Category:healing

The Need for a Healthcare Response to Violence in Canada

Interpersonal violence is often approached from different facets such as criminal, economic and health yet rarely are the actual health implications looked into, other than the immediate physical damage caused by violence. Yet, as the Global Status Report on Violence Prevention 2014 has found, the non-fatal consequences of violence are the greatest part of the social and health burden arising from violence and this burden is generally carried by women, elderly people and children throughout the world. This can include negative behavioural, cognitive, mental health, sexual and reproductive health problems, chronic diseases and social effects that all outweigh the physical injuries sustained from the violence.

It has been found that violence against women and children contributes disproportionately to the health burden, particularly child maltreatment and women who have experienced intimate partner and sexual violence have more health problems, incur considerably higher healthcare costs, make more visits to healthcare providers over their lives and have more hospital stays (including longer durations) than those who have not experienced violence.

This violence has also been linked to other adverse health reactions such as afflictions of the brain and nervous system, gastrointestinal and genitourinary systems, and immune and endocrine function. For the women going through or having survived intimate partner violence and other forms for violence associated with that, there are also sexual health implications, as chances for HIV and other sexually transmitted infections (such as syphilis), unwanted pregnancies and other reproductive problems skyrocket with experience of violence. This can include having low birth weight babies (16% higher risk) and chances twice as high of an induced abortion.

Evidently this violence also affects the behaviours of the victims and thus being exposed to violence is linked to high-risk behaviours such as alcohol and drug abuse, as well as smoking, which all increase the risks of several leading causes of death (i.e., cancer, chronic lung disease, liver disease, etc.). This can affect young victims as well, either as a learned behaviour or as backlash to their suffering, which becomes very dangerous.

There are also repercussions on victims’ mental health. The risk for anxiety, depression, post-traumatic stress disorder and suicidal behaviour is also heightened, not to mention that exposure to violence and men’s perpetration of violence against women have been shown to be associated with high-risk sexual behaviours. This can tie in with the aforementioned sexual health risks.

Unmistakably, with all of the health menaces associated with violence there are also a wide range of indirect costs, such as spells of unemployment, absenteeism and other health problems that can affect the victim’s job performance. There are also indirect costs that relate to lost productivity because of things such as premature death, long-term disability, the provision of places of safety for children and women, and disruptions to daily life for fear regarding personal safety. Obviously these indirect costs affect people at varying degrees and those with a less stable income to begin with, from poorer social economic classes are disproportionally affected. Those without proper social support (i.e. family/friends) can also be disproportionately affected.

Relatedly and just as importantly, there is the issue of other violent crimes like homicide and non-domestic assault, both of which can have long-term implications on health. The hazards associated with being victimized by violent crime also include engaging in negative coping mechanisms, such as substance abuse and said victims are at a much higher risk to turn to such behaviour versus the general public. Anxiety, depression and post-traumatic stress disorder also pose as huge perils. Furthermore, all of the aforementioned health risks have an impact and contribute to problems in regards to unemployment, loss of productivity and disruptions to normal, daily life.

Sadly, Canada does not take a public health stance towards victimization as a result of interpersonal violence or other forms of violent crime. We have chosen to instead focus on the causes of violence, over the impacts. Research done on restorative justice programs shows the positive impact RJ seems to have on the improvement of the psychiatric and physical health of victims. This is possibly because such programs focus on the harm (caused and suffered) versus justice processes. In Canada, many of the short and long-term health needs of victims and survivors alike go untreated as a result of this focus on justice. With violent crime being sudden and unpredictable, victims and survivors are at the highest risk for severe impacts from victimization, yet they have very few low-cost or free mental health supports or other healthcare services at their disposal. The CRCVC believes we must move toward a healthcare response to violence, without linking the services offered to offenders or perpetrators, in order to more fully address the impacts of violence on survivors.

