocacy, as well as access to other community services.

State statutes limiting access to firearms for persons under a domestic violence restraining order can serve as another preventive measure associated with reduced risk for intimate partner homicide and firearm intimate partner homicide.

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Approximately one in 10 victims of IPV-related homicide experienced some form of violence in the preceding month, which could have provided opportunities for intervention. Bystander programs, such as Green Dot, teach participants how to recognize situations or behaviors that may become violent and to safely and effectively intervene to reduce the likelihood of assault. In health care settings, the US Preventive Services Task Force recommends that women of childbearing ages are screened for IPV and that they refer those women who screen positive for intervention services.

Approximately 40% of non-racial/ethnic minority female homicide victims were aged 18-29 years. Argument and jealousy seem to be common precipitating factors.

Teaching safe and healthy relationship skills is important for strategically preventive efforts to reduce IPV. Young people must be taught to manage their emotions conflict management and improve problem-solving and communication skills. Preventing IPV from occurring also requires community efforts and the systemic factors that increase risk, like disadvantaged neighborhoods affected by poverty. Low social cohesion, lack of community or a ‘village’ approach to daily living also increases risk. Language barriers and lack of cultural competence or awareness of available services and resources adds to risk, too.

Ultimately, it behooves all stakeholders, service providers, educators, agencies and CBO’s need an awareness of risk factors and should have policies, protocols and culturally relevant strategies, including intervention strategies which serve to protect, educate, refer and identify women at risk or in relationships that have characteristic components associated with IPV. Women need empowerment and supportive involvement of all in close proximity. That includes neighbors, friends, families, and strangers.

We shouldn’t have to scream out,”FIRE” in order that someone will intervene. Intervening doesn’t mean physical involvement, or placing oneself at harm. It can be a telephone call to 911. That is the least that anyone can do. Ladies teach your children to dial 911. Give them the security pin to your phone, or teach them that none is needed if making an emergency call. Teach boys and young men to manage their emotions and anger, and tell them that emphatically, it is never ok to hit any females. Teach girls in ways that equip them with the self esteem and strength to leave or avoid relationships that begin to look toxic, harmful.

Education is the key to prevention, and emotional literacy, mutual respect, empathy, and academic achievement can all be fostered in the same environment and nurtured at home and in the community. It should be included within every content area at school, even if it is not addressed at home. If we aren’t a part of the solutions, then we are part of the problem! These types of problems, we do not need.

The Iceberg Concept of Culture

Icebergs are famously disproportionate in terms of visibility. You can see the top 10%, but 90% of its mass is below the surface. Culture is similar. You can observe about 10% of it, but to comprehend the rest, you have to go deeper. This is known as the iceberg model of culture. It was developed by anthropologist Edward T. Hall who, in the 1970s, defined many of our fundamental ideas about culture today. Hall’s model has provided a great way for us to capture the complexity of human cultures.

The need for mindful awareness or sensitivity to the ‘essence’ of others beyond the immediately visible is critical, especially when we are engaging and interacting with the diverse cultures represented in the classrooms of today. This means that we must be mindful and cognizant of the existence of the layers of culture that are at surface and those aspects below the surface as nuanced characteristics.  In other words, for an iceberg, there is the part that lays above the water line-above the surface, that we can immediately and clearly recognize as being an iceberg. The iceberg that we see and identify as such is merely a small part of that total iceberg as it is. In this case,  it is about culture.

When you first interact with a new culture, the top 10% is clearly evident. This is the part of culture that you can identify with your five senses. These things matter. The visible aspects of culture are important parts of how cultures interact and maintain their sense of unity. However, they also tend to be fluid. Recipes and games and arts can all change over time, and language shifts with each generation. Therefore, we can say that the cultural facets of the top 10% of the culture iceberg have a relatively low emotional load. They matter to people, but they can also be changed and altered without challenging the existence of a culture or  ideas about who they are.

We aren’t able to see exactly what lays just under the surface nor can we see all aspects of culture when we rely upon the surface indicators alone. There is much more to icebergs and culture than meets the eye. We, as human beings and social creatures, aren’t that simple. Neither are icebergs. If the surface answers the ‘what’ and the ‘simple who’ questions about a culture, then the below surface levels answer the ‘why’s’, and ‘how’s’ and the more complex ‘who’s’.                                                                                                           There is surface culture and there is deep culture, and the characteristics considered below the surface are the unspoken and unconscious rules of culture which are deeply submerged. The above the surface, immediately recognizable characteristics of culture is what we see when we’re introduced to a new group of people, but it’s literally just the tip of the iceberg. The minute we dip below the surface, things get more intense.

