The Immigrant and Refugee Mental Health Project facilitates a virtual Community of Practice (CoP) comprised of health, settlement and social services providers across Canada who support the mental health of immigrants and refugees. The CoP online discussion board allows providers to pose questions to the Project’s panel of subject matter experts (SMEs). We will be bringing you some of the questions posed by providers and answers provided by the SMEs.   

Question

As a case worker in an agency that serves women, I come across situations where a client will not disclose the abuse she is facing because she feels ashamed, or because of taboo. These women are suffering in silence because they don't want to be judged by society, and want to pretend that all is fine in their marriage or family. The abuse can be, financial, verbal, physical and more. By the time they disclose, it is sometimes too late, resulting in depression, substance abuse and suicide.  

Are there any tools, techniques or best practices in detecting the abuse earlier?

Vanessa Wright, Nurse Practitioner, Crossroads Refugee Health Clinic, writes:

Thank you for your thoughtful and excellent question on this very complex topic. As you referenced, the experience of abuse is shaped by the context of the survivor's life. This includes migration, war, unexpected displacement and the need to seek asylum. As such, immigrants and refugees face unique challenges related to pre-migration and migration trauma, post-migration stressors, language and cultural barriers, social isolation, unemployment and uncertain legal status - which in the context of domestic violence, can lead to further isolation, identification and disclosure.

If you have any suspicion, or recognize any risk factors, I have listed several suggestions below in terms of ways to support individuals and families involved in domestic violence:

Begin a conversation by expressing genuine care and concern for the individual's health and safety. This initial conversation opens the door to potential greater dialogue and trust. This initial conversation is the essence of this work... and can start laying the foundation for safe and welcoming conversations in the future.

If I am providing one-to-one clinical care for a client, once a rapport is created, I will often say 'this is a place where support can be provided in navigating the health and social service system, including experiences of hurt or violence, so to better support one's physical or mental health'.

Labelling the experience as “intimate partner violence” may not be congruent with how an individual perceives their relationship to an abusive spouse or the problem for which they can seek help. For this reason, it is suggested to adopt the description of the events used by the individual.

Following your heightened suspicion or awareness of an abuse of power within the family, you can share information (on a factual basis) regarding the provincial and federal laws that criminalize abusive behaviors in Canada.

Individuals gain strength from their culture and draw on values, religion, beliefs, and practices that help them cope. Such things as cultural celebrations, familiar food, and art forms can provide comfort and release. You can try to offer/source such connections for the individual - this allows for one to build a great support network - and possible sources of disclosure.

Community members can provide valuable information about the community and help identify and gain access to important people, such as religious leaders, community organizers, or community elders who can provide support to refugee women.

If appropriate, provide a list of family shelters to the individual, directions, and phone number. Walk through each step of safety planning and have a violence against women organization support you in this navigation process.

Below are some resources to support your work with gender-based violence. Although most are from Ontario, the information can be used as a general approach/guide to addressing intimate partner violence.

• Recognizing and responding to intimate partner violence resource guide for refugee resettlement assistance programs in Ontario by the Ontario Council of Agencies Serving Immigrants (OCASI)
• Intimate partner violence against immigrant and refugee women by OCASI and The Learning Network, Centre for Research & Education on Violence Against Women and Children.
• OCASI's online courses on gender-based violence.
• Abuse is Wrong in any Language by the Department of Justice Canada