Cultural Rounds in Mental Health

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Cultural Rounds in Mental Health

• Domestic Violence in Latinos

Presented by the Latino Newark team UBHC-UMDNJ
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• Special Thanks to Organizing Committee
• Carmelo Colon, ACSW, LCSW Latino Team Leader
  Newark
• Jeannine Burzynski, Mental Health Clinician II
• Evelyn Mejil, Mental Health Specialist
• Theresa Miskimen MD
• John Swanson, ACSW, LCSW
• Karen Somers, MA, MBA
• Esperanza Díaz, MD

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Thanks to Participating Community Panelists

• Nancy Kessler, Esq.
• Domestic Violence Hearing Officer, Essex
• Jane Hanson, Esq.
• Executive Director Partners for Women and Justice
• Ruth Kleinman
• Director Babyland Violence Shelter for Women

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And Speakers from UBHC-UMDNJ

• Jeannine Burzynski, Mental Health Clinician II
• Carmelo Colon, ACSW, LCSW Latino Team Leader
  Newark

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Introduction

• Domestic Violence in Latinos
• The audience will learn specific characteristics
  of Latino victims to use in evaluation and
  specific approaches in treatment and
  interventions
• This presentation is geared for professionals in
  mental health, judiciary system, health agencies
  and other areas addressing the cycle of violence

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Agenda

• Cultural remarks
• Case presentation illustrating problem
• Discussion from the panel

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Cultural Remarks Hispanic women deal with
domestic violence in specific ways

• By Jeannine Burzynski

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Cultural Barriers for a Latina in a Cycle of
Domestic Violence 1

• Language barriers
• Lack of education
• Single motherhood
• Dreams of furthering her education finding better
  jobs
• Financial concerns but emotional obligation to
  send money to her relatives away
• No supports from extended family
• Possibly undocumented

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Cultural Barriers for a Latina in a Cycle of
Domestic Violence 2

• Frequently brought up to be subservient to her
  partner
• Responsible for the upkeep of her home and child
  care
• Religious beliefs affecting her ability to make
  constructive decisions about a destructive
  marriage.
• Beliefs that anchored her to violence. Mother
  frequently modeled these beliefs

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Cultural Barriers for a Latina in a Cycle of
Domestic Violence 3

• Husband has power over her, forbidding her to
  take independent actions like work
• Partner might exert control by giving very little
  money, being verbally or physically abusive
• Reluctant to seek help even for injuries due to
  fears of retaliation when she gets back home

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Cultural Barriers for a Latina in a Cycle of
Domestic Violence 4

• She fears calling any authorities because of her
  undocumented status
• She believes that if uncovered she would be
  deported
• Dependent on her partner
• Powerless due to lack of income, lack of job,
  lack of language, fear survival without her
  abusive partner

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Consequences of this Powerless State

• Depression
• Isolation
• Feelings of worthlessness
• Constant fear
• Lack of attention and concentration
• Increased Startled reaction
• Nightmares

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Story Illustrating Domestic Violence in a Latina
Presented By Carmelo Colon ACSW, LCSW

• Identifying information was carefully removed to
  protect the confidentiality of this person. The
  facts are real and they resemble numerous cases
  of domestic violence.

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Story Illustrating Domestic Violence in a Latina

• Latino woman in her mid 30s
• Consulted for nervousness, poor sleep,
  depression, crying spells, weight loss, decreased
  appetite, and suicidal ideation.
• Complained of bruises on her abdomen and thighs
  that were explained by her as caused by small
  grotesque figures that made fun of her and poked
  her body. She also suffered from several physical
  problems.

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Story Illustrating Domestic Violence in a Latina

• Grew up poor and her education was limited.
• She was victim of physical and sexual abuse
  during childhood. She witnessed domestic violence
  in her own home.
• Initially she was given a Diagnosis of
  Schizoaffective Disorder and was offered
  treatment with tranquilizers and antidepressants.
  
• Eventually she was referred to the UBHC- UMDNJ
  Domestic Violence program. In this program she
  was evaluated in Spanish by bilingual bicultural
  clinician.
• She was able to trust and finally revealed she
  was being physically abused by her partner.