In Hall’s model, the 90% of culture that is below the surface can be divided into two categories. The first are those things which are near the surface, but still hidden. We can think of these as the unspoken rules of a society. unspoken rules are nonverbally communicated, like the way we show emotions, personal space, manners, and even our definitions of beauty. These aspects are just below the surface and takes time for an outsider to understand, as they aren’t immediately visible. The emotional load is heavier, and so attempts to change or alter them, will leave people to believe their culture is being threatened or misappropriated.

Cultures are defined more by what is unseen than seen. The surface is the place where limited information about a group of people becomes generalized and become stereotyped characteristics, which is unfair and unfortunate. It is a greater level of ignorance that perpetuates all negative stereotypes, and as an iceberg, 90% of pertinent aspects that define culture is unseen, unspoken and reaching those levels defies any immaculate perceptions, assumptions or stereotypes.

As the saying goes,” You can’t judge a book by its cover.”, for many times, it isn’t until we have read beyond the surface, that a plot emerges or we can truly understand an individual or a cultural group.

At the core of an iceberg, a culture, or even an individual who in essence, is a mini surface level reflection of their cultural group, is where the bulk of what defines it is found. At the core of culture there are concepts of self, childrearing, definitions of adulthood, gender roles[sex, age, class], family or kinship networks, and the tempo of society. These are the subconscious parts of culture that people adhere to without much conscious thought;  the values that define a culture.  To understand them, one would have to live among this culture for a long time to become absolutely fluid in the values. Should they change, it would fundamentally change what that culture is. Therefore, the heaviest emotional load is held at this level.

Relevance, you ask? To understand what culture really is, what it means to the group to which one belongs, is not easily acquired. Similarly, to understand any individual fully, is to first realize that humans are not one dimensional in any aspect. To stereotype a group based upon limited information or limited experience among that group, is to endeavor in ignorance.

Humans are social beings, and belonging to a group is an inherent desire and also a primary need. Children have a need to feel they belong, and as they/we age, that need becomes expressed differently, as it spreads outward into the greater society, which exists in groups or ‘sub’ cultures, too. Work, school, teams, neighborhoods, etc… all have what we term ‘cultures’. The message here is to acquire cultural competence, sensitivity, awareness, responsiveness and proficiency before endeavoring to presume intimate knowledge of any one person or group or family who stands before us.

Until we have walked a mile in someone else’s shoes, NEVER ASSUME or judge. Never assume an understanding of someone’s life, unless lived, too. Never assume an understanding of someone’s pain, unless felt, too. Never assume an understanding of attitude or behavior, unless in the same or similar context, you can relate. Empathize, ask questions, seek understanding, be observant and actively listen.  Go ahead-immerse yourself!

College and Your Mental Health Matters

Recently, I heard a tragic story of a young man, a college student, who attended my daughter’s alma mater, Penn State University. This young man was a vibrant and active student on  the State College campus. Upon hindsight and without detailing a very personal family tragedy,  this young man had displayed behaviors and attitudes indicative of a mental health matter. While with his friends one night, he either jumped or fell from a balcony. Fortunately he survived, but he lived as a quadriplegic, unable to speak until his death at age 22. I wonder whether this could have been avoided if this young man had received critical counseling interventions. There were signs of course, that if recognized, could have been  addressed-if his friends only knew what they were.

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The onset of mental health conditions tend to emerge before age 24 and one in five young adults will experience a condition during college.  College is part academic development, career development and personal development. We tend to focus on the first two, and forget that-youngsters are emerging and young adults. Many  youngsters experience -living on their own, away from parents, familiar surroundings, and though there are controlled, and structured settings and accommodations like campus housing and student dormitories, little focus is placed on psychological adjustments, attitudes, or total mental health and comprehensive wellness.

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Substance Abuse and Mental Health Services Administration[SAMHSA] in partnership with National Alliance on Mental Illness[NAMI] have just released guidance on mental health specifically during the college years. They suggest that we start the conversation-talk about mental health, destigmatize conditions and not attach blame, but rather offer help and resources, listen, and educate yourself and others about what a mental health disorder looks, feels and sounds like.

Very important to note is that mental health conditions are not  uncommon, and that you nor anyone else should feel alone. There is always someone who can relate, will listen and will provide the necessary assistance in order to help people manage a diagnosis and cope with a mental health condition if present.

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Feeling down or depressed? That’s ok, unless the feelings persist, last too long, are accompanied by other disturbing feelings, or you feel as though you can’t manage your daily life. No matter what, do not ever give up on yourself or your ability to come out of this  temporary ‘funk’ landing on the brighter side of life.  But, if deemed serious, you can manage that, too.

The highlights the importance of seeking help from someone you trust. You may come to understand that it may be due to ‘Freshman Depression'[which could occur at any time, not only freshman year], mid-term jitters, lack of sleep, an argument with a good friend, and relatively minor, non-alarming life circumstances. Until you have a conversation with an adult or professional, you won’t know how serious it may be.