Shameful that sexual assault survivors must wait for counselling

January 30, 2017 – Our hearts break for the family of Kassidi Coyle, who died by suicide four months after a man was charged with sexually assaulting her. Since her death, her mother Judi Coyle has been advocating for more resources to help sexual assault survivors, noting that Kassidi was put on a waiting list for counselling at her local rape crisis centre and took her life two weeks before her first appointment.

Waiting lists for counselling are a continuing problem for sexual assault support centres across Ontario, says Lenore Lukasik-Foss, the chair of the Ontario Coalition of Rape Crisis Centres.

At the Toronto Rape Crisis Centre/Multicultural Women Against Rape, counsellor and activist Deb Singh said they have one of the shorter waiting lists for free, continuing counselling at five months. “We need more counsellors and we need more funding to pay those counsellors who have a critical understanding of sexual violence, of intimate partner violence,” Singh said. “There are people out there who want to do these jobs . . . and we are not wanting for the amount survivors out there. We know the rates at which women in Canada are experiencing sexual violence.”

Kassidi was scheduled to have an appointment at Athena’s Sexual Assault Counselling and Advocacy Centre in Barrie, according to her mother.

Kathy Willis, the executive director of Huronia Transition Homes, which includes Athena’s, said waitlist times fluctuate between one and three months, although it is possible to get crisis appointments and for cases to be fast-tracked. Willis said she could not comment on what happened in Kassidi’s case due to privacy concerns, but says her death is a tragedy that shows the terrible impact sexual violence can have.

“We try a number of different strategies internally for waitlists, but we could absolutely use probably two more full-time counselling positions,” she said. But, she said, the organization is doing its best with the resources they have. “(It) doesn’t mean survivors shouldn’t be contacting sexual assault centres. We would never leave a woman who is struggling with the impacts of sexual assault by herself, without access to service,” she said.

Lukasik-Foss points to an increase of 50 per cent in crisis line calls last year to the Hamilton-based centre where she is the director. “We know the need for support but we are not able to keep up with demand in many of the centres. That is just the reality,” she said. “We are seeing more people reaching out as there is more public education . . . but we need to be able to support them as well.” In particular, she said, there is a need for more long-term therapy options.

Lukasik-Foss said sexual assault support centres provide a number of different resources beyond one-on-one counselling; most offer group sessions, drop-in groups, art-based therapy programs and one-off workshops. They can assist with criminal injury compensation claims and accompany sexual assault victims to hospitals to process a rape kit or to the police to make a report.

24-hour crisis lines remain crucial (with interpretation available), but work is being done to provide text or live chat, she said. She added that crisis lines are also open to parents, friends and partners of sexual assault survivors.

But there are still many barriers to sexual assault survivors accessing services, particularly if they live in a rural community, she said. More also needs to be done to support people going through the criminal court process, beyond the pilot program offering four hours of free legal advice, she says.

“We want to be able to meet the needs of all survivors, young and old, newcomers, indigenous, francophone, LGBT, sex workers,” Lukasik-Foss said

But it can’t just be sexual assault centres that do the heavy lifting when it comes to supporting victims of sexual violence, said Farrah Khan, the sexual violence education and support coordinator at Ryerson University. “How can we have trauma and sexual violence informed mental health services?” she said. “What emergency supports are available?” It’s important to connect people with supports and resources while they are waiting for specialized services, she added, whether it is through sexual assault centres, hospitals, community-based organizations or online. “This is such an epidemic that everyone needs to be trained on this.”

We agree. It is critical that survivors be able to access potentially life-saving supports such as counselling at the time when they need them. How, in a province where there is an Action Plan to Stop Sexual Violence and Harassment, are women are still forced to wait months and months for counselling? It is time for the province to step up and fund additional full time counselling positions at all of the sexual assault and rape crisis centres across Ontario to actually ensure more choices and better outcomes for survivors through the justice system.

The Canadian Resource Centre for Victims of Crime offers support, research and education to survivors and stakeholders.

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