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Story Illustrating Domestic Violence in a Latina

• Patient was treated for a total of 7 years in our
  Adult Outpatient Psychiatric Service with both
  individual and group psychotherapy, plus
  psychotropic medication maintenance
• Her psychotic symptoms responded quickly and
  favorably to anti-psychotic medications but her
  clinical depression became chronic and refractory
  to treatment
• Insight was very limited and she had exacerbation
  of her depressive symptoms in times of familial
  crisis, twice ending in hospitalization due to
  anger out of control and severe depression

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Story Illustrating Domestic Violence in a Latina

• She was provided with support. The goal was to
  stop the violence cycle even though she continued
  with her maladaptive pattern of repetitive
  abusive relationships. The last one became the
  most violent with unlawful restraint, kidnapping,
  and battering.
• She consistently refused to engage the legal
  system against her assailants, and eventually
  this drove her adolescent children to abandon the
  family home. They eventually looked for help and
  protection
• The perpetrator then stopped beating her, but
  still was emotionally and verbally abusive.
• Frequently the victim stopped treatment being
  lost from service despite our outreach efforts

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Newark Options Provided by Our Discussants

• Nancy Kessler, Esq.
• Domestic Violence Hearing Officer, Essex County
• Jane Hanson, Esq.
• Executive Director Partners for Women in Justice
• Ruth Kleinman,
• Director Babyland Domestic Violence Shelter for
  Women

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Preparing an Intervention in Domestic Violence 1

• 80 of women in domestic violence do not report
  the abuse
• Intervention should be attempted only after prior
  preparations for the change to occur are in place
  
• Consequences are discussed and well understood
• There is a plan with necessary support systems in
  place

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Preparing an Intervention in Domestic Violence 2

• Sufficient information in Spanish
• Safe place to be for victim and her children -gt
  know where she is going
• Keep in mind Latinos do not have easy access to
  protection information -gt there is a great need
  for education

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Preparing an Intervention in Domestic Violence 3

• Information about shelter and options after
  shelter
• Financial support what it is and it is not
  available
• Legal proceedings explained and consequences
  understood

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Legal Information

• Family courts and local courts will not prosecute
  undocumented status in cases of domestic
  violence
• Abuser is not going to come to court voluntarily
  thus there is a need to start legal proceeding
  but it could be done without pressing charges
• Professionals need to have empathy for people
  with language barriers

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Advice for Providers

• Women in domestic violence develop ways to
  survive so they minimize, distanced themselves,
  detached, present a tough persona
• Communication in their native language is
  crucial. If you cannot come across your immediate
  danger the situation will turn from bad to worse.
  Translators might missed the urgency and the
  negative impact on the victim finally calling for
  help could be tragic

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Advice for Providers 2

• Starting a legal process is protective but it
  will take a life of its own. After starting it is
  hard to pull back
• Victim is extremely ambivalent about the legal
  process
• Victim faces a complex set of issues including
  undocumented, custody and visitation
• Unless there is an immediate physical danger the
  first to do is to identify the domestic violence
  programs in the community and carefully prepare
  an intervention plan
• Intervention should have the goal to stop the
  violence

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Advice for Providers 3

• A call to 411 could be helpful
• If finally police is called they will assist in
  reporting and they are required to make an arrest
  and to file criminal charges
• Police is required by law to get a restraining
  order from a judge. The process goes emergency
  order-gttemporary order with a date in court-gt
  final order formal order of protection

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Do not Want to Press Charges

• If the woman does not want the police involved
  they could do a civil relief
• They can come to the court when in session to
  look for protection and obtain a restraining
  order
• Other protections could be obtained from the
  court but the woman needs to be trained to
  articulate her needs during the session
  finances, custody, child support, etc These will
  not be discussed unless the woman asked for them
  to be included. Women should be prepared to ask
  for what they need

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Babyland Shelter

• Shelter in the Newark community
• Offer many protections but for undocumented they
  have limitations due to lack of assistance
• The core of the problem are the perpetrators but
  it is very hard to reach them. We need to address
  this problem. Court mandated orders doing some
  but not effective enough
• Ideal is to have bilingual bicultural
  professionals. Translators useful as a last
  resource but they slow things down

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Babyland Shelter Wisdom

• A woman cannot ask for help. She is not supposed
  to talk.
• Shelter is to protect. A protective environment
  is helpful but victims need time to heal and
  change choices
• Referrals should be to a specialized program like
  the one at UBHC-UMDNJ Mental Health Clinic
• Frequently women are fearful of revealing the
  violence and are protective of perpetrators
  (Movie presented)

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Panel Wisdom for Mental Health Professionals

• Instill hope
• Empowerment by increasing self esteem
• Identification of supports in the community
• Provide clear useful information in their
  language as to how to protect themselves and to
  how deal with domestic violence
• Concrete information about protection and support
  to develop a plan to stop the violence

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Where to Get More Information

• NJ Coalition for Battered Women 800 572 7233
  http//www.njcbw.org/PDFs/spring2000new.PDF
• www.njvictims.org
• Linea de Ayuda de Violencia Doméstica Nacional 1
  800 799 7233
• www.njsbf.org 1 800 free law
• Domestic Violence Hotline [phone]
• Servicio de atención telefónica de violencia
  familiar 800 572 SAFE