Seek out someone with whom you can talk through the feelings or thoughts or behaviors that are disturbing to you. It is extremely important that you educate yourself and others about the warning signs of mental health conditions. Talk through and about your feelings, learn to recognize the signs, and tell someone, whether it is for you or a friend.

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Some symptoms or feelings may be considered within the range of ‘normal’, and can be attributed to recent changes or stressors in your life that can underlie coping behavior changes like poor eating habits-lack of appetite or overeating. Could be fear, anxiety, or a recent loss. You won’t know unless you start the conversation. Find the on-campus counseling center or seek off-campus counseling services. Or go to the school’s medical station/office[every school has one], since physical health and mental health are often related.

Let’s save lives, for it may be yours, mine or a perfect stranger. Be informed, and educate others, too. No one should suffer in silence, or feel that they are alone. Start the conversation at your school, in your community, or in your home.

Keep these thoughts in mind when you start your conversation:

Mental health conditions are common. In fact, one in five young adults will experience a mental health condition during college. If you develop a mental illness, remember that you are not alone.

Exercise, sleep and diet are important. Your physical health and mental health are connected and impact one another. Remember to take care of your body in order to take care of your mind.

Know where and when to seek help, and who to talk to. Make yourself aware of resources and care options on and off campus. If you start to feel overwhelmed, don’t hesitate to reach out to the counseling center or a trusted advisor.

Understand your health privacy laws. Devise a plan on whether and how you will allow your school to share sensitive information about your mental health with your family or a trusted adult. Find out if your school has an authorization form, or use the one included in our guide.

There are warning signs. Verse yourself on the warning signs of mental health conditions and how to respond. Being informed can save lives. Get the guide!

Findings From The Minority Mental Health Month Twitter Chat

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The National Institute of Minority and Mental Health Disparities[NIMHD] co-hosted a Twitter chat in observance of Minority Mental Health Month with Omega Psi Phi Fraternity, the U.S. Department of Health and Human Services Office of Minority Health, and the Substance Abuse and Mental Health Services Administration[SAMHSA] on July 12.

The #MinorityMH chat addressed the mental health of adults in minority groups at the community level and reached health organizations, researchers, federal agencies, mental health professionals, community health workers, and other members of the public health community.

Here are some discussed points and shared resources:

Factors Affecting Minority Mental Health

  • Stigma and fear associated with mental health contribute to a lack of understanding about illness, undiagnosed conditions, and treatment prevention in communities.
  • The limited number of culturally competent caregivers and resources, treatment discrimination, and structural inequalities lead to distrust, misdiagnosis, and not seeking care.
  • Socioeconomic factors hindering care include poor quality of care, inadequate health centers, finances and transportation for care, and limited Internet access.
  • Psychological distress caused by racial discrimination, poverty, environment, and other social determinants of health contribute to higher prevalence rates of PTSD (post-traumatic stress disorder), anxiety, depression, suicide, and substance abuse in minority communities.
  • There’s a need to change the narrative and encourage more minorities to talk about depression and seek care, particularly for elders, youth of color, African American and Latino males, and LGBT individuals.

Practices for Addressing Minority Mental Health in Communities

  • Various organizations are working to educate community members, teach care providers, and support research that helps us better understand factors affecting minority mental health.
  • Forming community-level help groups and forums, actively reaching out to minorities, considering faith-based partners, having culturally competent and diverse staff, serving as role models, and good screening at all levels of care are some methods for addressing the issue.
  • Community organizations are researching better solutions for specific groups and illness, examining race-based differential treatment, creating training programs for health professionals, and ensuring that community centers have multilingual resources to contribute to improve mental health services.

The takeaway here is to educate, inform, educate and inform. Next, communities that have been and remain underserved and underrepresented in availing themselves to mental health service providers, need access to licensed and qualified agencies with culturally responsive professionals in their area. Medical offices should be a referral source, and staff should be mindful of key indicators of mental health conditions when patients come in for routine doctor’s visits. Schools should be equally as mindful when it concerns students in attendance. Health fairs, held at school and in the community should have a forum for such information dissemination, and have readily available resources to make referrals.

The stigma attached to mental health can only be removed with education and outreach to minority populations. They tend to be the groups whose cultural beliefs have perpetuated and attached negative stigma to those who seek mental health counseling or individuals with mental health diagnoses. That must be countered by plainly talking about mental health, and bringing it out into the open. Make it a part of normal conversations and eliminate the shame.

There is no shame in seeking help! Reach out and spread the word; make it ok and learn to manage life with a mental health diagnosis. Teach families to cope, manage and support their relatives who have been diagnosed. Teach them to recognize signs and symptoms of mental health conditions, so they know when to seek professional advice-consultation, treatment. Don’t let a family member feel they are alone. Don’t let children feel they are bad people, either. Nobody, ADULT OR CHILD, should go through it alone–without professional help AND unconditional love AND familial support!

Culturally Tailored Mental Health Resources for Minorities